COVID 19 Reinfection: First Case in New Jersey

IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces an immune response but the degree and duration for which it provides protective immunity is still unknown. Herein we report a case of reinfection where the patient was tested positive again after being tested negative two subsequent times. Case DescriptionA 31-year-old Hispanic female with a past medical history of asthma, gastric sleeve surgery, and pulmonary embolism during pregnancy presented in March 2020 with subjective fever, dry cough, headache, and fatigue for 5 days. Vitals were significant for oxygen saturation of 96% on room air and BMI 44.4 kg/m2. Physical examination was normal. Labs and chest radiograph were normal. SARS-CoV-2 RT-PCR was positive. The patient was discharged and was advised to quarantine herself and monitor her oxygen saturation. She was re-tested again in July 2020 and September 2020 and SARS-CoV-2 RT-PCR was negative both times. The patient came to the hospital again in November 2020 with subjective fevers, chills, shortness of breath, body ache, and malaise for 1 week. Vitals were significant for a heart rate of 112/min, temperature 99.6 °F, respiratory rate of 20/min, hypoxia requiring 5L nasal cannula to maintain an oxygen saturation of 95%, and BMI 44.7 kg/m2. Physical exam revealed decreased air entry in the lungs bilaterally. Complete blood count and basic metabolic profile were within normal limits. Inflammatory markers were elevated. Computed tomography (CT) thorax showed bilateral, predominantly peripheral, and subpleural ill-defined ground-glass opacities consistent with pneumonia. SARS-CoV-2 RT-PCR was positive. The patient was treated with intravenous remdesivir for 5 days and oral dexamethasone 6mg for 10 days. She improved clinically and was discharged on home oxygen. DiscussionAlthough the risk of COVID reinfection is low, cases of possible reinfection have been reported. Our patient was not immunocompromised, tested negative after 4 months and 6 months but presented again after 8 months with severe symptoms as compared to the first time. There have been case reports where the reinfection was more severe, however, there is not sufficient data to support that. There is not enough data demonstrating degree and duration of protection after the primary infection either. Reinfection could be due to infection with a more virulent strain or evolution of the previous viral strain in the body. The absence of genomic sequencing limits our ability to diagnose that. More research in this field and genomic sequencing can help us with an accurate diagnosis.