The case of a 90-year-old woman has been reported from Belgium, who had simultaneously been infected with two variants of Covid-19. The patient was hospitalized in March this year after experiencing some falls, but later developed worsening respiratory symptoms. She tested positive for Covid-19 caused by two different variants of the virus, the Alpha variant (B.1.117, first detected in the UK) and the Beta variant (B.1.351, first detected in South Africa). She had not been vaccinated and died five days later after her condition deteriorated. It is not known how this infection occurred, but it is speculated that she acquired the infections from two different individuals. The case is yet to be published, but was presented at the virtual meeting of the 31^stEuropean Congress of Clinical Microbiology & Infectious Diseases, which concluded yesterday. Anne Vankeerberghen, molecular biologist from the OLV hospital and the lead author said that there had been “no other published cases” of similar co-infections. “Both these variants were circulating in Belgium at the time, so it is likely that the lady was co-infected with different viruses from two different people.”

Covid-19 is a once in a lifetime pandemic. It is still a new disease, although almost one and half years later, it has now become a manageable disease. Though much is known about the virus now, its impact is still mysterious and continues to throw up surprises such as this case, which probably justifies its well-deserved reputation of being “predictably unpredictable”.

This case, believed to be the first documented case of its kind, has come as a warning that it is possible to be infected with two Covid-19 variants at the same time.

Genomic studies are important for timely detection of new variants. The second wave was mainly due to the delta variant, though the alpha variant had its share of cases too, particularly in Delhi-NCR, Punjab. We are seeing via INSACOG and genomic surveillance a small fraction of AY.1, which is Delta plus, as well. The delta variant is still the most sinister, most fit and faster spreading. The second wave is not over yet. It is not time to let down our guard. Now more than ever, strict adherence to Covid-appropriate behavior is the need of the hour as the disease is still evolving.

The answer to this conundrum lies in vaccination before the virus mutates further, to its advantage, and more new variants of concern emerge. The mantra should be vaccinate, vaccinate and vaccinate....as fast as possible and as many as possible. 

Independent of vaccination, we must continue masking, sanitisation and distancing and avoid crowds and congregations. We should not invite the next wave by behaving irresponsibly.

(Source: Unvaccinated Belgian woman contracted two COVID variants simultaneously - Medscape –Jul 12, 2021; BBC News, July 11, 2021)

Dr Shashank R Joshi

Member Covid-19 Task force Maharashtra