Longest Known COVID-19 Infection Leads to Over 50 Mutations in Immunocompromised Patient

Researchers in the Netherlands have reported the longest known case of continuous COVID-19 infection, lasting an astonishing 613 days in a 72-year-old immunocompromised patient. The prolonged infection led to the emergence of a highly mutated novel coronavirus variant with over 50 mutations, raising concerns about the potential for new strains to develop in vulnerable individuals.

The patient, who had a history of stem cell transplantation and post-transplant lymphoma, received multiple COVID-19 vaccinations but failed to mount a measurable antibody response. Despite treatment with the monoclonal antibody Sotrovimab, the virus continued to replicate and evolve within the patient's body, eventually developing resistance to the therapy.

Routine genomic surveillance revealed that the patient was initially infected with the Omicron BA.1.17 variant in February 2022. However, over the course of the 20-month infection, the virus underwent extensive evolution, accumulating more than 50 mutations, including changes in the spike protein's receptor-binding site that are indicative of immune escape.

Why this matters: This case highlights the risk of persistent SARS-CoV-2 infections in immunocompromised individuals, where unique viral variants can emerge due to intra-host evolution. The findings underscore the importance of continued genomic surveillance of COVID-19 in vulnerable populations to assess the potential public health threat posed by new variants.

While the patient ultimately succumbed to an underlying illness rather than directly from COVID-19, the case raises important questions about balancing the protection of public health with providing humane, supportive care for severely ill patients near the end of life. The researchers emphasize the need for increased awareness, early testing, and genomic surveillance to address this potential threat, while also acknowledging the complex ethical considerations involved.

Dr. Marije Vonk Noordegraaf-Schouten, the lead author of the study, stated, "This case underscores the importance of monitoring SARS-CoV-2 infections in immunocompromised individuals and highlights the delicate balance between protecting public health and providing compassionate care for vulnerable patients." The findings, published in the journal Nature Medicine, serve as a reminder of the ongoing challenges posed by the COVID-19 pandemic and the need for continued vigilance in tracking the evolution of the virus.

Key Takeaways

• Longest known COVID-19 infection lasted 613 days in immunocompromised patient.
• Virus evolved over 20 months, accumulating over 50 mutations, including immune escape.
• Highlights risk of persistent infections in immunocompromised, leading to new variants.
• Underscores importance of genomic surveillance in vulnerable populations.
• Raises ethical considerations in balancing public health and compassionate care.