
Surviving the coronavirus, then testing positive again - mudil
https://www.latimes.com/world-nation/story/2020-03-13/china-japan-korea-coronavirus-reinfection-test-positive
======
newfeatureok
There are some questions I haven't been able to find good answers to in
addition to the one posed in the article:

1\. Is it possible to get COVID-19 twice?

2\. If (1) is true, are the symptoms the same (if applicable)?

3\. If (1) is true are you still contagious?

4\. There's evidence that there are multiple strains, can you get both
strains?

5\. What's the likelihood that a mutation will occur once treatment is more
widespread?

6\. Does the heat make it significantly less likely for you to get COVID-19?

My impression so far is that we'll never get rid of this thing, and at _best_
this will be something like the seasonal flu, where we'll just have to live
with it and great shots yearly.

~~~
leesec
1\. Is it possible to get COVID-19 twice?

No, doesn't seem to be, but you might still have "viral shedding" for a bit
even after you are "recovered". meaning you could still be contagious.

4\. There's evidence that there are multiple strains, can you get both
strains?

You shouldn't think about them as multiple strains, as of now it is 1 disease.

5\. What's the likelihood that a mutation will occur once treatment is more
widespread?

Mutations occur all the time, there are already 10's of known mutations of
virus, it doesn't mean there are 10 separate diseases.

6\. Does the heat make it significantly less likely for you to get COVID-19?

There's some evidence warm weather slows spread for viruses like this, but we
can't assume that about this virus yet. A good counterpoint is Qatar adding
258 cases in one day, it's hot there.

~~~
nostromo
Flu viruses don’t spread less when it’s warm. They spread less when it’s more
humid.

For the northern hemisphere it’s much less humid in winter, but that’s not
true everywhere.

[https://www.livescience.com/27533-flu-transmission-
humidity....](https://www.livescience.com/27533-flu-transmission-
humidity.html)

We really should be increasing humidity in hospitals and offices in the
winter. Newer planes have already been moving in that direction (to increase
comfort).

~~~
nedwards72756
Also, spreading of flu during "flu season" is marked by holidays when long
distance travel happens. This causes slightly different strains of the flu to
be brought into regions where people do not have a natural defense to that
strain.

~~~
slowmovintarget
Interesting tidbit I learned at a Town Meeting (streamed) yesterday. Winter
Break in Massachusetts was instituted to halt the rapid spread of flu during
the winter months. Kids would take it into school, spread it among themselves
and bring it home to adults, who would get hit harder by it.

The winter break put an an incidental isolation in place that slowed the
person-to-person spread down.

This is why schools have to close now to control the spread of COVID-19.

~~~
cvwright
I think you mean February break.

Winter break usually refers to the break that includes Christmas and New Years
Day.

In Massachusetts they instituted a second break in February, in addition to
spring break in April, in order to cut the flu season.

------
Ahmed90
Dr. Vincent Racaniello was a guest on a Twitch.tv podcast hosted by Ethan
Evans (Amazon VP) and Devin Nash (CMO @N3RDFUSION)

They talked for 2 hours and pretty much covered a bunch of questions about
this subject, there is so much misinformation and panic going around

Here is a youtube link if anyone is interested @
[https://www.youtube.com/watch?v=WWNuDT4t-TM](https://www.youtube.com/watch?v=WWNuDT4t-TM)

Also a Pastebin with the highlights
[https://pastebin.com/8juyjNFq](https://pastebin.com/8juyjNFq)

\---

Dr. Vincent Racaniello, Ph.D. (@profvrr on twitter) is Higgins Professor of
Microbiology & Immunology at Columbia University Medical Center. He has been
studying viruses for over 40 years.

~~~
pmoriarty
Dr Racaniello is also the host of the _This Week in Virology_ podcast, which I
highly recommend.

They've had a series of episodes on COVID-19 recently, all highly informative.
Episode 590, the most recent one, debunked the "two strains" rumor that's been
going around.

You can hear the episode here: [1] and read a transcript of the portion of the
episode where the rumor was debunked here: [2]

[1] -
[http://www.microbe.tv/twiv/twiv-590/](http://www.microbe.tv/twiv/twiv-590/)

[2] -
[https://news.ycombinator.com/item?id=22564199](https://news.ycombinator.com/item?id=22564199)

~~~
Ahmed90
Yep

------
jostmey
I did some reading on coronaviruses and learned these viruses do not have
reverse transcriptase, which would allow an RNA virus, like a coronavirus, to
incorporate into the host genome, becoming a permanent resident. In other
words, the viruses lack the machinery necessary to convert themselves into DNA
and cannot cause a chronic infection.

That said, it is possible that people co-infected with another RNA virus
expressing reverse transcriptase would allow the coronavirus to incorporate
into the host genome

~~~
echelon
Some DNA viruses, such as the Herpesviridae, integrate into the host genome by
injecting a circular plasmid into the nuclear membrane.

This is why you can always have HSV, chicken pox (singles), Epstein-Bar...

Granted, Coronavirus is an RNA virus, and RNA is much shorter lived and more
susceptible to mutation than DNA.

~~~
ksk
A plasmid does not 'integrate into the host genome'. The entire genome for
human cells is stored inside the nucleus packaged as chromosomes. The plasmid
exists outside of this, and just hijacks our replication machinery.

------
DiogenesKynikos
These tests test for the presence of viral nucleic acid. You can still have
detectable levels of viral nucleic acid in you after the infection has ended.

What actually matters is whether or not you have virus replicating in you. The
presence of viral nucleic acid is an imperfect proxy for that.

------
tannerbrockwell
I warned you a week ago we would "waste of resources" and here we are:

"Health officials are struggling with a complicated message — more people can
get tested, but those with mild symptoms should stay home and practice social
distancing. Some go so far as to warn that widespread testing at this point
could threaten the U.S. response by burning through precious supplies just as
a tidal wave of sick people descend on the system — a message at odds with
administration announcements that millions of test kits are finally becoming
available."

[1]:
[https://www.washingtonpost.com/health/2020/03/21/coronavirus...](https://www.washingtonpost.com/health/2020/03/21/coronavirus-
testing-strategyshift/)

------
strategarius
There are many cases of "false negative" with current testing kit. Most
probably, patient who almost recovered, received false negative result and has
been released from quarantine still being contagious. Partying with neighbors
definitely was a bad idea.

~~~
sbmthakur
There are case(s) in India where potential patient(s) got around thermal scans
by consuming paracetamol that suppressed their fevers.

------
irjustin
I really hope it's simply poor diagnosis. It appears to be, so it's not yet
time to be scared.

But, if the virus is capable of mutating at the rate of the common cold and
reinfect - I see no way out from under this other than a new way of life.

~~~
_bxg1
Seeing as China's condition seems to be improving, instead of having cases
just keep burning indefinitely, I doubt that's the case.

~~~
ceejayoz
China's still in lockdown, though, which would be that "new way of life"
(until a vaccine) if re-infection is common.

~~~
malandrew
I'm wondering if China is shooting itself in the foot by being on lockdown
because they may just be delaying the inevitable now that it's pandemic and at
risk of becoming endemic.

If we assume this will become endemic and a vaccine is a ways off, it would
seem like the best approach is to flatten the curve just under the healthcare
system capacity and get it to "pass through" most of society quickly (i.e.
everyone who is at lower risk gets infected and quarantines until viral
shedding stops).

Doing this would allow us to return the economy back to normal as quickly as
possible and prevent all the fallout from an indefinitely stopped economy.
Once most people have had it, we'll essentially end up in a state of herd
immunity and it becomes statistically less likely than other health concerns
at-risk populations had before COVID-19 was even a thing.

Meanwhile China, being on lockdown the entire time is still susceptible to
having it become a pandemic within their own population as soon as they lift
the lockdown and try to return to normal because they citizens haven't had the
opportunity to develop antibodies as broadly.

~~~
peterwoerner
That seems to be what England is planning on doing.

[https://twitter.com/wtgowers/status/1238395750360461312](https://twitter.com/wtgowers/status/1238395750360461312)

~~~
DanBC
But see this thread for some discussion of the risks of the strategy:
[https://twitter.com/iandonald_psych/status/12385183716516495...](https://twitter.com/iandonald_psych/status/1238518371651649538?s=20)

~~~
christoph
Thanks for posting this. I was initially very negative about the UK strategy
yesterday, but on reflection today I think they may have a very sensible long
term approach to the situation, although highly risky to balance correctly.

------
KCUOJJQJ
Can someone tell me if the virus could be persistent? The virus is related to
chickenpox according to [0]. And according to [1] "Once _chickenpox_ has
resolved, the virus may remain inactive in nerve cells." Risk factors for
_shingles_ are: "Old age, poor immune function, having had chickenpox before
18 months of age".

[0]
[https://www.osha.gov/SLTC/covid-19/medicalinformation.html](https://www.osha.gov/SLTC/covid-19/medicalinformation.html)
[1]
[https://en.wikipedia.org/wiki/Shingles](https://en.wikipedia.org/wiki/Shingles)

------
codeulike
A slightly more informed article on huffpost:

"Can You Get Coronavirus Again After You've Already Had It?"

[https://www.huffingtonpost.co.uk/entry/can-you-get-
coronavir...](https://www.huffingtonpost.co.uk/entry/can-you-get-coronavirus-
again-after_l_5e6a8e2fc5b6dda30fc57d7d)

Edit: Also, Fortune:

"Why are patients who recover from coronavirus testing positive again?"

[https://fortune.com/2020/03/06/coronavirus-recover-test-
posi...](https://fortune.com/2020/03/06/coronavirus-recover-test-positive-
twice/)

------
numpad0
The article doesn’t say whether the status of survivors are declining or not,
only that they remain positive.

~~~
koheripbal
_some_ , not all.

------
djaychela
Heard something about this on one of Sam Harris' two podcasts on the subject
this week - that this is typically because of a false negative test
(indicating recovery from the virus) during what in reality is a longer,
uninterrupted period of infection.

~~~
taeric
Please be crisp on this. That is one hypothesis, but do we have the data yet
to make sure it is the answer? I'm doubtful. Could also be unknown recall
rates on the test. Could be plenty of things.

~~~
xeromal
What does crisp mean in this context.

~~~
taeric
I am just meaning to be clear and not to stretch claims beyond what we know.

So, for example, I have a hypothesis that this is mainly baseline lung damage
causing severe cases. That said, I cannot claim that is what it is.

I'm sure I have been sloppy and pushed this idea some without being clear it
is just a hypothesis of mine. That said, I try and be clear with that message.

~~~
cblades
"mainly baseline lung damage" could you expand on what you mean there?

~~~
taeric
Copying from
[https://news.ycombinator.com/item?id=22562362](https://news.ycombinator.com/item?id=22562362)

The part of Italy hit also has air quality, per aqi searches, that is
comparable to the region in China that was hit hard.

Have people looked that it is not age, but baseline damage to your lungs that
is the main factor in serious cases? Older people will have more exposure to
local air pollution, just from having lived longer. That existing damage can
be what contributes to complications, right?

------
mensetmanusman
If there is a 20+% false positive/negative rate, then there are many people
this will happen to.

------
chiefalchemist
My understanding is PCR doesn't actually test for the virus itself. It tests
for antibodies. Such that, once you get a virus and have antibodies, you have
them for life. The idea of getting it twice seems odd.

~~~
jhayward
No, PCR is not an antibody test. It amplifies DNA or RNA sequences which are
known to exist in the virus. If enough unique sequences are found the test is
positive.

~~~
chiefalchemist
Right. Thanks for clarifying.

To clarify further, it doesn't actually test for the virus. It tests for DNA /
RNA presence. It's a proxy.

Not being critical, etc. Simply nailing down loose ends.

~~~
jhayward
> it doesn't actually test for the virus. It tests for DNA / RNA presence

The virus is nothing but DNA or RNA.

The snippet testing establishes a statistical baseline that rules in the
presence of the specific dna/rna of the virus to within the required
certainty.

In other words, you don't have to feel every inch of an elephant to know for
sure you've got a hold of one. Just enough features to make it unique to just
elephants.

------
allovernow
If you can get reinfected, there's a good chance that the second infection
will have a particularly high mortality rate, because this virus likely has a
property known as antibody dependent enhancement[1]. Long story short, your
normally protective antibodies actually work for the infection. This was a
property of past coronaviruses like SARS and is likely why no vaccine was
successfully developed.

1.[https://www.sciencedirect.com/science/article/pii/S128645792...](https://www.sciencedirect.com/science/article/pii/S1286457920300344)

~~~
sashaafm
That means the population overall may build immunity to it?

~~~
allovernow
Well, not exactly, it means that "immunity" may actually be dangerous or
fatal. Because immunity implies release of antibodies on re-exposure, except
in this case the antibodies bind to the virus, as normal, but then the virus
infects much more readily, prompting the body to produce more antibodies and
mount an ever greater immune response in a dangerous cycle.

------
rossdavidh
Maybe because the false-positive rate for asymptomatic patients is estimated
at 80%?

~~~
numpad0
False _positive_? I’ve heard although false _negatives_ (contracted but
asymptomatic) can be up to 40-60%, but RT-PCR is reliable at declaring
positives.

~~~
whoisjuan
There's a possibility for false-positives. I think there's a type of test that
looks for an enzyme that you could have without contracting the virus. I saw
an article in HN this morning, but I can't find it anymore.

Also, false positives could happen as a result of bad logistics and management
of the specimens.

Some useful sources that seem to validate the occurrence of false positives:

\- This research on testing specifically calls out the fact that their method
didn't yield false positives in trials:
[https://www.eurosurveillance.org/content/10.2807/1560-7917.E...](https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.3.2000045),
which seems to indicate that it's common for false positives to occur when
developing testing methods for new viruses.

\- This research talks about false positives in asymptomatic patients:
[https://www.ncbi.nlm.nih.gov/pubmed/32133832](https://www.ncbi.nlm.nih.gov/pubmed/32133832).
"In the close contacts of COVID-19 patients, nearly half or even more of the
'asymptomatic infected individuals' reported in the active nucleic acid test
screening might be false positives."

\- This guy in Egypt is apparently a false-positive, likely due to a
mismanaged testing protocol: [https://www.livescience.com/matt-swider-stuck-
in-egypt-coron...](https://www.livescience.com/matt-swider-stuck-in-egypt-
coronavirus-quarantine.html)

------
sandGorgon
This is a very weird article. I'm not sure if its just an old article that got
recently republished.

Because the latest research shows that there are two strains of COVID and
reinfections are happening because of the other strain infecting you.

[https://academic.oup.com/nsr/advance-
article/doi/10.1093/nsr...](https://academic.oup.com/nsr/advance-
article/doi/10.1093/nsr/nwaa036/5775463)

[https://www.cnbc.com/2020/03/04/coronavirus-chinese-
scientis...](https://www.cnbc.com/2020/03/04/coronavirus-chinese-scientists-
identify-two-types-covid-19.html)

~~~
allemagne
I can't find where in those links it supports the claim that "reinfections are
happening because of the other strain infecting you"

------
tannerbrockwell
The tests are not accurate. [1] We are running around like chickens freaking
out about tests. The only thing to do at this point is Social Distancing so
the growth curve flattens out. Testing is NOT a solution. Testing will not
make a sick person better. We have limited resources. Testing is being
advocated by those trying to trace the community spread. I have news for you,
if you think you have it you got it! Everyone will get it. Tracking this is a
waste of resources at this point as the false positives mean additional
limited Frontline Health Care workers treating actually sick individuals. We
need to minimize the community spread, that means stay away from events. Work
from home.

Individuals should self quarantine at any sign of illness. Critical patients
should be admitted to hospitals. Everyone else should do everything in their
power to slow the spread. You got a cough? Stay home. You feel tired or run
down? Stay home. You have a fever and it went away? Stay home for the next 14
days. If your employer will not let you work from home, email them that you
believe you are an asymptotic carrier of the COVID-19 virus and if they will
not let you take paid sick leave or work from home you will be in the office
immediately. Tell all your coworkers you requested to stay home and management
wouldn't let you... Let the lawyers sort it out with HR.

[1]:
[https://www.ncbi.nlm.nih.gov/pubmed/32133832](https://www.ncbi.nlm.nih.gov/pubmed/32133832)

~~~
grawprog
>I have news for you, if you think you have it you got it! Everyone will get
it. Tracking this is a waste of resources at this point as the false positives
mean additional limited Frontline Health Care workers treating actually sick
individuals.

I'm glad to see someone say this. The over reaction is causing more problems
than the actual virus. With every other recent potential pandemic, there was a
reasonable response, the severity of the diseases were responded to
accordingly, panic was at a minimum, especially considering more recent scares
have been with viruses that cause far more serious diseases than this latest
one.

This time, there's been an extreme focus on infection rates and zero focus on
actual symptoms, which from every account i've seen so far, do not seem to be
very terrifying for 99% of the population, yet the reaction has been just over
the top everywhere.

This is going to spread around the world, we'll either get it or we won't,
it's not going anywhere, it's out in the world, as soon as the first person
got sick and spread it, it was inevitable. There's so much effort globally
going into trying to stop or hide from this and I still don't really
understand why.

When I was a kid, it was a regular thing to expose kids to chickenpox because
it was just better to get it and get it over with, chickenpox sucked a whole
lot. A whole lot more than having covid-19 would be from what I can tell.

It's the symptoms of a disease that scare me, not whether i'll get it.
Personally, I was a lot more worried about the recent flu virus from a few
years back that was killing young healthy people, than this disease that's not
much more than a bad cold unless you're knocking on death's door already or in
your 80's.

If people that get it, don't even realize they have it and nothing bad is
really happening to them, then why should I be losing my shit and freaking
out? Why should I be scared of getting a disease that's about the same as
something I get nearly every year anyway?

~~~
wpietri
> do not seem to be very terrifying for 99% of the population

This is a dangerously bad take. The death rate is in the 2-3% range.
Hospitalization in China was 15%, with 5% in critical care.

Even if you are not personally vulnerable, please understand that those who
are also actual humans, and have actual humans as family members. And if you
can't manage to care about that, recognize that a pandemic of this magnitude
could easily overwhelm the US hospital system:
[https://www.statnews.com/2020/03/10/simple-math-alarming-
ans...](https://www.statnews.com/2020/03/10/simple-math-alarming-answers-
covid-19/)

As we're seeing in Italy, an overwhelmed hospital system leads to increase
death rates from many other causes, because suddenly the level of care goes
down. If all the ICU beds are full and you, say, get hit by a truck, you'll be
triaged along with all the other people needing ICU. If a COVID-19 patient
looks more likely to recover than you, well, you'll be left out in the
hallway.

