She thought she had defeated the coronavirus; then it hit her again

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It had been over a month since Mirabai Nicholson-McKellar had been infected with the coronavirus, and the 35-year-old filmmaker thought she was on the mend. Then shortness of breath returned, followed by chest pain.

Another positive result was an emergency room visit and a second test for COVID-19. Just three days earlier, she had been authorized by the health authorities of the Australian state of New South Wales and had been authorized to end her home quarantine after 72 hours without symptoms.

“When is it going to end?” I think about it constantly, “she said of the twists in her health. “Am I still contagious? How do I know if I am not contagious? ”

His experience is added to an increasing number of reports of patients appearing to have reactivation of symptoms, positive tests again, or even potentially re-infected. Such incidents do not correspond to the generally accepted understanding of the functioning and spread of viral infections.

Phenomenon of the “false dawn”

This so-called dawn phenomenon deceives health experts as they try to attack the mysterious pathogen that emerged only five months ago. Solving the puzzle will shed light on a wide range of challenges, from the development of an effective vaccine to the speed with which governments can safely end blockages and allow normal lives to resume.

More immediately, the situation is wreaking personal havoc, making the journey to recovery a complex and frustrating ordeal for some of the more than one million survivors of the pandemic.

So far, there has not been enough research to conclude why symptoms appear to return in some people, and if they experience re-infection or if the virus persists for weeks. One possibility is that COVID-19 causes blood clots that can cause potentially dangerous complications unless treated with blood thinners, said Edwin JRvan Beek, president of clinical radiology at the Queens Medical Research Institute of University of Edinburgh.

South Korean researchers also provided clues this week when they reported that so-called nucleic acid tests could be positive based on the detection of dead viral particles that could give the false impression that a patient is still infectious when it is not.

“Try to understand this”

“Everyone is trying to understand this,” said Yvonne Maldonado, professor of infectious diseases at Stanford Medical School. “What happens when people are sick and infected – will we consider them immune and therefore not at all sensitive?” Or are they immune and serve as potential infection points for other people? “

Officials in countries that have successfully suppressed the first wave of the pandemic are concerned that the virus may have a seasonal pattern and may return in the fall to repeat the nightmare scenario.

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Hospitals already under severe strain may see new demand if patients return. It also has long-term implications for social safety nets and insurers, as some struggle with the lingering effects of coronavirus on their daily lives and health. Severe cases that require ventilators and ICU stays would require ongoing follow-up care as they recover from the ordeal, which puts additional pressure on health systems.

There may also be an increasing psychological cost. Governments can try to isolate survivors longer for fear that they will still be infectious, adding more anxiety to patients who already suffer from uncertainty about when they will be healthy again.

“Many patients will suffer from mental health issues,” said Michelle Biehl, an intensive care pulmonary physician at the Cleveland Clinic in Ohio. “They will suffer from anxiety, depression, PTSD. “

As the number of patients recovered increases, the burden will begin to move down the chain of medical practice, said Biehl. More primary care physicians, mental health specialists and physiotherapists will see survivors.

“What’s going on then? “

“You send them home and what happens then?” Asked Maldonado. “On the outpatient side, we are just starting to get to the point where we see people in the longer term.”

There is a consensus that so-called collective immunity is essential to end the pandemic, but with a vaccine that is unlikely to be widely available this year, it will depend on factors such as the duration of immunity. people who have recovered and the percentage of people who need to recover. immune to protect the “flock”.

There are “many unknowns and uncertainties in the development of individual immunity,” said Kentaro Iwata, professor of infectious diseases at the Japanese University of Kobe. “The development of antibodies inside the body is not necessarily the development of immunity against this disease. “

Unknowns about infectivity, immunity and persistent symptoms create frustrating dilemmas for patients like Daniela Alves. The London resident paid 200 pounds ($ 251) for a private test which told her that she was positive. Like Nicholson-McKellar, she was never hospitalized but had coughs, shortness of breath and body aches that came and went for weeks, never in a straight path to recovery, leaving her uncertain of her health.

“I don’t know when I’m going to be negative so I can go out,” she said. “Do I have to pay another 200 pounds so that I know I’m safe for others?” “

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© 2020 Bloomberg News

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