If dual infections occur with two SARS-CoV-2 viruses, will recombination result in more contagious or deadly variants?

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By Daniel R. Lucey MD, MPH, FIDSA

Persistent infection with one SARS-CoV-2 virus in a person with an autoimmune disease receiving extensive immunosuppression, was documented in detail last month by more than 30 authors from Boston. This patient also had “accelerated viral evolution”, with mutations particularly in the spike (S) protein (57%), including the receptor-binding domain.

SARS-CoV-2 variants with multiple mutations in the spike protein and its receptor binding domain have been widely reportedly since last month. These include “B.1.1.7” (first linked with the UK), “B.1.351 (first linked with South Africa) and P.1. (first linked with Brazil). One hypothesis to explain development of such variants is persistent infection in immunocompromised patients, perhaps after receiving convalescent plasma with multiple antibodies to SARS-CoV-2.

In contrast to persistent infections with a single virus, it is not certain that dual infections with genetically-distinct SARS-CoV-2 viruses occur. If dual infections do occur, however, a reasonable hypothesis would be that they are most likely in immunocompromised persons.

If dual infections (overlapping in time) do occur, then would the two viruses be able to recombine and result in a third “offspring” or “progeny” virus that would be more contagious or more deadly, or both?

One of several potential ways to address this question is by focusing on immunocompromised persons while sequencing viruses looking for dual infections. A second focus would be sequencing viruses from persons with unusually rapid clinical progression to severe disease or death.

Dr. Daniel Lucey

Daniel Lucey, MD, MPH, FIDSA, FACP, is a Clinical Professor of Medicine (Teaching) at Dartmouth Geisel School of Medicine, adjunct Professor at Georgetown Medical Center, senior scholar at Georgetown Law, Anthropology Research Associate at the Smithsonian Museum of Natural History and a member of the Infectious Diseases Society of America Global Health Committee. He served as a volunteer to outbreaks overseas including patient care in Sierra Leone and Liberia (MSF) during Ebola 2014, SARS 2003, MERS 2013, Plague 2017 as well as H5N1, Zika, and Yellow Fever. Since Jan. 6 he has contributed more than 50 posts to Science Speaks on COVID-19 and traveled to China Feb. 11. With career experiences, he proposed and helped design the 2018-2022 Smithsonian Exhibition on Epidemics.

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