Patient with weak immunity had Covid for record 613 days

New variant of coronavirus also developed inside the man (72)

A patient had Covid-19 for a record 613 days – and it led to a new variant of the illness, according to a study.

Research to be presented at next week’s Escmid Global Congress in Barcelona also highlights the risk of new immune-evasive variants emerging in patients, who have an compromised immune system.

The patient’s illness is the longest anyone has been infected with Covid-19, also called SARS-CoV-2, it is understood. The research report is by Magda Vergouwe, of the Centre for Experimental and Molecular Medicine at the University of Amsterdam, and her colleagues.

While healthy Covid-19 infected patients can clear the virus within a period of days to weeks, an immuno-compromised individual can develop a persistent infection with prolonged viral replication and evolution – leading to the creation of a new variant.

For instance, it is thought that the initial emergence of the Omicron variant originated in an immuno-compromised individual, highlighting the importance of close genomic, or genetic, surveillance in this patient population.

In their study, Ms Vergouwe and her colleagues report on a 72-year-old immuno-compromised man who was admitted to Amsterdam University Medical Centre in February 2022 with Covid.

Previously, he had already received multiple Covid-19 jabs without any measurable increase in antibodies.

Routine genomic surveillance showed infection with the Covid-19 Omicron variant BA.1.17.

He received treatment with the Covid19 medicine Sotrovimab and other drugs without clinical response.

Follow-up laboratory work showed a “Sotrovimab-resistant mutation”. The prolonged infection led to the emergence of a “novel immune-evasive variant”.

The authors said the research underscored the risk of persistent Covid-19 infections in immuno-compromised individuals as unique Covid viral variants may emerge as the virus evolves in a patient’s body.

“We emphasise the importance of continuing genomic surveillance of SARS-CoV-2 evolution in immuno-compromised individuals with persistent infections given the potential public health threat of possibly introducing viral escape variants into the community,” they said.

But the authors said there had to be a balance between protecting the public from potential new variants and humane supportive care at home of severely ill patients near the end of life.

Possible solutions can include an increased awareness of potential risks combined with providing early accessible diagnostic testing of known family contacts as soon as they develop relevant symptoms.

“The duration of SARS-CoV-2 infection in this described case is extreme, but prolonged infections in immunocompromised patients are much more common compared to the general community,” they said.

“Further work by our team includes describing a cohort of prolonged infections in immuno-compromised patients... with infection durations varying between one month and two years.

“However, from the viewpoint of the general public, prolonged infections remain rare as the immuno-compromised population is only a very small percentage of the total population.”