Thread by @aliostad

Special thread discussing #COVID19 reinfection evidence in Iran. I felt it is time to compile it in a separate thread from my daily ones.

/start

First of all, what we have is just simply anecdotal evidence that is not confirmed by PCR.

What is shocking to me, is the horde of experts flat out rejecting these reports, saying there is NO PROOF for reinfection yet.

/pre1

Bear in mind in a binary case (reinfection vs no chance of reinfection) with grossly asymmetric risk profiles, burden of proof is for the side with less risk (no reinfection). That is just basic risk management.

/pre2

When you are about to enter a street with a homeless walking over to you saying "I saw a shooter!", you probably would not ask for a proof - you either do not enter or find enough evidence to believe it was a hoax.

/pre3

This same simple Risk Management could have saved thousands of lives had WHO taken the risk of human-to-human infection seriously on Jan 5 and then 23 rather than playing it down.

/pre4

who.int/csr/don/05-jan…

who.int/dg/speeches/de…

With that in mind, I reported the first case of reinfection a month ago on June 21st: a nurse in Tehran. I asked but could not confirm that both episodes confirmed by PCR but likely they were since she was a medic. But we know one-off cases could occur /1

https://twitter.com/aliostad/status/1274762370552868865?s=20

Then 5 days ago, an official in Tehran reporting they are increasingly seeing more such cases /2

https://twitter.com/aliostad/status/1283840062002692097?s=20

Next day, similar report but this time from the province of Kurdistan which had a relativelt bad 1st wave and a worse 2nd wave. These were seen in medical staff and apparently confirmed reinfection cases. /3

https://twitter.com/aliostad/status/1284572934720323584?s=20

Then, health ministry strongly rejected these reports since it has not been proven [against the same thing, wrong burden of proof] and attributing it to long episode looking like reinfection. But they say can take 60 days while these were ~120 days. /4

https://twitter.com/aliostad/status/1284573977634115584?s=20

Currently a medical centre in Zanjan (431K) is tasked with a pilot to track reinfections, but they have not seen any yet. /5

isna.ir/news/990429215…

A well-known Infectious Disease specialist in Iran believes reinfection is rare and if it happens, the likelihood of getting a severe or mild case is the same. [I like his self confience in his statements!] /6

isna.ir/news/990428208…

Another confirmed case of reinfection has been reported in Isfahan (3.6M) again in a medical staff. Reported 3 days ago. /7

isna.ir/news/990428206…

Another report today from Kashan (304K) which was involved during the 1st wave. This research centre says the likelihood of reinfection is higher due to a mutation. /8

tasnimnews.com/fa/news/1399/0…

Now, looking at 4 provinces that had a severe 1st wave:

- Gilan
- Qom
- Mazandaran
- Golestan

In Gilan, antibody was present in up to 40% of population after the end of 1st wave. We also see this provided some protection and COVID is rising but not yet at the 1st wave level. /9

So after removing lockdown, immunity of these people kept R low although still above 1.

In Qom, it seems we are near the 1st wave level. In Mazandaran and Golestan, the situation is far worse than the 1st wave.

So reopening happened at the same time but different response? /10

Different strain of virus could be one reason. Perhaps 1st wave and 2nd wave was due to a different strain. Or one strain results in shorter protection.

All of them good questions - but the answer will take some time to come. /11

In the end:

- confirmed reinfections exist
- many more non-confirmed reinfection cases
- barely 4 months since the 1st wave peak, hence it might be clearer in a couple of months
- This is a question of risk management, not scientific proof
- virus strains to blame?

/summary

Overall, Iran gives an early view to the rest of the world so use it.

Also do not look for PCR confirmation of reinfections in Iran, testing kits are scarce, most cases do not get tested even hospitalised cases.

/end

OK, I might have to update this as more news arrive:

Just news out that Dr. Seyyed Hossein Reza Azizi from Ardabil died in Tehran due to #COVID19 reinfection.

isna.ir/news/990431235…

Another report: 4 confirmed cases in Khuzestan where the patients between the two positive PCR result of each episode, had two negative results. (i.e. + - - +)

isna.ir/news/990501004…

After Tehran and Kurdistan, we have now reports from Hormozgan province that several cases [does not say whether confirmed or not] of reinfection have been seen in this province.

tasnimnews.com/fa/news/1399/0…

#BREAKING Dr. Minoo Mohraz, Iran's most prominent specialist in Infectious Diseases, just confirmed reinfection especially among the medical staff during the second wave.

isna.ir/news/990506038…

Report of reinfections among 200 staff infection in Shohadaye-Tajrish hospital in north Tehran

https://twitter.com/ilnanews/status/1287260954124857344?s=20

#BREAKING More PCR-confirmed #reinfection cases reported now from Isfahan - Iran's 2nd biggest city. Also:

- higher IgG if symptoms more severe
- mutation could also play a part

irna.ir/news/83858915/…

#BREAKING as per report by ISNA, Ali Larijani, ex-head of the parliament has contracted #COVID19 for the 2nd time.

He got it once during the 1st wave and was hospitalised for a long time. [I think he lives in Qom, @qomnews can you confirm?]

https://twitter.com/isna_farsi/status/1288539172064681984?s=20

[Off-Topic since I just report on COVID in Iran]

ICYMI, this paper released 2 weeks ago by a Canadian blood bank suggesting disappearance of antibodies only after 2-3 months. I guess many have already seen this.

biorxiv.org/content/biorxi…

A health official in Fasa (111K), Fars, reported a [PCR-confirmed] 'reinfected' patient has died from a more severe episode: one out of total 14 COVID casualties in this town.

[Due to testing kit shortages confirmed COVID deaths are grossly underreported]
irna.ir/news/83891302/…

A report from 12 days ago from Quchan (102K) claims that 30% of their COVID cases became PCR-positive again once retested after 3 months. No reference to whether they had symptoms or not [but it seems to me they didn't].

isna.ir/news/990501009…

In case wondering, there has not really been any news on the reinfection front. The news suddenly stopped. I doubt it is another layer of coverup frankly... but no news is good news. The world does not need a COVID reinfection added to the worries right now.

An official from Ilam (moderately involved during both 1st and 2nd wave) claims "There is a risk of reinfection as it has already been seen."

Not clear if he brought any evidence. Strange that reinfection exists in the title but not in the text [censor?].
irna.ir/news/83897489/…

A virologist in Iran stated that the data is still scarce but based on what we have it seems that "reinfection after 3 months is a rare incident possibly happening around 1 in 10,000".

irna.ir/news/83903226/…

I wrote an analytical thread on reinfection here.

https://twitter.com/aliostad/status/1293278400627580930?s=20

#BREAKING In an unprecedented and weird announcement, Deputy Health Minister just stated that according to their data, 14% of patients have been re-infected!

He does not explain whether this has been reactivation after a few weeks or true ...

https://twitter.com/isna_farsi/status/1297846529366142976?s=20

... re-infection but explains that this reinfection has been seen in some reports up to 30% [where?? which reports??] while some countries had it at 0 but goes on to reaffirm that many patterns first appeared in Iran and reinfection rate has been 14% over the last 6 months.

In another development, head of the Infectious Diseases ward of Masih Daneshvari, Iran's most advanced centre for COVID in Tehran has confirmed that despite several papers rejecting re-infection, they have seen it with their own eyes. [how many???]

isna.ir/news/990602017…

Also we have a news from Ilam province, confirming the reinfection of 2 nurses among the medical staff. But the disease has not been severe and not resulting in admission.

I had already reported this in the thread a few weeks back so just more context.

irna.ir/news/83918756/…

[Overall it seems as I said before Iranian authorities are still covering up - initially on cases and now on re-infection. This 14% cannot come all of a sudden, I think they have been systematically suppressing the news around it. Having said that I take 14% with a pinch of salt]

On an interview, Dr. Rashidi head of lab in Tajrish Hospital (one of the designated COVID hospitals) claims in a number of [how many??] patients, even with a positive PCR, the antibody cannot be detected and they are susceptible to reinfection.

isna.ir/news/990616114…

Reports from Semnan saying that "some" [how many??] got it again during the 3rd wave.

I assume he is talking of confirmed cases probably 6 months apart since Semnan was mostly spared during the 2nd wave => 1st wave and then 3rd #reinfection

isna.ir/news/990629221…

Another report from Hormozgan again mentioning a case of reinfection which passed away and "a number" [how many??] of other reinfected cases in this province.

#reinfection

irna.ir/news/84041842/…

#Breaking Dr. Zali, head of the COVID Taskforce in Tehran reports of "high number" [what percentage??] of #reinfection cases during the 3rd wave and warns that even a 60-70% infection rate is not enough to provide Herd Immunity.

isna.ir/news/990630228…

#Breaking after Ali Larijani ex-head of the Parliament, another MP has contracted COVID for the 2nd time and has been hospitalised.

The first episode was reported on 5th of July => ~80 days ago.

https://twitter.com/khabaronlinee/status/1310114946118803458?s=20

#Breaking a medical official in Gilan reports that of those who contracted COVID during the first wave, 70% are at risk of reinfection. Although not explicitly mentioned, he appears to point to non-detectable titres of antibody [yes, there is also T-cell].
isna.ir/news/990722164…