An oral pathologist's tryst with COVID 19: A chronicle of understanding, experience and despair.

Ever since the COVID 19 pandemic struck our nation and started to cripple our health care infrastructure around the world, a considerable number of research was directed toward the development of the COVID Vaccine. However, when it finally came into our medical infrastructure, people were skeptical about taking the vaccine because of the considerable confusion on its efficacy and adverse effects. An attempt has been made through this communication to narrate my personal experience; My journey from First Infection to Vaccination finally culminating with COVID Reinfection, lessons learnt!! Copyright:

It was the early half of the year 2020 when the World Health Organization (WHO) declared the COVID 19 outbreak a Public Health Emergency of International Concern on January 30, 2020, and a pandemic on March 11, 2020.[12]

Ever since the pandemic struck our nation and started to cripple our health care infrastructure, our unit fought against all odds and had been the vanguard in rendering emergency, urgent and routine dental services to the patients with strict compliance on regular directives, recommendations and advisories issued by Centers for Disease Control, Ministry of Health and Family Welfare, WHO, Armed Forces Medical Services and Dental Council of India with regard to infection control, sterilization, disinfection and Bio-Medical Waste management protocols.[3]

A large number of health care workers (HCWs) have been affected by COVID due to higher risk, many have lost their lives, and few were lucky enough to have returned from the doors of death. While I have been fortunate to have fought COVID twice, I do have my own experience to narrate, bringing forth some of the enigmas surrounding the viral behavior. It almost seemed as though the virus was playing games with me!

It all started in June 2020, in the midst of the first wave of pandemic, I was one of the first dental practitioners of my unit to have contracted the so-called deadly Corona Virus infection! Fortunately for me, I had mild symptoms of fever and experienced two small ulcers one at lower left labial mucosa and another at the left ventral surface of the tongue.[4] I had successfully come out of hospitalization on the 10th day of my admission with a negative reverse transcription-polymerase chain reaction (RT-PCR) test report, of course with an assured and definite hope that I am surely done away with this dreadful disease of COVID 19, at least in this lifetime! On completion of a 07 day home quarantine, I had rejoined office with rejuvenated energy and was proud to be designated as a successful “COVID warrior” by my office colleagues.

Around July 2020, our country was still reeling under the pressure of rising COVID cases. As the economy could not be any longer under complete lockdown, the various unlock phases had started. The daily patient footfall started to rise, it was difficult to segregate patients based on the triage of emergency, urgent and scheduled. Slowly but surely, COVID fatigue was setting in among the visiting patients. It was getting difficult to convince them to follow appropriate COVID protocols.

At this point of time, we approached the ICMR and got necessary sanction for conducting point of care rapid antigen test (RAT) for COVID 19 within our hospital premises. All patients requiring aerosol-generating procedures were initially being subjected to RAT test. Simultaneously, we also introduced Rapid Antibody Tests for our HCW as part of a serosurvey study to check for the qualitative presence of COVID 19 specific immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies through lateral flow immunochromatographic Ab check card.

I happened to check the efficacy of the rapid antibody card on myself, as I was about a month and a half post my COVID infection and hoping to have the desired antibodies. But to my utter disappointment, the rapid card showed “nil” IgG and IgM antibodies. I was shocked and crestfallen!

This was also the time when the news of COVID 19 Re infection had started doing the rounds both in India and across the world. The very first such case was reported from Hong Kong in a 33-year-old man.[5] The United States had its first reported of coronavirus disease 2019 (COVID-19) reinfection, in a young male, patient with no underlying immune conditions.[6] In India, three cases of suspected coronavirus reinfection-two from Mumbai and one from Ahmedabad-had been “described” by the ICMR.[7]

On the back of my mind, the fear of contracting the infection again for the second time kept looming. However, an understanding was also there that it is not only the neutralizing IgG antibodies which can ward off the threat of re-infection but also the presence of memory T cells and B cells in patients who have been previously infected with COVID, which could suggest potential for long-term immunity.[8]

In January 2021, the wait was finally over! Our Government was ready to unleash the two major COVID 19 vaccines-Covishield from Serum Institute of India Ltd, Pune, and Covaxin from Bharat Biotech International Ltd, Hyderabad. India rolled out the world's largest vaccination drive on January 16 to vaccinate around 300 million priority groups against the coronavirus disease (COVID-19).[9] The first vaccine was administered to a sanitation worker at the All India Institute of Medical Sciences, New Delhi, and then, the campaign picked up its speed.

I got my first dose of Covishield on the January 21 and subsequently got the second dose on February 18 within a gap of 28 days as per Government regulations laid out at that time.

Whatever said and done, I had finished my both shots of the vaccine. Sitting comfortably relaxed in my Laboratory after about a month and a half post my second dose of vaccination, a thought pondered over my head. Why not check my antibody levels again through my Rapid Antibody test kit? I carried out the test on my blood sample and this time, I was not disappointed. A faint marking on the IgG test line indicated the mere presence of some amount of COVID 19 specific antibodies. I was thrilled and ecstatic. I was delighted as I thought my year-long experience with COVID had finally succeeded to develop some amount of immunity. I felt like a Winner!!

It is the fag end of April 2021. The news of COVID second wave has already started doing the rounds. Every morning newspaper gave a grim picture, almost a repeat of exactly what was there a year back.

The harsh reality was yet to unfold. The morning of April 19, I experienced mild body ache. Symptoms of running nose existed a day prior. With children and elderly parents at home, my wife insisted that I should get a COVID test done. I was supremely confident, that it might be just flu and the coronavirus infection can’t touch me again!

To my sheer misery, my COVID RAT test came positive. I was under the false sense of security that my previous history of exposure and the antibodies developed postvaacination will be sufficient enough to protect me at least in this current wave of the pandemic.

Disheartened and disgruntled, I gave my RT PCR sample for whole-genome sequencing, to check which strain of the coronavirus could have possibly affected me this time. Multiple variants have recently made headlines, including a UK variant B.1.1.7 lineage, a South African variant known as B.1.351 lineage, a Brazilian variant P. 1 lineage. Some emerging variants like the “Double Mutant” believed to be more transmissible, super infectious, supervirulent and therefore have potential to increase hospitalizations and deaths were also doing the rounds.[101112]

This day when I am penning out this note, I am yet to receive the confirmation through genome sequencing on the nature of the strain which has possibly caused me this reinfection. Also, I have given my blood samples for the evaluation of COVID-specific antibody titers, just to have a fair bit of idea at what titer levels the body was unable to defend against the COVID reinfection. After a week of intriguing wait, I was informed that my antibody titers are 155 IU/ml, apparently an acceptable high value and a potential plasma donor candidate.

But, I was just wondering with such substantial values, still I was exposed to the COVID Infection! Was it because of the potential “immune escape” characteristics of the newer strains? This may only be answered after the genome sequencing results are available.

Surely, we can presume that there is not enough evidence about the effectiveness or duration of antibody-mediated immunity to guarantee the accuracy of an “immunity passport” or “risk-free certificate.”[13]

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Conflicts of interest

There are no conflicts of interest.