A confirmed, severe case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection with the new variant B.1.1.7 at a hospital in London was reported in Clinical Infectious Diseases. The reinfection occurred 8 months after an initial mild course of SARS-CoV-2 during the first wave of the pandemic in the United Kingdom.
The patient was a 78-year-old male with a history of type 2 diabetes mellitus, diabetic nephropathy on hemodialysis, COPD, mixed central and obstructive sleep apnea, and ischemic heart disease. On April 2, he presented with fever during hemodialysis, subsequently tested positive for SARS-CoV-2, had a mild illness, and an uneventful recovery.
He was tested on December 8, 2020 as part of routine SARS-CoV-2 testing performed at the hemodialysis clinic. His sample’s relative light unit (RLU) value was 1348. A repeat sample sent on December 14 using reverse transcription polymerase chain reaction (RT-PCR) had Ct values of 27.5 and 27.9.
The patient was brought to the emergency department reporting a 3-day history of worsening shortness of breath and presented with shortness of breath, difficulty speaking and severe hypoxia. He was intubated immediately and admitted to intensive care.
Whole Genome Sequencing performed in-house on the patient’s nose and throat swabs revealed that the sample from April 2 belonged to lineage B.2 with no mutations in the S region, and the sample from December 8 belonged to lineage B.1.1.7 with 18 amino acid replacements in the S region and 2 deletions in the spike region, corresponding to the new SARS-CoV-2 variant VOC-202012/01 which is rapidly spreading in the United Kingdom.
Although the new variant is associated with increased transmissibility, it has not been associated with increased pathogenicity. In this patient’s case, however, reinfection with the new variant caused a life-threatening illness.
Anti-SARS-CoV-2 antibodies were detected in the patient shortly before the reinfection with no evidence of antibody waning, which “may raise some concerns about immune evasion by this new variant, which is a concern with the high number of spike region mutations seen,” the authors wrote. They added that the spike region mutations also raise concerns for vaccine evasion and likelihood of reinfection.
The authors cited regular PCR screening of their dialysis cohort and access to in-house whole genome sequencing as key components allowing them to confirm reinfection with the new variant. They estimated that such reinfection is “drastically underreported” worldwide.
Harrington D, Kele B, Pereira S, et al. Confirmed reinfection with SARS-CoV-2 variant VOC-202012/01. Clin Infect Dis. Published online January 9, 2021. doi:10.1093/cid/ciab014