First proven case of breakthrough reinfection: Delhi woman doctor gets COVID thrice

New Delhi:  A 61-year-old Delhi doctor, infected with Covid thrice and contracting both the Alpha and Delta variants after vaccination, presents the first such documented case of two reinfections and two breakthrough infections.

Dr Veena Aggarwal, wife of late Dr K.K. Aggarwal, first tested positive on August 16, last year and was asymptomatic.

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She took her first dose of Covishield vaccine on February 1 this year, followed by the second dose on March 15.

On April 12, she tested positive for the second time and had symptoms such as acute abdominal pain, fever, myalgia, and fatigue. Within 19 days, on May 3, she tested positive for the third time. The infection resulted in hypoxia, hospitalisation, and illness lasting seven weeks. Whole genome sequencing showed the second infection was caused by Alpha variant and third by Delta variant.

"It is known that mutations always have the ability of skipping/escaping the antibodies vaccine. You don't know what you are going to be exposed to since this is a new virus," Aggarwal, who is also Trustee at the Heart Care Foundation of India, told IANS.

"Anybody can get infected anytime whether you are vaccinated or not. But yes, if you are vaccinated, the chances of severe illness and death gets reduced. Me and (husband) Dr K.K. Aggarwal were an exception to the rule. I got saved because of my vaccines, but Dr K.K. didn't because he also had other comorbidities. However, this should not be a deterrent for people to say that vaccines don't work. They do work and there is no doubt about that. My children were exposed to Covid, but got saved due to vaccination," she said.

Dr K.K. Aggarwal, a cardiologist at the HCFI, passed away at Delhi's All India Institute of Medical Sciences after a long battle with the virus in May.

Her case, published in the peer reviewed medical journal Frontiers in Medicine, showed that the doctor-patient had developed antibodies after her second infection and even had vaccine-induced antibodies.

"There is no quantitative data, so far anywhere in the world, yet on which antibodies will prevent infections and what is the cutoff level for protection from the infections. There is so far no guidelines/literature on this," Aggarwal told IANS.

The study identified a rare breakthrough infection, in 19 days and also confirmed it as a reinfection.

Breakthrough infections happen when people get infected after vaccination because the virus broke through the protective barrier the vaccine provides.

"There are certain criteria laid down by the US Centers for Disease Control and Prevention (CDC) and the Indian Council of Medical Research (ICMR) for reinfection. They indicate that there has to be an infection on two different occasions, which are 45 to 90 days apart as per the CDC and 102 days, according to the ICMR. This can be detected only if a person has access to whole-genome sequencing. A study conducted by the ICMR indicates that the possibility of reinfections currently stands at 4.5 per cent," said lead researcher Dr Jayanthi S Shastri, Head at molecular diagnostic laboratory at Kasturba Hospital, Mumbai.

Aggarwal said: "I would say this is the most horrific experience in my life. I want to tell everybody to take this seriously, wear masks, maintain hand hygiene and social distance and get vaccinated."

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