While CDC studies coronavirus’ reinfection phenomenon, this woman has suffered 2 bad bouts

By medical standards, Nicole Worthley is considered extraordinarily rare. She was diagnosed with the coronavirus on March 31 and again in September.

She was walloped both times, with a fever for six weeks and side effects all summer before round two kicked in.

But she can’t prove she had COVID-19 twice. That would require genetic testing of both infections, which has happened only a few dozen times anywhere in the world and never in South Dakota, where she lives.

Many states are keeping track of claims of reinfection, but they still are considered extremely unusual, according to health experts including the World Health Organization.

The U.S. Centers for Disease Control and Prevention says it’s investigating some possible reinfections but has not yet confirmed any. It only considers infections more than 90 days apart to be possible reinfections. Otherwise, someone’s illness is likely to be a lingering infection.

Worthley said she’s not sure which would be worse: being able to be reinfected or having a lingering virus that could flare up anytime.

“Whether or not I personally have a proven reinfection isn’t to me as important as it’s possible that you can get it again,” she said. “Or, if you don’t believe that, then it’s possible that for six straight months you can have COVID-19, still test positive for COVID-19 and still be actively ill from it — because I don’t think there’s a lot of understanding of that right now.”

No one knows how long the immune system can keep someone safe from COVID-19 after infection.

Some diseases, like measles, are one and done: Once infected or vaccinated, the immune system typically provides protection forever.

With other viruses, like the common cold — some of these closely related to the coronavirus that causes COVID-19 — protection might not last a year or even a season.

COVID-19 was discovered less than a year ago, so scientists don’t yet know how long the body can fight it off.

The answer has implications for the longevity and effectiveness of vaccines, the possibility of developing so-called herd immunity, in which the virus no longer spreads because so many people have already been infected, and how those infected once should behave.

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Worthley, 37, could be considered a “long-hauler” — someone whose COVID-19 lasted for months after infection.

She was diagnosed the last day of March after suffering sharp chest pains. A few days later, she was so short of breath that she could barely walk across her apartment.

A single parent to three kids ages 6, 8 and 10, Worthley struggled to function.

“The room would be spinning, and I’d be wheezing and stuff,” she said. “Sometimes, I could feel my teeth tingling.”

She ran a fever for four straight weeks, then had a break for a day or so — not enough to meet the 72-hour window to be declared healthy — and then spiked again for two more weeks.

She and her kids were stuck in their Sioux Falls apartment from late March until early June.

Her kids never got more than a few tired days and a yucky cough. But she knows her illness affected them. During his bedtime prayers, her oldest son often said he was thankful she was still alive.

In early June, the family was finally allowed to go out. Worthley was told she didn’t need another test, that she no longer was considered infectious.

She went back to work at the daycare center where she’s an assistant manager — but only part-time because the pandemic had driven away some families.

Still, all summer, Worthley, previously healthy though admittedly overweight, had weird symptoms. Her doctor prescribed a beta blocker for heart palpitations and an anticonvulsant for nerve pain in her legs.

She donated convalescent plasma in September, hoping the antibodies her immune system had developed could help someone else fight off the coronavirus.

Then, at the end of September, about a month after her kids started in-person school, her 10-year-old came down with strep.

Worthley was feeling lousy, too, so she got tested for strep. Negative.

A few days later, still feeling weak, she called her doctor, who asked: Can you smell anything?

“I got the Vicks out,” Worthley said. Nothing.

Four days later, she got a positive COVID-19 test result.

“It was easier this time,” she said. “I was only feverish for 17 days.”

She had diarrhea, upset stomach, loss of taste and some respiratory issues but not as bad as the first infection. But she still can’t smell and still coughs a lot.

Worthley thinks she is among the 28 people the South Dakota Department of Health has said it’s investigating for reinfection, though she’s yet to hear from anyone with the state.

So far, only a few dozen people worldwide have been confirmed to have been infected twice with SARS-CoV-2, the virus that causes COVID-19.

One man in Hong Kong didn’t know he’d been infected a second time. He found out when he was routinely tested on his return home from a trip to Italy. Another man, just 25, in Nevada, was sicker the second time.

In both cases, genetic analysis of the infections proved they were infected twice, with slightly different versions of the virus — rather than just being long-suffering. The World Health Organization has received reports of reinfections, but they are relatively rare so far.

“Our current understanding of the immune response is that the majority of people who are infected mount an immune response within a few weeks of infection,” a WHO spokesman said. “We are still learning about how long the antibodies last. So far, we have data that shows that the immune response lasts for several months.”

Jeffrey Shaman, a professor at the Columbia University Mailman School of Public Health who has been investigating reinfections, said scientists still have a lot of questions, including:

• How often can reinfection happen?
• Are people contagious with the second infection and for how long?
• And if you’re reinfected, do you have less severe cases the second time or worse?

To answer those questions, researchers like him have to figure out what’s behind these reinfections, Shaman said.

People might fail to generate immune memory with the first infection and need repeated exposure to build up immunity. If so, a vaccine might have the same problem, and it won’t be very effective.

Or people might get antibodies to the virus and then lose them, Shaman said. Which would mean a vaccine’s benefit might not last long.

The worst-case scenario would be what happens with dengue. In the case of that mosquito-borne tropical disease, someone can get sicker if infected a second time or infected after getting a vaccine. Then, a vaccine actually could be harmful — though there’s no evidence that’s the case with COVID-19.

Sometimes, diseases that start as outbreaks can become endemic, returning year after year.

The 1918 flu, for instance, was so devastating because it was new and no one had built up resistance, Shaman said. It came back repeatedly but “didn’t have the huge pulses of people dying,” he said, possibly because their bodies had built some immunity to it.

If that’s the case with coronavirus, then a vaccine, even a partially effective one, could have a big benefit by exposing people to the virus and helping them build tolerance, he said.

It’s not yet clear how long someone is contagious with COVID-19 if their symptoms linger or recur.

A study published in JAMA Internal Medicine found that 18% of COVID-19 patients in an Italian hospital tested positive again after recovering from symptoms and having a negative test. Only one of the 32 patients tested showed signs of replicating virus in their bloodstream, suggesting that either that they were still infectious or reinfected. But that couldn’t be confirmed because no genetic testing was done. That patient was still suffering symptoms 39 days after the initial diagnosis, though the others who tested positive again were unlikely to be contagious, the study concluded.

Until scientists learn the answers to these questions, people who have been infected once shouldn’t assume they’re protected indefinitely, and should continue to wear masks, wash their hands, maintain distance and avoid crowds, Shaman said.

“The only way we’re going to get a sense of it is over time,” he said.

Worthley said she could have been more careful about wearing a mask. When she first caught COVID-19 in March, few people were wearing them, and Worthley didn’t know of anyone — at church, work, her kids’ schools — who had the virus.

In the summer and early fall, she wore a mask at work but not at church. She assumed she’d be protected because she’d been sick for so long.

Now, Worthley said she’s not confident of being protected against the virus, so she always wears a mask.

“I have a whole bunch of them in my van,” she said.

Read more at USA Today.