SARS-COV-2 REINFECTION

Abstract

Background: SARS-CoV-2 reinfection investigation is on rise, and despite the fact that reviews and studies have attempted to study and define reinfection, none have compared it with all documented conditions in the literature. Therefore, in the quest to better understand COVID-19, this study aims to develop assessment criteria for SARS-CoV-2 reinfection and distinguish other post COVID-19 conditions based on a scoping review, and further study characteristics of reinfected cases in Qatar through a cross-sectional study. Methods: A scoping review of SARS-CoV-2 reinfection was performed and was reported using the PRISMA-ScR checklist. Eight electronic databases were searched from inception to June 2021, and studies where selected based on a priori identified inclusion criteria. Outcomes compared with reinfection were reactivation, relapse, recurrence, repositive, and persistence. A cross sectional study was further conducted to study characteristics of reinfected cases in Qatar between March and June 2021, intending to use the developed criteria. Univariate and multivariable logistic regression and ordinal logistic regression models were utilized for studying the association between preventive and risk practices with symptomatic status of reinfection and time interval until reinfection. Results: A total of 96 studies were included in the scoping review. Published evidence varied in the used definition for reinfection while others did not use any. Other post COVID-19 conditions (persistence, relapse, recurrence, reactivation, repositive) were mainly distinguished from reinfection in terms of age, asymptomatic status, time interval, and seroconversion. The key findings in determining SARS-CoV-2 reinfection are occurrence of reinfection after ?3 months with at least three negative PCR tests for a confirmed recovery to ensure viral clearance. Subsequently in Qatar, 411 reinfected cases (0.73%) were identified after least 90 days from the first infection. Always performing all combined preventive practices (wearing masks, social distancing, and hand hygiene) had a significant inverse association with symptomatic status of reinfection (adjusted prevalence odds ratio (aPOR)= 0.41, 95% CI= 0.24,0.72, P= 0.002), while engaging in some or all risk practices (physical contact and attending social gatherings) had a significant positive association with symptomatic status of reinfection (aPOR= 1.94, 95% CI= 1.21,3.12, P= 0.006). Combined preventive practices was borderline associated with longest time interval (>332 days) until reinfection (aOR=1.57, 95% CI= 1.00,2.48, P=0.051), however, risk practices showed insignificant association with shorter time interval to reinfection (<275 days) (aOR= 0.81, 95% CI= 0.55,1.20, P= 0.291). Conclusion: The findings will help in development of guidelines and implementation of strategies for global public health measures, thereby assisting in impeding the spread of the virus.