Patient COVID-19 positive for nearly 300 days; longest documented infection, researchers believe

At the end of March 2020, David Smith, a U.K. patient in his 70s, tested positive for COVID-19. He continued testing positive for more than 290 days until early March 2021 and is believed to have had the longest documented COVID-19 infection, according to a case study recently published in the preprint server medRxiv.

Researchers said the man was immunocompromised, as he had previously been treated for chronic lymphocytic leukemia.

Throughout the course of infection, Mr. Smith tested positive more than 40 times and was hospitalized seven separate times, according to the June 4 case study. Genetic sequencing showed the virus also evolved and acquired mutations, including those present in the alpha variant, first identified in the U.K. 

A 15-day course of remdesivir 213 days after Mr. Smith's first positive COVID-19 test failed to clear the virus. On day 265, he was treated with casirivimab and imdevimab — two monoclonal antibodies — and experienced a "dramatic clinical improvement," researchers said. Forty-five days after the antibody treatment, the virus was no longer detectable. 

"There are increasing reports of immunocompromised people who are repeatedly infected with SARS-CoV-2 for longer than six months," said Dr. Andrew Davidson, co-author of the case study and virologist at the University of Bristol's School of Cellular and Molecular Medicine in the U.K. "As the virus can evolve in this group, and develop mutations that are present in emerging [variants of concern], it is key that we monitor the evolution of the virus in these individuals and effective treatment options are available to eliminate the virus.”

"I'll never be 100 percent because the COVID-19 has destroyed my lungs, so I run out of breath quickly," Mr. Smith said in a follow-up interview with The Guardian.. "But every day I live now is a bonus. I always say, when you're lying down in the gutter, all you can see is the stars. I've been down to the bottom, everything's brilliant now."


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