In March of 2020, Dave Smith, a British driving instructor from 72 years, he caught covid – 19.
UK was at the time going through the first wave of the pandemic and Smith had a number of pre-existing health conditions – he had been diagnosed with leukemia and successfully treated with chemotherapy in 2019 – which made it particularly vulnerable to the virus.
Most people infected with SARS-CoV-2, even those who suffer from the so-called covid – of your body on an average of 19 days.
In the case of Smith , instead, it remained in the active state inside your body for more than 290 days.
“I counted them. They were 43 times , “Smith tells the BBC, recalling the number of PCR tests that came back positive.
“I prayed all the time asking that the next one be negative, but it never was.”
The doctors confirmed that it was not a reinfection but a persistent infection after sequencing the virus in the laboratory.
Those close to 10 months that Smith spent sick —which included seven hospital admissions— were agony for him: his energy levels were minimal, and he needed help for almost everything.
“At one point I was coughing for five hours without stopping. From five in the morning until ten at night. You cannot imagine the exhaustion that this generates in your body ”, says the patient, who lost 60 kilos during his illness.
Smith’s is one of the cases of active infection by covid – 19 the longest ever recorded in the world.
Persistent infection vs. long-term covid
Smith’s case is extremely rare, mostly because of the amount of time it took to clear the virus, but it is something that can occur in immunocompromised people.
This is explained to BBC Mundo by Andrew Davidson, professor of virology at the School of Cellular and Molecular Medicine at the University of Bristol, in the United Kingdom, and part of the team that investigated Smith’s case.
“Normally your immune system gets rid of the virus by producing antibodies that bind to it, thus preventing it from infect cells, and also T lymphocytes, which destroy infected cells with the virus and other mechanisms, ”he says.
But since Smith’s immune system was weakened, he couldn’t fight it.
This can occur not only with SARS-CoV-2 but also with many other viruses that can remain inside the body permanently.
“Some viruses cause a persistent infection and once you are infected it is very unlikely that you will free of the virus “, explains Davidson, and gives as an example the HIV virus that remains inside the body, in a latent state.
” You can treat it with antivirals that suppress the virus, but do not eliminate it ”, He adds.
The virologist clarifies that the covid – 19 long lasting and persistent covid infection are two different things: while in In the first, certain symptoms such as tiredness or shortness of breath persist even though the virus has already been eliminated, in the second the virus is present and active.
A hypothesis that is being investigated in the case of the Long-term covid is the possibility that the virus continues to be inside the patient, hidden inside an organ, and that is why it is not detectable.
So far this has not been confirmed and this form disease remains an enigma for doctors.
Trump’s treatment
Smith finally managed to overcome the disease with a cocktail of antiviral drugs from the American pharmaceutical company Regeneron containing two monoclonal antibodies (casirivimab and imdevimab).
The treatment – the same that the former president of United States Donald Trump – is not approved in the United Kingdom, but it was supplied to Smith for humanitarian reasons, given the particularity of his case.
After 45 days after receiving the medication, the PCR gave a negative result for the first time.
“It was like having received a new life “, remembers Smith, who confesses that he was” ready to give up the fight “and that he had talked with his wife Lyn to” put things in order “, thinking that he would not survive.
His doctors believe that it was the drugs that made it possible to cure the disease, although they estimate that there is a minimal possibility that the patient was about to improve by s himself and what happened was a coincidence, rather than a cause-consequence relationship.
“The only way to prove it is with an adequate clinical trial,” says Davidson.
Dangers of a persistent infection
Beyond the personal implications of suffering an infection persistent, the situation creates an epidemiological risk at the community level.
First, a patient with an active infection is potentially contagious , although it is difficult to know to what degree compared to a person who has a recently acquired infection.
In Smith’s case , he could not pass the virus to other people since, due to his weakness, most of the time he did not leave home.
“But this makes us wonder if there cannot be people (with a persistent infection) within the community expelling and spreading the virus ”Davidson points out.
On the other hand, as long as the virus continues to be active within a person, it will continue to evolve and change.
“We know that in this case it changed rapidly and some of these changes were also found in the worrisome variants,” explains the virologist.
“The virus has the possibility to test all kinds of mutations and see what it can do, and it can evolve to become more transmissible, ”he adds.
Now, out of the woods, Smith lives each day gratefully, as if it were a gift.
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