With input from Dr Monica Vasudev

1097: Round Table Expert Zoom Meeting on “COVID-19 Reinfection”

26^th September, 2020, 11am-12pm

Participants: Dr KK Aggarwal, Dr Ashok Gupta, Dr AK Agarwal, Dr Suneela Garg, Dr Jayakrishnan Alapet, Dr JA Jayalal, Dr DR Rai, Dr Anita Chakravarti, Prof Bejon Misra, Dr Anil Kumar, Dr KK Kalra, Mrs Upasana Arora, Ms Ira Gupta, Dr S Sharma

Key points from the discussion 

• A study (preprint) published in The Lancet has confirmed reinfections of SARS-CoV-2 in healthcare workers in India. The studydefined reinfection as RT PCR positive → RT PCR negative and then again → RT PCR positive.
• Reinfections are occurring in India. But we do not know if they are common.
• RT PCR does not confirm reinfection. The only way to detect reinfection is by doing genome studies, which can be done only in labs assigned to do so by the government. ICMR and NCDC must be informed.
• Look for reinfection, suspect reinfection and send them for test. Persistent antigen for more than 3 months may be reinfection.
• If patient is symptomatic and both antigen and antibody are positive, think of reinfection.
• We do not know whether the people who develop reinfection need to be isolated and if they are infectious.
• The Lancet study has shown some changes in amino acid sequence of genomes of the virus. This could have long-term impact on the immunity of the patient. It could affect the clinical presentation of the patient. The second infection is more severe.
• There is only one strain of the virus in the country. There are no serotypes like dengue.
• Different types of coronaviruses do have cross immunity. A study from Singapore has shown that those who had developed SARS-1 cellular immunity are immune to SARS-CoV-2 infection.
• A study from Brazil says that there could be some cross-protection even in high dengue endemic groups. But we are seeing that dengue and COVID-19 can exist together.
• Some major change in amino acid sequence may cause reinfection.
• All RNA viruses lack proofreading capability. They cannot transcribe properly and many times some amino acids may be missing. This is why they are called quasi species.
• If somebody has suffered COVID-19, masking must be continued as second infection may occur. Universal masking is must before, during and after COVID.
• Policy makers need to be aware about reinfection. But there should not be any panic among the public about reinfection.
• Notification of re-occurrence of infection is very important. We have to be aware and report if re-infection is suspected and if that occurs, then that strain has to be analyzed.
• Coronavirus is not a latent virus. The reinfection could have come from a source (droplet).
• Viral load is for infectiousness, not seriousness of illness. Ct value has to be interpreted taking into consideration lab error of ± 2.
• PCR is not 100% positive; it is only 50-70% positive.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA