Relapse Versus Reinfection: A Case of Recurrence of COVID-19 Infection During Pregnancy

Introduction The world has been experiencing a novel COVID-19 pandemic since December 2019. Since that time there has been rapid spread and considerable mortality and morbidity. The immunology of COVID-19 is still being determined in the general population as well as select groups such as pregnant females whose immune response may be altered. Here we present a case of questionable relapse vs reinfection of COVID-19 in a pregnant health care worker. Case description A 32 year old female healthcare worker, with no significant past medical history developed slight shortness of breath and loss of taste and smell soon after she discovered about her first pregnancy. She subsequently tested positive for COVID-19 in April 2020. At that time she was at six weeks gestation. She never developed a fever, cough, GI symptoms, malaise, muscle fatigue or sore throat. Because her symptoms were mild and stable, and she never required oxygen supplements, she was asked to quarantine at home, and to take the needed precautions. Telephone visits have been conducted daily to check on her clinical status and patient had access to pulse oximetry and thermostat and therefore has been keeping track of her vital signs and wellbeing. In May 2020 - one month after initial infection- she reported total clearance of her initial symptoms and she has been preparing to return to work. She however reported that she has had contact COVID-19 positive individuals. Because of that she has been retested prior to returning to work. Nasopharyngeal swab was performed and PCR was negative. Two weeks later, she reported acute onset on dyspnea on exertion, and loss of taste and smell. Nasopharyngeal swab was performed and PCR was positive. She experienced mild symptoms and was quarantined home. One month later, she reported resolution of symptoms and repeat COVID19 testing was negative. Discussion Studies have shown that post infection immunity has conferred for at least 3-6 month. Clinical course and prognosis of COVID19 in pregnancy has been found to be associated with more complications and rapid clinical deterioration. Hence, frequent ICU admissions and need for mechanical ventilation were noticed in pregnant COVID19 infected females, however, limited data is available on post infection immunity in pregnancy. Hence, it remains unknown if this presented patient has experienced relapse of an initial infection or if given her immunosuppressed state in setting of pregnancy she has re-acquired the infection.