SARS-CoV-2 reinfection and COVID-19 severity

Abstract

SARS-CoV-2 reinfection rate is low. The relative severity of the first and second episodes of infection remains poorly studied. In this study, we aimed at assessing the frequency of SARS-CoV-2 reinfections and comparing the severity of the first and second episodes of infection. We retrospectively included patients with SARS-CoV-2 positive RT-PCR at least 90 days after clinical recovery from a COVID-19 episode and with at least one negative RT-PCR after the first infection. Whole genome sequencing and variant-specific RT-PCR were performed and clinical symptoms and severity of infection were retrospectively documented from medical files. A total of 209 COVID-19 reinfected patients were identified, accounting for 0.4% of positive cases diagnosed from 19 March 2020 to 24 August 2021. Serology was performed in 64 patients, of whom 39 (60.1%) had antibodies against SARS-CoV-2 when sampled at the early stage of their second infection. Only seven patients (3.4%) were infected twice with the same variant. We observed no differences in clinical presentation, hospitalization rate, and transfer to ICU when comparing the two episodes of infections. Our results suggest that the severity of the second episode of COVID-19 is in the same range as that of the first infection, including patients with antibodies.

Keywords: COVID-19; SARS-CoV-2; coronavirus; reinfection; severity.

Figure 1.

Dynamic of SARS-CoV-2 infections and reinfections diagnosed at IHU Méditeranée Infection, 2020–2021.

Figure 2.

Prevalence of reinfection (proportion of COVID patients who sustained a previous infection with SARS-CoV-2, red curve) and estimated risk for reinfection (proportion of patient infection during a given wave of COVID-19 who got reinfected at the time of study, histograms). The prevalence of reinfection increased from 0 to 1.54% from the first to the fourth wave. The risk for reinfection decreased from 0.77 for the first wave to 0.19 for the third wave (data were not available at the time the study was done to calculate the risk for reinfection for the fourth wave).