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Covid reinfections are possible. Should we worry?

The patient walked into the Washoe County community testing station in the US state of Nevada on April 18 with a sore throat, dry cough and a headache, but no reason to worry.

He was only 25, had no prior medical conditions, and although the PCR nasal-swab test for Covid-19 he took came back positive, he was soon feeling well again.

Thirty five days later, he was rushed to the emergency room, short of breath and with a raging fever, and placed on oxygen support.

He had become the first confirmed US case of Covid-19 reinfection. 

Up to now, there have been only a handful of similar cases worldwide, and experts say it is too early to draw sweeping conclusions from such a small head count.

But the prospect of getting reinfected with Covid-19 — and getting even sicker the second time around — could have a significant impact on how governments chart the path out of the pandemic.

In particular, reinfections may render the idea of herd immunity — that is, a sufficiently high percentage of people eventually becoming immune to Covid-19 — unrealistic.

“Reinfection cases mean that in some people, the immune response is not enough to protect them from infection or disease,” Akiko Iwasaka, a professor of Immunobiology and Molecular, Cellular and Developmental Biology at Yale University, told AFP.

“Reinfections from SARS-CoV-2 (the virus that causes Covid-19) mean that immunity acquired through natural infection is not perfect.”

Researchers who documented the Nevada patient’s case offered a number of possible explanations as to how he could have gotten sick twice.

He may have been exposed to a very high dose of the virus the second time around, triggering a more acute reaction.

Alternatively, it may have been a more virulent strain of the virus. 

The study, published this week in The Lancet Infectious Diseases, listed other confirmed reinfections in Belgium, the Netherlands, Hong Kong and Ecuador.

– Too soon to tell? –

Frederic Altare, director of Immunology at the Inserm Research Centre of Oncology and Immunology Nantes-Angers, said there was currently little evidence that Covid-19 reinfection was going to be a “major issue” given the low case figures.

“With the number of people who have been infected there are only a dozen or so proven reinfections — that’s not much,” he told AFP.

But others said it was difficult to accurately gauge reinfection numbers given the relative lack of testing during the first wave this spring. 

In other words, many people could have in theory been infected in March or April and remained asymptomatic, only to test positive later in the year when they were reinfected, but this time with symptoms. 

According to Jeffrey Shaman, professor of Environmental Health Sciences at the Columbia University Mailman School of Public Health, the main obstacle to ascertaining reinfection numbers is that SARS-CoV-2 — unlike other coronaviruses that circulate among humans — is brand new, epidemiologically speaking. 

“The world has only been dealing with this for a number of months,”

Amid rising Covid-19 cases and hospitalizations, local leaders and public health experts worry of a coming surge

With 33 states reporting a rise in new Covid-19 cases and a nationwide uptick in hospitalizations, local officials worry this could be the beginning of the coming surge experts have warned about.



a person standing in a parking lot: A medic prepares to transfer a patient on a stretcher from an ambulance outside of Emergency at Coral Gables Hospital where Coronavirus patients are treated in Coral Gables near Miami, on July 30, 2020. - Florida has emerged as a major new epicenter of the US battle against the disease, with confirmed cases recently surpassing New York and now second only to California. The state toll has leapt over the past week and more than 6,500 people have died from the disease there, according to health officials. More than 460,000 people have been infected with the virus in Florida, which has a population of 21 million, and a quarter of the state's cases are in Miami. The US has tallied a total of 151,826 deaths from COVID-19, making it the hardest-hit country in the world. (Photo by CHANDAN KHANNA / AFP) (Photo by CHANDAN KHANNA/AFP via Getty Images)


© CHANDAN KHANNA/AFP/Getty Images
A medic prepares to transfer a patient on a stretcher from an ambulance outside of Emergency at Coral Gables Hospital where Coronavirus patients are treated in Coral Gables near Miami, on July 30, 2020. – Florida has emerged as a major new epicenter of the US battle against the disease, with confirmed cases recently surpassing New York and now second only to California. The state toll has leapt over the past week and more than 6,500 people have died from the disease there, according to health officials. More than 460,000 people have been infected with the virus in Florida, which has a population of 21 million, and a quarter of the state’s cases are in Miami. The US has tallied a total of 151,826 deaths from COVID-19, making it the hardest-hit country in the world. (Photo by CHANDAN KHANNA / AFP) (Photo by CHANDAN KHANNA/AFP via Getty Images)

In Colorado, Denver Mayor Michael Hancock said Covid-19 cases are rising at a “concerning rate,” while the city’s seven-day average daily case rates are as “high right now as they were at the height of the pandemic back in May.”

The seven-day average of hospitalizations also rose about 37% in a little more than a week, he said during a Monday news conference, and warned residents could soon see tighter Covid-19 restrictions if the city’s numbers continue to trend in the wrong direction.

Officials across the country warn of similar patterns. White House coronavirus task force coordinator Dr. Deborah Birx last week warned the Northeast was seeing “early surggestions” of alarming trends. Kentucky’s governor said recently the state is seeing a third major escalation in infections. In Wisconsin, a field hospital is opening this week in response to a surge of Covid-19 patients — days after the state reported record-high numbers of Covid-19 cases, hospitalizations and daily deaths.

The US is now averaging more than 49,000 new infections daily — up 14% from the previous week, according to data from Johns Hopkins University. And last week, the nation recorded more than 50,000 new cases for at least four days in a row. The last time that happened was in early August.

“I think we’re facing a whole lot of trouble,” Dr. Anthony Fauci told CNBC on Monday. “We’ve got to turn this around.”

That doesn’t have to mean another lockdown, the infectious disease expert has previously said. Instead, it means more people heeding to safety guidelines like wearing masks and social distancing.

Otherwise, the US could be in for a devastating winter. Researchers from the University of Washington’s Institute for Health Metrics and Evaluation project more than 135,000 Americans could die within the next three months.

Healthcare professionals ‘deeply afraid’

Hospitalizations nationwide are also on the rise. At least 10 states have recorded record-high hospitalization

Why Covid-19’s Impact on Health Is a Long-Term Worry

1. What are the persistent ailments?

Surveys and preliminary research indicate the most commonly reported include fatigue, breathlessness, headache, insomnia, chest pain, joint pain, coughing, loss of taste and smell, intermittent fevers and skin rashes. Less frequently, hearing problems, “brain fog,” mental-health problems and hair loss have been reported, though these have yet to be confirmed by studies. Besides these general symptoms, specific organ dysfunction has been reported, involving primarily the heart, lungs, and brain — even among those whose acute infection led to no discernible symptoms. But the science is still evolving and there’s no consensus yet on a clinical definition for long, or post-acute, Covid.

It probably increases with the severity of the initial bout of Covid-19. For instance, two-thirds of patients who had mild-to-moderate Covid-19 reported at least one persistent symptom 60 days after falling ill, according to a French study that followed 150 non-critical patients from March to June. A similarly sized study of older, more seriously ill hospital patients in Italy found 87% had at least one symptom, particularly fatigue and shortness of breath, an average of two months later. A survey in the U.S. found 35% of patients who weren’t hospitalized had not returned to normal health as long as three weeks after testing positive. Among 18-to-34-year-olds with no chronic medical conditions, the figure was 19%.

3. How big a problem is this?

We don’t know yet because Covid-19 is a new disease. Researchers haven’t studied enough patients over a long enough period of time to know what the full range of long-term effects, or sequelae, might be. Nor do they know what proportion of patients will suffer from them or for how long. The uncertainties have sometimes led to what so-called long haulers describe as medical gaslighting by health professionals who don’t take their complaints seriously, especially if the patient is a woman. Early findings and the demand for specialized post-Covid clinics to help survivors deal with scarred lungs, chronic heart damage, post-viral fatigue and other debilitating conditions indicate a significant prevalence. The social and economic impact would be magnified if people end up enduring years or decades of coronavirus-related disability. Some researchers say the pandemic may spur chronic fatigue syndrome, also called myalgic encephalomyelitis or ME, and neurodegenerative diseases like Parkinson’s.

4. Do other viruses cause prolonged illness?

Yes. Post-viral syndromes occur after many viral infections, including the common cold, influenza, HIV, infectious mononucleosis, measles and hepatitis B. Diabetes and other long-term consequences were observed in survivors of severe acute respiratory syndrome, which is caused by a related coronavirus. A Canadian study found 21 health-care workers from Toronto had post-viral symptoms for as long as three years after catching SARS in 2003, and were unable to return to their usual work. Some people who were hospitalized with SARS in Hong Kong still had impaired lung function two years later, a study of 55 patients published in 2010 found. Still, it’s not known yet whether the lessons of SARS are applicable to Covid-19.

Should Peloton Investors Worry About Apple’s New Fitness Service?

Apple (NASDAQ: AAPL) recently unveiled Apple Fitness+ as the latest addition to its suite of subscription services. Demand for interactive fitness services is booming, as evidenced by Peloton Interactive‘s (NASDAQ: PTON) explosive growth over the last year. With a large installed base of active devices, Apple could gain traction quickly in this market. Should Peloton investors be concerned?



a person sitting at a table using a laptop: Should Peloton Investors Worry About Apple's New Fitness Service?


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Should Peloton Investors Worry About Apple’s New Fitness Service?

Apple joins a crowded market

Peloton still makes most of its money from selling exercise equipment. Subscription revenue made up 20% of its top line in fiscal 2020 (which ended June 30). This amount includes the $39 per month fee that users pay to access workout programs on their Peloton Bike or Tread. It also includes the $12.99 per month fee members pay to access workout programs through the Peloton digital app.



A woman exercising at home.


© Getty Images
A woman exercising at home.

Peloton finished the last quarter with 1.09 million connected fitness subscriptions, up 113% year over year. Paid digital subscriptions through the app grew 210% year over year but only totaled 316,800. 

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The Peloton digital subscription is included with all connected fitness subscriptions made with a Peloton Bike or Tread. The app was initially offered as a supplement for Bike and Tread owners to access classes while away from their equipment. As of June 2020, 67% of connected fitness product users engaged with the Peloton app to supplement their workout routine.  

Keep in mind that Peloton digital app subscriptions have grown rapidly despite the availability of Nike‘s (NYSE: NKE) Training Club app, which is free to use. Lululemon Athletica also offers exercise classes on its website, not to mention the content available on the Mirror platform that Lululemon recently acquired. There’s plenty of competition out there, and it hasn’t fazed Peloton. 

As for Apple’s new offering, Fitness+ will cost $9.99 per month, or users can access it through the Apple One Premier plan, which bundles several services together, for $29.95 per month. 

The main selling point for Fitness+ is that the service will include special integration features with the Apple Watch. In fact, Apple says Fitness+ was specifically designed for that wearable device. The app will intelligently incorporate metrics from Apple Watch to offer a “first-of-its-kind personalized workout experience.”

Apple’s advantages

It’s a major advantage for Apple that Fitness+ will be integrated into every active device through the new Fitness app on the iPhone, which the company says it will also be available on iPad and Apple TV. 

The company already has a massive built-in user base with more than 1.5 billion active devices around the world. If Peloton’s digital subscription growth is any indication, Fitness+ could be one of the more popular services when it launches later this year. It helps Apple that Fitness+ is slightly undercutting the subscription price of the Peloton app by a few dollars too.

Apple is tapping into a big opportunity. Peloton reported that more of its members