Is COVID-19 reinfection a myth?

INTRODUCTION: Novel coronavirus disease (COVID-19) is associated with a multitude of complications that lead to catastrophic outcomes There is insufficient data on evidence to support that COVID-19 infection leads to immunity We present a case of COVID 19 re-infection in a patient who was tested positive after multiple negative tests in the past METHODS: A 31-year-old male with a recent admission for COVID-19 pneumonia three months ago presented to the hospital with dyspnea He reported progressively worsening non-productive cough and fevers for 2 weeks He was treated with hydroxychloroquine, tocilizumab, and convalescent plasma therapy during his prior hospitalization He had 3 negative tests before he was discharged He was readmitted with hypoxia with the oxygen saturation in the 80s and was placed on high-flow nasal cannula Laboratory investigations revealed elevated inflammatory markers, with a ferritin of 559 ng/ml, C-reactive protein of 3 6 mg/dl, and lactate dehydrogenase of 294 U/L His repeat COVID-19 test was positive Computerized tomography scan of the chest demonstrated bilateral patchy ground-glass infiltrates suspicious for viral pneumonia The patient was admitted to the hospital for hypoxic respiratory failure secondary to COVID 19 re-infection Given his critical condition, he was initiated on remdesivir therapy with gradual amelioration of symptoms RESULTS: Although it has been reported that COVID-19 persists in the sputum or feces for a few weeks after the resolution of the disease, our patient presented with active symptoms and elevated inflammatory markers Zhou et al reported a median shedding duration of 31 days, ranging from 18 to 48 days Our patient presented after three months, further pointing towards re-infection rather than residual shedding This supports the hypothesis that not all COVID 19 infections mount an immune response that leads to adequate immunity Since COVID-19 testing parameters are not currently optimal, clinical and laboratory assessment remains of paramount importance irrespective of the test result It is essential to maintain vigilance during the convalescence period until we have enough data to suggest a non-infectious state Physicians should have a high degree of clinical suspicion for COVID-19 reinfection to prevent fatal outcomes