Going through covid twice in a few months

BarcelonaJosé Antonio Valle has had covid twice. The first time in March, the second this October. But, in spite of having evidence that he has suffered it twice, clinically it cannot be considered a reinfection: worldwide, only about twenty cases have been accepted so far.

It all started at a Madonna concert in Paris - which was eventually cancelled - on the weekend of March 7 and 8 with a slight discomfort in the throat of his partner, Alfred. He alleviated the pain with some sweets. After a couple of days, already in Barcelona, José Antonio began to have symptoms. First a cough, which lasted five weeks and woke him up at night. Then a fever, which lasted 3 or 4 days and was close to 39º. And then the intense headache and the bone pain started to appear. For two nights he had a skin rash on his hand, and he even lost part of his sense of smell. As the Catalan health system was collapsed, in the middle of the first wave of the pandemic, no PCR was done. "I went two months without stepping on the staircase landing," he explains. Until May 8, when he was discharged. It was all done by phone, without any evidence that he had passed the virus until July 27, when he took a serological test that confirmed that he had passed the disease.

Second infection

After a summer in which he continued with a minimal social life, respecting the security measures and restrictions set by the health authorities, even carrying the hydro-alcoholic gel on him despite feeling "liberated" by the fact of having passed the virus, in October he fell again. Again the covid gave the first signs of life away from the flat they have in Gràcia, in a family meal in Girona where there were 6 people. The first evidence was a conjunctivitis to which they did not give importance. They had already gone through the virus and nobody could think that that redness in the eyes could be the first manifestation of the covid. They went to a house they have in Urgell to spend a few days of holidays, and there José Antonio developed a sore throat and a cough. However, covid was still far from their thoughts. In fact, as the symptoms were mild, and he did not even want to go to the health centre in Tàrrega. "I went so that I didn't have to listen to Alfred," he says with a smile. Four days after getting a PCR on October 14th, it was confirmed that he had the disease again. He was locked up in his house again until November 6, when he was discharged.

Over the last few weeks, José Antonio has witnessed firsthand a series of misconceptions from the administration. Track and trace has had its shortcomings: there was confusion about who had to be contacted, not all the names he gave have been contacted, the confidentiality he requested was broken, and even a relative with whom he had eaten on October 10, the first day he developed symptoms, was kept waiting longer than he was: on the 18th he was contacted, on the 20th he was tested, until the end of the month he did not have the results. He was requested to spend 10 days isolating at home. "He has been in confinement longer than I have been; I have tested positive and had symptoms, and he has not", says José Antonio, who, however, highlights the effort of the doctor from the health centre in Vila de Gràcia - Cibeles who has followed him and who persisted in obtaining all the available information and trying to get the bottom of everything: the first test was in Vall d'Hebrón, the second in Arnau de Vilanova, Lleida.

The doctor, who has not seen any similar cases, has been trying to prove that the case of José Antonio is a reinfection, but with the material she has available she has not been able to do so. If confirmed, it would be one of the few cases in the world. In Catalonia, until now, and still pending review, there has only been the case of a doctor from the Hospital de Palamós, Ramon Valls, who in the second infection suffered much more severe symptoms than those suffered in the first, and suffered a significant vital risk.

When the second wave began, Valls did not have immunity, a fact that happens in 20% of people who have suffered covid, according to Roger Paredes, a specialist in infectious diseases at the Germans Trias i Pujol Hospital. Valls's is one of ten suspected cases of reinfection that the hospital is analysing. "There are reinfections, but they are not frequent. There are very few. In Korea, for example, there were 200 possible cases that ended up being ruled out," describes Paredes, who differentiates between a new positive and reinfection. In the first case, the patient tests positive again for the same infection, because PCR has a high sensitivity and detects the presence of the initial virus after some time. In the case of re-infection, Paredes highlights the differences: "We have to have the same clinic twice, we have to obtain the sequence of the virus and it must be different in both cases". The genome is sequenced and the two viruses are compared.

Possible reinfection

With all the usual prudence because he does not know the details of José Antonio's case, Dr Paredes understands that it could be a "possible" case of reinfection - the fact that he lost his sense of smell plays would seem to indicate so - but it cannot be demonstrated without following "objective criteria" set by the scientific community and which require information that is often not available due to the multiplicity of different tests that are carried out.

José Antonio will probably never know if he is part of this select group of clinically validated re-infected people. Even though the future may bring many surprises. "With my luck, I'm waiting for the third wave, I can catch it again," he says slyly, while calling on the administration not to shift all responsibility to citizens when it comes to fighting the pandemic. He has been meticulous in complying with the regulations and yet he has caught the coronavirus twice. "I get indignant when someone doesn't wear a mask, when I see a lot of people in front of the bodega underneath my house, drinking at the door as if nothing was wrong. I walk around trying not to get in the way," he explains. And he does it, despite having gone through covid, out of responsibility and not to put his mother, whom he hasn't seen for months, at risk.

Cases like José Antonio's, who have already been through covid twice, whether they are reinfected or not, are beginning to proliferate. This is the case, for example, of the JxCat deputy Maria Elena Fort, who has had covid twice in three months. On both occasions she received a PCR test and she also testes negative twice between the two infections. On the first occasion she was asymptomatic, while the second time she had some symptoms associated with the coronavirus: she lost some of her sense of taste and smell and was very tired and in pain. She still suffers from fatigue and has trouble breathing even though she didn't have pneumonia. Nine months after covid hit Catalonia, the cases of people who have suffered it twice are increasing. However, very few will end up being considered reinfected.