45-year-old man dies of Covid-19 after three recurrences

The man with underlying disease succumbed to the virus after four bouts of infections. The virus in his body has noticeably mutated to more perilous strains within 5 months.
November 14, 2020 | 13:20
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The covid-19 pandemic has claimed the lives of millions victims (photo: nordic life science)
The COVID-19 pandemic has claimed the lives of millions of victims (Photo: Nordic Life Science)

The patient's death after 154 days of battling

According to Daily Mail, the male patient had a severe autoimmune disorder that prevents unnecessary blood clotting. He also suffered from a complication of the autoimmune disorder known as diffuse alveolar hemorrhage, in which blood vessels bleed into the lungs.

In an effort to keep these life-threatening conditions, the man was on blood thinners, steroids and drugs that suppress the immune system, putting him at high risk for coronavirus, for multiple reasons.

He came to a hospital with a fever and promptly tested positive for coronavirus.

Doctors began treating the man with a five-day course of the antiviral remdesivir and bumped up the dosage of his steroids out of concern that he might be bleeding into the air sacs of his lungs, due to his pre-existing condition.

By day five, he was discharged, and did not need supplemental oxygen.

But his improved state didn't last long. Over the course of the next 62 days, he was supposed to be quarantined at home, but instead had to be readmitted to the hospital three times for abdominal pain, trouble breathing and fatigue.

Each time, his blood-oxygen levels were below normal and his doctors remained on edge that he would suffer pulmonary bleeds, and his steroid dose was bumped up to try to prevent them.

However, his viral load of SARS-CoV-2, which causes COVID-19, fell lower over the course of that 62-day period - an encouraging sign he would clear the infection.

But 105 days after his first diagnosis, the man wa admitted again, with the same issues, and a higher viral load, 'which caused concern for a second COVID-19 recurrence,' write the study authors.

He was given another course of remdesivir and finally tested negative for coronavirus afterward, but he wasn't out of the woods and remained on treatment.

A little over a month later, the man was positive again, which 'caused concern for a third recurrence of COVID-19.'

This time, he was given Regeneron's experimental antibody cocktail.

But for this man, it was not the 'cure' that President Trump claimed it had been for him.

A week after getting the antibody drug, the man had to be put on a ventilator. His viral load was nearly as high as the previous test had suggested, and he had developed a fungal infection in his lungs.

Despite treatment with more remdesivir and antifungal, the died, 154 days after his initial positive test.

The virus has mutated at a quick pace inside the patient's body during 5 months of infection (photo: technology networks)
The virus has mutated at a quick pace inside the patient's body during the 5 months of infection (Photo: Technology Networks)

Scientists found alarming virus evolution in his body

When the Brigham and Women's scientists sequenced the genome of the virus that infected the man, they found an alarming evolution.

Not only had it seemed to linger in his body for more than 150 days, coronavirus had mutated more quickly than scientists have observed it do in most samples.

And most of the changes were to the portion of the genome that codes for the spike protein, the protruding elements on the virus's surface that allows it to infect human cells.

The spike protein is also what vaccines and treatments - including Regeneron's antibody cocktail, and Pfizer's promising vaccine candidate - target.

'Although most immunocompromised persons effectively clear SARS-CoV-2 infection, this case highlights the potential for persistent infection and accelerated viral evolution associated with an immunocompromised state,' the study authors wrote.

It's unclear whether the mutations to the spike protein the strain of virus the researchers found in the man would make it more or less infectious, more deadly or even more treatment-resistant.

But, the case is a worrying reminder that people - especially those with weakened immune systems - can be reservoirs, where the virus can become a stronger form of itself, and from which it could jump to others and potentially evade treatments and vaccines, according to the case report published Wednesday in the New England Journal of Medicine (NEJM).

At the end of August, the world recorded the first re-infection case, who was a 33-year-old male patient. More than a week later, the US also reported a re-infection, with symptoms more serious than the first time. In October, the Netherlands had its first death after a second bouts of infection. The victim was an 89-year-old woman whose immune system was severely damaged during the treatment of bone marrow cancer.

The world sees more than 52.4 million people infected, at least 1.29 million, of deaths from Covid-19.

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