Man With Longest Recorded COVID-19 Infection Gives Rise to New Viral Variant: An Unprecedented Evolution

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Scientists have recently disclosed the longest-known COVID-19 infection, cautioning that it could hold serious implications for public health.

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Infectious disease specialists at Amsterdam University Medical Center in The Netherlands reported on a 72-year-old immunocompromised man who battled COVID-19 for 613 days. During this lengthy struggle, the virus mutated, evolving into a new immune-evasive variant within his body.

The patient, who had received multiple COVID-19 vaccinations, was unable to mount a sufficient immune response, a common problem among older and immunocompromised individuals. This failure to respond effectively allowed the virus to linger and mutate, posing a risk to public health.

Experts stress the importance of community protection, especially for those with weakened immune systems, who are at a significantly higher risk of severe illness from COVID-19. These individuals are also up to 13 times more likely to require hospitalization, even when fully vaccinated.

In this particular case, the man’s immune system was compromised by previous health issues and treatments. He had undergone a stem cell transplant and later developed lymphoma, which required aggressive therapy that weakened his immune response.

“The duration of SARS-CoV-2 infection in this case is extreme, but prolonged infections in immunocompromised patients are much more common compared to the general community,” said Magda Vergouwe, a medical student at Amsterdam University Medical Center, in a statement. Vergouwe and her team plan to present the case at the 2024 European Society of Clinical Microbiology and Infectious Diseases Global Congress.

Although the study has yet to be peer-reviewed, the case brings attention to the challenges of treating long-term COVID-19 infections. In some instances, doctors have successfully selected treatments based on repeated genetic sequencing of the virus, allowing them to adapt therapies to evolving strains.

The patient in this report, however, died in October 2023, nearly 20 months after contracting COVID-19, not from the virus but due to his lymphoma’s return.

Genomic sequencing revealed that he was initially infected with the Omicron BA.1.17 variant in February 2022, which soon developed resistance to sotrovimab, a neutralizing antibody therapy. Genetic mapping of the virus showed it had accumulated an extra 50 mutations compared to other Omicron BA.1 strains. The mutations included deletions in the SARS-CoV-2 spike protein, allowing the virus to evade immune detection.

“This case underscores the risk of persistent SARS-CoV-2 infections in immunocompromised individuals,” Vergouwe and colleagues wrote in their case summary, emphasizing the importance of ongoing genomic surveillance to prevent the potential public health threat posed by new viral variants.

Though no transmission of the mutated variant was observed in this case, similar occurrences have been documented in other reports, indicating the importance of continued vigilance.

Massachusetts General Hospital infectious disease physician Jacob Lemieux, who studied persistent COVID-19 infections in more than 50 immunocompromised people, highlighted the variability of risk among this group. Those undergoing immunosuppressant treatments for blood cancers or organ transplants often experience prolonged infections.

“It’s really important to identify the best ways to eradicate infection from persistently infected patients,” Lemieux told STAT News’ Elizabeth Cooney. This step not only helps the patients but also minimizes the risk of transmitting the virus to others.

While researchers continue to investigate effective treatments for immunocompromised individuals with COVID-19, many questions remain about the best approaches to manage chronic infections.

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