Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection Associates With Unstable Housing and Occurs in the Presence of Antibodies

Abstract

Background The factors associated with severe acute respiratory coronavirus 2 (SARS-CoV-2) reinfection remain poorly defined. Methods We identified patients with SARS-CoV-2 infection and at least one repeat reverse transcription (RT) – polymerase chain reaction (PCR) result a minimum of 90 days after the initial positive test and prior to January 21, 2021. Those with a repeat positive test were deemed to have reinfection (n = 75), and those with only negative tests were classified as convalescents (n = 1,594). Demographics, coronavirus disease 2019 (COVID-19) severity, and treatment histories were obtained from the Boston Medical Center electronic medical record. Humoral responses were analyzed using SARS-CoV-2 specific enzyme linked immunosorbent assays and pseudovirus neutralizations in subset of reinfection (n = 16) and convalescent samples (n = 32). Univariate, multivariate, and time to event analyses were used to identify associations. Results Individuals with reinfection had more frequent testing at shorter intervals compared to the convalescents. Unstable housing was associated with more than two-fold greater chance of reinfection. Pre-existing comorbidities and COVID-19 severity after the initial infection were not associated with reinfection. SARS-CoV-2 IgG levels and pseudovirus neutralization were not different within the early weeks after primary infection and at a time-point at least 90 days later in the two groups. In the convalescents, but not in those with reinfection, the late as compared to early humoral responses were significantly higher. Conclusions Reinfection associates with unstable housing, which is likely a marker for virus exposure, and reinfection occurs in the presence of SARS-CoV-2 antibodies.

Clinical Characteristics and Outcomes of Patients With SARS-CoV-2 Reinfection

“…Similar to a recent study, we have seen seropositivity in patients with reinfection. 32 In our cohort, the hospitalization rate was higher in fully vaccinated patients compared with unvaccinated ones. However, given that fully vaccinated patients were older and had a significantly higher number of comorbidities, we considered that the comparison was confounded by these factors.…”

“…33 Because of logistic limitations (inability to preserve initial samples, limited laboratory resources, cost issues), this approach is less likely to be pursued in clinical practice. 32,33 Therefore, we adapted investigative criteria of the Centers for Disease Control and Prevention to define the reinfected population. 11 This approach allows us to capture a larger cohort of patients but at the risk of possible overestimation of the reinfected patients as prolonged viral shedding can occur for weeks to months after the initial infection.…”

SARS-CoV-2 reinfection and COVID-19 severity

“…This proportion rose to 83.3% in those who were vaccinated. Bean et al reported that reinfection occurred in individuals despite the presence of antibodies against SARS-CoV-2 in their sera [ 17 ]. In our series, 64 reinfected patients had available serological results; 39 were positive after the first time of infection and 25 were negative.…”

The durability of natural infection and vaccine-induced immunity against future infection by SARS-CoV-2

“… 21 ] that was validated by a subsequent empirical finding of 18% reinfection by 275 to 300 d after primary infection [ref. 22 ] and, likewise, predicting a 34% probability of reinfection at ∼450 d after primary infection [ref. 21 ] that was validated by a subsequent empirical finding of 34% breakthrough infection 420 to 480 d after primary vaccination [ref.…”