On the issue of reinfection, reactivation and persistent infection
There have been reports of people in our community who appear to have had COVID in the past (evidenced by antibody presence, viral test, or classic symptoms) and have since recovered for many weeks, and who now have covid-like symptoms again. Some of these individuals are now testing positive for the virus. What does this mean; how do we interpret this?
There are several possibilities:
- Their body had completely fought off the virus, and then they caught the virus again from someone else, resulting in the second set of symptoms.
- This is the most worrisome possibility, and what people typically mean when they say “reinfection”. These people lend credence to the possibility that protection acquired from the original infection is indeed short lived (as witnessed by IgG antibody levels falling quite rapidly as we see), and that given a sufficient exposure to another infectious individual, they may become reinfected and sick with COVID all over again, and may themselves be infectious. They would need to quarantine fully for at least 10 days after the onset of symptoms, just in case this truly is a new infection (even if they have antibodies).
- Their body did not completely fight off the virus; some virus remained dormant. That remaining virus was somehow reactivated, causing those second set of symptoms.
- This is less worrisome, as it does not necessarily imply community spread. As of this time we have tended to think of people who have the virus as not being infectious 2 weeks after symptom onset. Whether patients with “reactivated infection” truly exist, or this is either option 1 above or 3 below remains to be proven.
- Their body completely fought off the virus, but some viral particles remained in their secretions for many weeks, presumably dead/inactive. Their second set of symptoms was in fact not due to active infection with coronavirus but possibly is a delayed immune response or other infectious cause, however when tested for the virus, the test sensed those remaining viral particles and returned a positive result.
- This is the least worrisome, although there is a limit to how long we think dead viral particles hang around for.
- In addition, if they had tested negative for the virus (twice ideally) while they were recovered, and then the test turned positive on their second set of symptoms, this option is no longer a reasonable consideration.
Which one of these possibilities is the true answer, or indeed whether the true answer is a combination of these three possibilities, is still unknown. This is currently one of the most pressing questions about the virus, and one which is being actively researched.
A somewhat related question is how long antibodies last for. Meaning, even if we assume that someone who interacted with the virus indeed does have protection, we are still studying how long that lasts for, and whether the antibodies are the sole measure of this protection, or does immunity possibly rest elsewhere in a profoundly complex human immune system (and not necessarily dependent on antibody levels). Again, this is something being studied, and we hope that for the majority of people protection lasts at least several months and more.
Practically:
- If someone already had covid (by antibodies, viral test, or classic covid symptoms) and is now experiencing a second set of typical covid-like symptoms, please do get tested for the virus. If the test is positive, please isolate yourself until 10 days have elapsed from the beginning of the symptoms and your fever/symptoms have resolved.
- If someone already had covid (by antibodies, viral test, or classic covid symptoms) and then later has a positive viral test but is not having any covid symptoms, they do not need to quarantine, however they should be very careful with mask use and social distancing.
When we speak of the possibility of NEW covid cases in Crown Heights, we are referring to individuals who have never had covid symptoms and never had positive antibodies/viral test, who then develop covid-like symptoms and test positive for the virus. Such a situation would truly be a new covid case. Boruch Hashem, after speaking to the various primary care offices and medical practices in the community, we still have not had a NEW case in many weeks. The more sobering news is that we may be currently dealing with a case of reinfection locally, with all its possible ramifications.
As we go from Gimmel Tammuz, where there surely were visitors from states that are going through surges in infection rates, we urge everyone to be particularly attentive to any symptoms suggestive of COVID, and immediately to see your health care professional, or one of many free city testing sites, so that we can protect all those who may be vulnerable.
PLEASE DO NOT GO TO SHUL OR OTHERWISE SOCIALIZE IF YOU FEEL ILL IN ANY WAY!
If anyone has any new COVID symptoms, regardless of whether you may have had COVID already before, please fill out this survey:
Summer camps:
We have been attempting to create a unified approach to overnight camp policy, in particular with respect to screening campers/staff before camp, although the effort is limited by local policy and guidelines, as well as the inherent uncertainty that remains about the virus and its spread. The greatest risk revolves around campers and staff from out of Crown Heights who have not had the infection, and particularly those from “hotspot” states, such as Florida. The safest option would be to limit travel from out of town for those who have not yet had the virus. If travel is necessary from these “hotspot” areas, then for the safety of all campers and staff, these individuals must not come to camp without the required testing and quarantine period. In addition any camper/staff who has had first degree contact with an individual suspected of COVID should quarantine for 14 days at home and be tested twice for the virus (nasally) before coming to camp. Double testing is a higher standard that we consider reasonable under the current circumstances. It goes without saying that any camper/staff member who in any way feels ill should receive proper care and testing prior to going to camp.
We wish to once again reiterate the appeal for limited travel to and from Crown Heights, in order to reduce the possibility that vulnerable people may become infected, as they increasingly come out of shelter in order to resume normal life. We would like to urge all those who remain vulnerable and at risk to continue to be mindful of strict social distancing and mask use.
Wishing everyone a Good Shabbos, and a gezunten zummer,
- The Gedaliah Society, in conjunction with Dr. Rosen
