At least two Bahamians have been reinfected with COVID-19 since the country’s declared outbreak back in March, and individuals as young as 30 are suffering COVID-related strokes and heart attacks, according to Dr. Duane Sands and Dr. Charlyon Bonimy, in interviews with Perspective.
Sands said, “We have seen at least two patients reinfected with COVID, and we have the dates that they were tested, the dates that they came back negative, the intervening period when they were asymptomatic and then they come back with COVID.
“There is a patient who had COVID about three months ago. He also had cancer and kidney failure. He came back in the hospital with fever and chills. He was tested for COVID, and sure enough he was COVID-positive, and he died.”
Several countries have reported cases of COVID-19 reinfection, including most recently the United States, which issued its first peer-reviewed report of repeat infection last week on a 25-year-old Nevada man with no pre-existing conditions who, according to a report published in The Lancet Infectious Diseases, tested COVID-19-positive on April 18 and again on June 25, with his initial recovery documented by two negative tests.
The report indicated, “Genomic analysis of SARS-CoV-2 showed genetically significant differences between each variant associated with each instance of infection. The second infection was symptomatically more severe than the first.”
Bonimy, an infectious disease specialist and clinical director of infectious disease at Doctors Hospital who manages COVID-19 cases in both the private and public sector, advised, “I know of two re-admitted patients who were previously declared recovered in our first wave, and by that I mean they became asymptomatic and they had two negative PCR tests.
“And then about three to four months later on re-admission, their PCR tests were again positive and they had clinical features of COVID. Now to determine reinfection objectively, we would need to do genomic analysis to see if there was any difference in variance, or if it was a new strain.
“So, we have to rely on our clinical acumen, and we can only clinically say that reinfection has occurred in these cases. We do know from our antibody studies that immunity from SARS-CoV-2 wanes after about four months, so these two individuals would have fallen into that time period.”
Bonimy, who is also a consultant physician at Princess Margaret Hospital, posited that these clinical findings point to the fact that widespread community transmission of COVID-19 is continuing in the country.
Scientists are continuing to probe cases of COVID-19 reinfections and their implications for vaccination, as well as considerations on herd immunity against the disease.
Earlier this month, researchers in the Netherlands reported on what is currently believed to be the first COVID-19 reinfection fatality, which together with the Lancet’s recent report, sparked questions within the scientific community about what may account for incidences of more severe illness on second infection.
Sands disclosed his intention and that of colleague physicians to document their findings for peer review.
Serious and lasting COVID-19 complications
While there are still many unanswered questions about COVID-19, what has been documented by physicians worldwide are serious complications and lasting COVID-19-related comorbidities which extend beyond lung damage.
The United States Centers for Disease Control says it is actively working to understand COVID-19’s short and long-term effects, and it is learning that many organs besides the lungs are affected by COVID-19.
Bonimy disclosed, “I have seen young people presenting with COVID-related stroke and heart attacks. The usual age groups I am seeing are patients between the age of 30 and 60 that are coming in with these atypical presentations.
“Usually they do not have any chronic medical illness that would predispose them to heart attack or stroke, and then [for] some who were not known to have any medical illnesses, the COVID-19 unmasked diabetes or hypertension that would give rise to some of these other complications.”
A Rapid Review report published in The Lancet Neurology last month concluded that “data supporting an association between COVID-19 and stroke in young populations without typical vascular risk factors, at times with only mild respiratory symptoms, are increasing”.
The review stated, “There are many reports of early COVID-19 presenting with thrombotic events, which has led to the consensus to start anticoagulation therapy early in the COVID-19 disease course before any thrombotic event.”
COVID-19 patients in New Providence are coming in to hospital with seizures and gastro-inflammatory disorders, according to Bonimy, who highlighted other serious complications, including kidney failure requiring dialysis and neuropsychiatric manifestations such as hallucinations.
He explained, “I have seen patients who are perfectly healthy and young develop severe COVID-19 pneumonia [and] I have seen patients who are hypertensive, diabetic [and] obese have no symptoms.
“However, for the most part, the patient who has comorbidities tends to do far worse once they have developed COVID-related pneumonia.”
Bonimy further indicated that even after recovery, half of patients after a six-week period continued to exhibit symptoms including chronic fatigue and hair loss.
He said, “Some young folks are coming in with palpitations and persistent tachycardia (a heart rate that is too fast), difficulty sleeping, brain fog and forgetfulness, and half of patients after two months describe a decreased quality of life.”
Though respiratory disorders continue to make up the majority of serious complications from COVID-19, Bonimy advised that incidences of stroke or seizure are high enough that patients who come in with these conditions ought to be checked for COVID-19, as physicians now know that both clinical syndromes are associated with the disease.
Long-term effects require more attention
Long-term effects of COVID-19 must be given more attention by the medical community and the government, Bonimy maintained, else “we are going to miss the big picture”.
“Applying emphasis on these non-mortality complications is equally if not more important than dealing with the acute phase treatment of this disorder,” he asserted, “and it involves engagement from the entire medical community – multidisciplinary teams geared at managing the post-COVID cases.
“Something as simple as providing psychosocial support through a telemedicine platform could potentially go a long way. For me, I would love to see the development of long-term care health facilities or ambulatory services that would provide ongoing monitoring, pulmonary or physical rehab for the COVID patient who has not returned to baseline function, and we haven’t reached that point as yet at all.”
Insufficient focus on caring for recovered COVID-19 patients and those who are not yet recovered but past the stage of acute illness, has resulted in bottlenecks in providing beds for patients.
Bonimy outlined, “From an institutional standpoint, we’re still dealing with how do we house and treat the acute patient that comes in with COVID.
“Based on my experience, we have a subset of the patient population who have already been treated through that acute phase so for the most part, they are no longer at risk of dying, but their lungs might not have fully recovered and they may still require some level of oxygen support.
“They don’t necessarily have to be in hospital under physician management, however, family members aren’t equipped to support them at home and are fearful to bring them into the home, so what it does is create a bottleneck in the acute care environment as those bed spaces need to be taken up by patients who are actually acutely ill.”
Researchers in the UK have launched a long-term research study to recruit 10,000 patients who have been hospitalized with COVID-19, charting clinical assessments over the next year that will track patients to gain a comprehensive picture of the impact COVID-19 has had on longer term health outcomes.
A similar study in the US will follow patient outcomes over the next two years.
Bonimy insists that The Bahamas must begin to move toward a necessary focus on the multifaceted impact of COVID-19’s lasting health effects.
“I think for the most part we are still behind the eight ball,” he said in response to our question on whether the country is putting sufficient focus on post-COVID care.
“I think that we are still looking for that magic bullet or that special potion. With regards to post-COVID patients, you still have healthcare workers afraid to touch them, and family members afraid to deal with them.”
Bonimy added, “I think that’s the phase we really and truly need to start focusing on. I have kept my clinic open for those same reasons, and the amount of patients still coming in with vague, constitutional symptoms is still pretty high, and that affects many things including them going back to work, where they work [and] how they work.”
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source https://thenassauguardian.com/at-least-two-bahamians-reinfected-with-covid-19/
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