COVID-19 reinfection: A Rapid Systematic Review of Case Reports and Case Series

Abstract

The COVID-19 pandemic has infected millions of people worldwide and many countries have been suffering from a large number of deaths. Acknowledging the ability of SARS-CoV-2 to mutate into distinct strains as an RNA virus and investigating its potential to cause reinfection is important for future health policy guidelines. It was thought that individuals who recovered from COVID-19 generate a robust immune response and develop protective immunity, however, since the first case of documented reinfection of COVID-19 in August 2020, there have been a number of cases with reinfection. Many cases are lacking genomic data of the two infections and it remains unclear whether they were caused by different strains. In the present study, we undertook a rapid systematic review to identify cases infected with different genetic strains of SARS-CoV-2 confirmed by polymerase-chain reaction and viral genome sequencing. A total of 17 cases of genetically confirmed COVID-19 reinfection were found. One immunocompromised patient had mild symptoms with the first infection, but developed severe symptoms resulting in death with the second infection. Overall, 68.8% (11/16) had similar severity, 18.8% (3/16) had worse symptoms, and 12.5% (2/16) had milder symptoms with the second episode. Our case series shows that reinfection with different strains is possible and some cases may experience more severe infections with the second episode. The findings also suggest that COVID-19 may continue to circulate even after achieving herd immunity through natural infection or vaccination suggesting the need for longer term transmission mitigation efforts.

Protective immunity of the primary SARS-CoV-2 infection reduces disease severity post re-infection with Delta variants in Syrian hamsters

“…Although the risk of re-infection appears to be low in humans, there are reports of varying disease severity in re-infected individuals. 9,11,15,16 Wang et al, 2021 has reported 68.8%, 18.8% and 12.5% of similar, worse and mild disease severity in re-infection cases. 11 Severe disease has also been reported with Delta variant re-infection.…”

Reinfection With Severe Acute Respiratory Syndrome Coronavirus 2 Without Recurrence of Multisystem Inflammatory Syndrome in Children

“… 14 These cases show a high diversity in clinical presentation, varying from asymptomatic infection to severe disease, although a publication bias for more severe cases is certainly conceivable. 15 Because the exact pathogenesis of MIS-C remains elusive, it is currently unknown if immunologic memory will prevent recurrence of MIS-C upon reinfection with SARS-CoV-2.…”

The mystery of COVID-19 reinfections: A global systematic review and meta-analysis of 577 cases

“…The average time duration between first infection and reinfection in our review was 63.6 days. Wang et al in their review noted it to be 76 days[99] whereas Manish et al in their review[100] observed a lengthier duration of median 113.5 days. This variation in time duration outlines the need for vigilance when it comes to COVID-19 reinfection, especially considering waning antibodies.…”

“…Whilst our review did not analyze the cause of reinfection being due to different variants, they cannot be excluded. A review by Wang et al[99] concluded that previous COVID-19 reinfection did not confer total immunity and a second infection by a different variant was possible with the second infection being more severe than the first. Even though most of the studies in our review predated the announcements of the new variants, however, given the ability of the virus to mutate at a rapid pace, some reinfection cases reported in our study could be due to the variants which would have resulted in more severity of reinfection.…”