It is the first time that a patient has apparently died in Germany after being infected with the corona virus for the second time. The 73-year-old man from Baden-Württemberg had, according to information from NDR, WDR and Süddeutscher Zeitung Infected with Sars-CoV-2 for the first time in April of last year and successfully fought the virus. In December he contracted the pathogen again, on January 11th he died “of Covid-19 pneumonia and sepsis with multiple organ failure,” as the regional council of Stuttgart announced on request.
There was a long symptom-free phase between the two infections, emphasizes Christine Wagner-Wiening, the deputy head of infection monitoring at the State Health Office in Stuttgart. In addition, his wife was infected during the second infection – and there was a lot of virus genetic material in the man’s samples. These are “strong criteria” for an actual reinfection.
The State Health Office cannot say whether the man who suffered from cardiovascular disease was infected the second time with the same virus or a mutated form. The sample of the initial infection no longer exists. The English virus variant B.1.1.7 was discovered for the first time in Germany in the Freudenstadt district, where the man lived, but according to the State Health Office there is “no epidemiological evidence” that the deceased came into contact with this variant. Therefore no exact virus analysis by means of sequencing was commissioned. “Only in cases where there is a travel connection to Great Britain, South Africa or Ireland would we notify the health department to initiate sequencing,” explains Wagner-Wiening.
Experts warn again and again that a previous infection does not necessarily protect against a renewed infection
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Renewed infections with the coronavirus have so far been rare. The world’s first confirmed case was in August when a man from Hong Kong tested positive again after visiting Spain. Since then, reinfections have been reported from all over the world – in Hong Kong, Belgium, Ecuador, India and the USA. At least 15 cases are considered certain. The Robert Koch Institute is currently reviewing “a number of such reports” from Germany, as it reports on request.
Since the beginning of the pandemic, experts have repeatedly warned that a previous infection with Sars-CoV-2 does not necessarily protect against re-infection with the virus. However, reinfections of this kind are usually mild, as the body has at least partial immunity after the initial infection. It is extraordinary that renewed infections lead to death. However, two other cases have already become known: In October, an 89-year-old Dutch woman died, but her immune system was weakened from cancer. In December, according to a newspaper report, a 74-year-old resident of a nursing home in Israel died of Covid-19 after he was infected for the first time in August and tested negative three times in between.
Recently reports from Brazil about a virus mutation that could allow renewed infections also caused a stir. In two case reports, scientists describe reinfections in two health care workers. The two cases are receiving special attention, since the Brazilian researchers found a mutation called E484K in the spike protein of the virus in the second Covid-19 episode. This mutation is also present in the virus variant from South Africa, which is said to be particularly contagious. To what extent this mutation favored the renewed infections is still unclear.
Hartmut Hengel, virologist at the University of Freiburg, assumes that reinfections are even “widespread” in Brazil. “There is now a certain population immunity there, which means that the virus now has to work harder.” The former president of the Society for Virology believes that this is why more and more variants and mutants will emerge.
In addition to mutations, the reason for the possible re-infection could also be a declining immune response. The number of antibodies in the blood of those who have recovered seems to decrease in the first few months after a natural infection. This is also known from other coronaviruses. However, the memory cells of the immune system are apparently still active after half a year, as scientists from Rockefeller University have just reported. How long the immune response lasts seems to have something to do with the severity of the course. It is especially short-lived when a patient shows only mild symptoms or no symptoms at all.
What such reinfections mean for vaccinated people is still unclear. However, the vaccination leads to a much stronger immune response than the disease itself. Therefore, experts hope that the protection of the vaccination lasts longer. It may also be necessary to re-vaccinate closely.
It is also questionable how the already approved vaccines react to the new mutations. “I don’t think the vaccines are no longer working,” says Hengel, a virologist. But he fears that they may become less effective. “I think the current virus will end up as a seasonal coronavirus,” says Hengel. You will always see severe corona infections. But by and large one will get the matter under control. Even if the vaccines have to be repeatedly adapted to the new virus variants, this can be done quickly and easily: the mRNA vaccines are ideally suited for this.
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