Is my patient with Covid-19 immune to future infections due to the same virus?

Since Covid-19 is a new disease, it is unclear if our body’s immune response can protect us from future infections, and if so, for how long.

In a MedRxiv study involving 175 Covid-19 recovered patients (median age 50 y) with mild symptoms, the production of neutralizing antibodies (Nab) varied, with ~30% of patients considered to have “very low level” titers. So at least a subset of patients with mild symptoms may not produce adequate antibodies against Covid-19 despite seemingly uncomplicated recovery.  Whether these patients are at risk of re-infection with Covid-19 virus remains to be seen.1

In a study involving patients with Covid-19 (median age 62 y) of variable severity, the rate of seropositivity at 2-4 weeks was 88% or higher. However, despite development of antibodies against surface spike protein and internal nucleoproteins of SARS-CoV-2, the Covid-19 virus, viral RNA could be detected in the throat samples from a third of patients for 20 days or longer.2

In another study involving mild Covid-19 cases, despite seroconversion after 7 days in 50% of patients and after 14 days in 100% of patients, no rapid decline in pharyngeal viral load was noted. These findings raised doubts about the role of antibodies in clearing the virus.3

Somewhat more encouraging is the finding that experimentally infected monkeys rechallenged with Covid-19 virus after full recovery 28 days following initial infection seem to be protected against Covid-19.4 So there may be some protection for couple of weeks at least! 

Ultimately, whether immunity to Covid-19 will be like seasonal coronaviruses that cause common colds with unpredictable protection after 1 year, or more similar to that of SARS virus with persistence of antibodies for ~2-3 years, only time will tell. 4,5

Stay tuned!

 

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References

  1. Neutralizing antibody responses to SARS-CoV-2 in a COVID-19 recovered patient cohort and their implications. MedRxiv preprint doi: https://doi.org/10.1101/2020.03.30.20047365
  2. To KKW, Tsang OWTY, Leung WS, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet 2020; March 23. https://doi.org/10.1016/S1473-3099 (20)30196-1
  3. Wolfel R, Corman VM, Gugggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature https://doi.org/10.1038/s42586-020-2196-x (2020) .
  4. Bao L, Deng W, Gao H, et al. Reinfection could not occur in SARS-CoV-2 infected rhesus macaques. bioRxiv doi: https://dli.org/10.1101/2020.03.13.990226.
  5. Callow KA, Parry HF, Sergeant M. et al. The time course of the immune response to experimental coronavirus infection of man. Epidemiol Infect 1990;105:435-46. https://www.ncbi.nlm.nih.gov/pubmed/2170159
  6. McKenna S. What immunity to COVID-19 really means? Scientific American, April 10, 2020. https://www.scientificamerican.com/article/what-immunity-to-covid-19-really-means/

 

Disclosures: The listed questions and answers are solely the responsibility of the author and do not necessarily represent the official views of Massachusetts General Hospital, Harvard Catalyst, Harvard University, its affiliate academic healthcare centers, or its contributors. Although every effort has been made to provide accurate information, the author is far from being perfect. The reader is urged to verify the content of the material with other sources as deemed appropriate and exercise clinical judgment in the interpretation and application of the information provided herein. No responsibility for an adverse outcome or guarantees for a favorable clinical result is assumed by the author. Thank you!

Is my patient with Covid-19 immune to future infections due to the same virus?