COVID Transmissions for 8-26-2020

More reinfections!

Aug 26, 2020

Greetings from an undisclosed location in my apartment.

It has been 283 days since the first documented human case of COVID-19.

Housekeeping note:

Headlines today as more reinfections emerge around the world; in the headlines section I provide an answer to a reader question.. In-depth will come tomorrow or Thursday.

Glossary terms are bolded words with links to the running newsletter glossary.

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Now, let’s talk COVID.

The first, second, and third reinfected patients

Today, two new reports of reinfected patients emerged on top of the one that appeared yesterday.

One was in Brussels and the other in the Netherlands. I think the researcher who announced the Brussels case made some VERY irresponsible statements about it, so I’m not linking to those statements. The one in the Netherlands doesn’t have a lot of details, so I’m not linking anything about that one either.

What’s important is this: what I said yesterday about the HK patient still stands. These two cases don’t change that. However, they do suggest that out of 20-25 million infections, there are bound to be some unusual cases where patients don’t mount what we would think of as a typical immune response. The case in the Netherlands was a patient with a compromised immune system, for example. These are not surprising cases. If indeed immunity wanes rapidly or does not get induced properly at all, we would expect many many more such cases. Perhaps we will see many more such cases—I cannot be sure, because it is always possible that immunity lasts only 8 months, or 9, or 48. I would be lying if I said I knew.

But what I do know is that if immunity waned rapidly, I would expect there to be hundreds or thousands of such cases already. We haven’t found those, and they would be easily noticed.

Following yesterday’s in-depth, reader “E” asked if a patient without sterilizing immunity would still have the ability to infect others. I answered online, but I’m providing my answer here too:

“…it depends, of course. If the immunity that is granted by infection with the virus the first time is sufficient keep viral load low in the patient on their second infection, I would expect this to have an impact on transmission. If it simply alleviates symptoms but the viral load is still over the threshold for transmission, it won't prevent it. We will learn more about this when we have vaccine trial data.”

Long-term follow-up

CIDRAP reports on a new study showing the long-term impacts of COVID-19 on recovered, previously hospitalized patients: https://www.cidrap.umn.edu/news-perspective/2020/08/covid-19-symptoms-can-persist-months-after-hospital-stay

The research letter can be found in the Journal of Infection: https://www.journalofinfection.com/article/S0163-4453(20)30562-4/fulltext#%20

There is a lot in this study, so I’ll do some bullets:

Symptoms persisted in the 120 formerly hospitalized patients in the study for a mean of 110.9 days; these symptoms included fatigue, shortness of breath, etc
Oddly, less common but still substantial were hair loss, inattention, and memory loss
There were also meaningful impacts on health-related quality of life as reported by these patients
The patient group skewed older and more male than the general population, which is not a surprise

This is a small study, but if anything, it should tell us—especially those of you reading who have had COVID-19 and recovered—that it’s expected to still struggle with recovery for some time after being discharged from the hospital. However, symptoms resolved eventually in a lot of these patients, so persistent impacts do not necessarily mean permanent impacts.

We will, of course, learn more as time goes on.

First community spread in Gaza

We now have reports that the Gaza Strip is under a 48-hour curfew because a cluster of community-acquired infections was detected there. Al Jazeera has a story: https://www.aljazeera.com/news/2020/08/gaza-lockdown-covid-19-community-transmission-200825061033725.html

I know this has a potentially political dimension, which I will be putting aside. I believe that everyone can agree that Gaza is a place with some serious healthcare system challenges already, though. Hopefully the outbreak there will be contained, rather than making a bad situation worse.

India currently leading the world for daily new cases

This is unsurprising given its high population, but for the 18th straight day yesterday, India reported the largest number of new COVID-19 cases in the world, documented in this story from Reuters: https://www.reuters.com/article/us-health-coronavirus-india-cases/india-reports-more-than-60000-coronavirus-cases-for-a-seventh-straight-day-idUSKBN25L0CO

This is also the 7th straight day that there have been more than 60,000 new infections reported in India.

With such a large population, this does not reflect a high per capita infection rate. However, it is likely that virus surveillance in India lags substantially behind other countries, and as a result this number is probably a substantial underestimate.

This is, of course, concerning. Hopefully the benefits of nearly 10 months of clinical knowledge surrounding the treatment of this virus will help to save lives as this infection spreads through one of the world’s most populous countries.

What am I doing to cope with the pandemic? This:

Playing

I have been making an effort, as I’ve mentioned before, to keep to an exercise routine to continue weight loss that I started before the pandemic. I’ve lost about 25 pounds so far, but this relies on getting regular exercise.

Twice a week, I bike about 15 miles. Twice a week, I do some weightlifting with a set of adjustable weights that we ordered early on. Twice a week, I run about 3 to 4 miles.

Today, due to a freak thunderstorm, the run got a little more difficult:

Image is of the Central Park Bridle Path, which has been blocked almost 90% by a fallen tree.

Before you text me, Mom (yes, of course she reads this), I was not running during the storm, only after.

Join the conversation, and what you say will impact what I talk about in the next issue.

Also, let me know any other thoughts you might have about the newsletter. I’d like to make sure you’re getting what you want out of this.

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