From the Wall Street Journal:
“By Joshua Robinson
Dec. 2, 2020
Back in February, when the sports world was still wondering how severe an outbreak of something called Covid-19 might be, a Colombian cyclist named Fernando Gaviria was finding out for himself.
Gaviria was doing his job, racing bikes in the United Arab Emirates, when he became one of the first international athletes to contract the coronavirus. The symptoms were harsh enough to land him in hospital for two weeks. “Back then we knew very little about the virus,” he wrote in an email.
By the time Gaviria was healthy enough to leave Abu Dhabi, his world was a more uncertain place. The sports calendar had been scrubbed. Entire countries were shutting down. But Gaviria’s virus ordeal seemed to come with a personal silver lining. Prevailing wisdom suggested he’d at least be immune for the foreseeable future.
That future lasted barely seven months. In October, Gaviria tested positive a second time. His reaction was sheer disbelief.
“I was completely asymptomatic and felt OK,” he wrote.
His team ran a slew of backup tests to be certain—the implications of his apparent reinfection were immense. A second case of Covid-19 wouldn’t just make Gaviria a rarity in sports. It would make him one of the most curious cases in the world.
That’s because the possibility of contracting Covid-19 twice remains one of the pandemic’s great mysteries, even after a year and with a vaccine on the horizon. Researchers have confirmed only around 25 cases of reinfection world-wide with perhaps 500 more suspected, according to Richard Tillett, the University of Nevada biostatistician who described the first U.S. reinfection this summer.
What makes Gaviria’s case more compelling is that he belongs to a small population with generally excellent health—and access to frequent testing: They’re known as professional athletes. From the time he resumed competition in late July until his second positive test on Oct. 19, the 26-year-old Gaviria underwent more than a dozen PCR tests, according to his team. All of them came back negative.
Those results further point to reinfection rather than a long-haul case that has dragged on from February, according to Tillett. “With eight months in between and so many negative tests, it’s plausible.”
That frequency of testing is also what detected Gaviria’s apparent second infection. Were he not an elite athlete, he probably wouldn’t have sought out a test on his own, considering he was asymptomatic and had been previously infected. But because he was on the pro cycling circuit, the test came to him.
Under the standards laid out by the Centers for Disease Control and Prevention, Gaviria is considered merely a “suspected” case of reinfection, not “confirmed.” The CDC requires a process known as genomic sequencing for both samples to prove that they contain different strains of Covid-19. The problem is that tracking down Gaviria’s first positive sample, now eight months old and taken in the United Arab Emirates, is no longer possible.
A growing body of evidence, however, suggests that reinfections could become more widespread in the near future. Recent studies have shown that the body’s immune response to the virus—measured in levels of antibodies and T-cells—tends to wane over time.
“We don’t know how long it lasts,” said Akiko Iwasaki, Professor of Immunobiology at Yale University. “For seasonal coronaviruses, reinfections do occur within a year. So I wouldn’t be surprised that the Covid immunity also doesn’t last very long when acquired from natural infections.”
Nonseasonal flavors of coronavirus are much less understood. Researchers have only had fleeting chances in the past to examine the large-scale behavior of those similar to Covid-19, such as Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome.
“They tended to burn themselves out fast even though we were totally unprepared for them,” Tillett said. “It was a very short time frame that we had to study them in the wild.”
But professional sports this year turned into pop-up Covid laboratories. Their intense testing regimes and controlled environments created easy-to-monitor populations with lessons to offer on transmission, isolation, and sanitary protocols. Those conditions also made cycling into one of 2020s unlikely success stories.
Organizers managed to pull off the Tour de France, the Giro d’Italia, and the Vuelta a Espana—three-week stage races around countries with rising case numbers—by holding them in roving bubbles after the season resumed this summer.
Over the nine weeks of competition, 4,568 tests were carried out, returning just 14 positives, according to cycling’s world governing body. And whenever a case cropped up, organizers didn’t panic. They simply sent the infected individuals home and retested those who had been in contact with them without aborting the race.
“We had a very strict protocol and for the most part it was very successful,” said Jeroen Swart, the head of medicine at Gaviria’s UAE Team Emirates. “We managed to navigate the entire [post-hiatus] season with only one case in a race scenario.”
The problem for Gaviria was that the one case was him. Again.
His spectacular bad luck came on the second rest day of the Giro d’Italia, after 16 stages from Sicily to the Alps. Gaviria had raced on 40 different days since the season resumed in July without issue. He had been cleared repeatedly by negative tests. But Gaviria, one of the first pro cyclists in the world to contract Covid, now seemed to be the first to do it twice.
“That was a little bit more surprising than if somebody else had it,” Swart said.
Gaviria was immediately sent into isolation, where he displayed no symptoms. Whether or not that’s typical for reinfection is hard to say, since experts have yet to find a common thread in the handful of confirmed reinfections they’ve been able to examine.
“I cannot see a pattern between confirmed cases of reinfection and what kind of immune response they had prior to the second exposure, Iwasaki said. “It’s possible that people who had reinfections had low levels of antibodies or T-cells. We just don’t have enough data.”
The two data points supplied by Gaviria merely suggest reinfections could become more widespread, experts said. But for him, they also underscore what he had already realized back when he made his way out of an Abu Dhabi hospital eight months ago.
“The virus,” he said at the time, “is turning out to be more serious than we imagined.”’
