Kaitlyn Romoser first caught Covid-19 in March, likely on a trip to Denmark and Sweden, just as the scope of the pandemic was becoming clear. Romoser, who is 23 and a laboratory researcher in College Station, Texas, tested positive and had a few days of mild, coldlike symptoms.
In the weeks that followed, she bounced back to what felt like a full recovery. She even got another test, which was negative, in order to join a study as one of the earliest donors of convalescent blood plasma in a bid to help others.
Six months later, in September, Romoser got sick again, after a trip to Florida with her dad. This second bout was much worse. She lost her sense of taste and smell and suffered lingering headaches and fatigue. She tested positive for Covid-19 once more — along with her cat.
Romoser believes it was a clear case of reinfection, rather than some mysterious reemergence of the original infection gone dormant. Because the coronavirus, like other viruses, regularly mutates as it multiplies and spreads through a community, a new infection would bear a different genetic fingerprint. But because neither lab had saved her testing samples for genetic sequencing, there was no way to confirm her suspicion.
“It would be nice to have proof,” said Romoser. “I’ve literally been straight up called a liar, because people don’t want to believe that it’s possible to be reinfected. Why would I lie about being sick?”
As millions of Americans struggle to recover from Covid-19 and millions more scramble for the protection offered by vaccines, U.S. health officials may be overlooking an unsettling subgroup of survivors: those who get infected more than once. Identifying how common reinfection is among people who contracted Covid-19 — as well as how quickly they become vulnerable and why — carries important implications for our understanding of immunity and the nation’s efforts to devise an effective vaccination program.
Scientists have confirmed that reinfections after initial illness caused by the SARS-CoV-2 virus are possible, but so far have characterized them as rare. Fewer than 50 cases have been substantiated worldwide, according to a global reinfection tracker. Just five have been substantiated in the U.S., including two detected in California in late January.
That sounds like a rather insignificant number. But scientists’ understanding of reinfection has been constrained by the limited number of U.S. labs that retain Covid-19 testing samples or perform genetic sequencing. A KHN review of surveillance efforts finds that many U.S. states aren’t rigorously tracking or investigating suspected cases of reinfection.
KHN sent queries about reinfection surveillance to all 50 states and the District of Columbia. Of 24 responses, fewer than half provided details about suspected or confirmed reinfection cases. Where officials said they’re actively monitoring for reinfection, they have found far more potential cases than previously anticipated.
In Washington state, for instance, health officials are investigating nearly 700 cases that meet the criteria for possible reinfection, with three dozen awaiting genetic sequencing and just one case confirmed.
In Colorado, officials estimate that possible reinfections make up just 0.1 percent of positive coronavirus cases. But with more than 396,000 cases reported, that means nearly 400 people may have been infected more than once.
In Minnesota, officials have investigated more than 150 cases of suspected reinfection, but they lack the genetic material to confirm a diagnosis, a spokesperson said.
In Nevada, where the first U.S. case of Covid-19 reinfection was identified last summer, Mark Pandori, director of the state public health lab, said there’s no doubt cases are going undetected.
“I predict that we are missing cases of reinfection,” he said. “They are very difficult to ascertain, so you need specialized teams to do that work, or a core lab.”
Such cases are different from instances of so-called long-haul Covid-19, in which the original infection triggers debilitating symptoms that linger for months and viral particles can continue to be detected. Reinfection occurs when a person is infected with Covid-19, clears that strain and is infected again with a different strain, raising concerns about sustained immunity from the disease. Such reinfections occur regularly with four other coronaviruses that circulate among humans, causing common colds.