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Scientists confirm Nevada 25-year-old got coronavirus twice, second case was more severe

Scientists have confirmed the first case of coronavirus reinfection in the United States: a 25-year-old Nevada man whose second round of the virus was more severe than the first. 

The findings were published Monday in the medical journal The Lancet.

The man, who remains unnamed, first tested positive in April before recovering and testing negative in May. Then in June, he tested positive for the virus again, developing symptoms of COVID-19 a second time. 

According to the case study, his second infection included more severe symptoms than the first time around, including fever, cough and dizziness. 

The researchers sequenced the RNA from both virus samples and found they were two different strains, making it a true reinfection.

Scientists have not concluded why someone might contract the virus twice or if some people are more predisposed to reinfection. The Nevada case marks the fifth case globally of reinfection, and scientists say so far that instances are rare.

Yale University immunobiology professor Akiko Iwasaki told NPR a second positive test could happen for a number of reasons, including being exposed at higher levels to the virus or an immune response making the virus seem worse rather than better the second time around.

Generally, researchers are finding that people who get COVID-19 develop a healthy immune response, but it’s unknown how long it lasts. 

The case study was first sent to The Lancet in August, but it was officially published and the case was confirmed as the first U.S. reinfection this week.  

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A Nevada man got COVID-19 twice. His case shows why we need a vaccine

FILE - In this Monday, May 25, 2020 file photo, a vile of a COVID-19 vaccine candidate on a shelf during testing at the Chula Vaccine Research Center, run by Chulalongkorn University in Bangkok, Thailand. Refrigeration, cargo planes, and, above all, money: All risk being in short supply for the international initiative to get coronavirus vaccines to the world's most vulnerable people. (AP Photo/Sakchai Lalit, File)
A vial of an experimental COVID-19 vaccine. A new report that confirms a case of coronavirus reinfection underscores the need for a vaccine to achieve herd immunity, researchers say. (Sakchai Lalit / Associated Press)

If you were counting on a coronavirus infection to keep you safe from COVID-19 without having to get a vaccine, scientists have some bad news: It won’t work.

The evidence for this comes from a Nevada man who was infected with two distinct versions of the novel coronavirus and became sick with COVID-19 both times. In fact, he was sicker the second time around and had to be admitted to a hospital so that doctors could give him extra oxygen to help him breathe.

The unidentified patient is the first confirmed case in North America of a person being reinfected with the virus known as SARS-CoV-2, according to a report published Monday in the medical journal Lancet Infectious Diseases.

At first glance, the Nevada man wouldn’t seem to be a likely candidate for a case of COVID-19, let alone two. He was young — only 25 — and had no history of underlying medical conditions that would increase his risk of illness, the report authors wrote. He wasn’t taking any drugs that could have suppressed his immune system. Blood tests showed he was HIV-negative, and his cell counts all appeared normal, they added.

But on March 25, he started coming down with an ominous list of symptoms: sore throat, cough, headache, nausea and diarrhea. By April 18, they’d become bad enough that he went to a coronavirus testing center run by the Washoe County Health District. Workers obtained a specimen from the back of his nasal cavity. Sure enough, it contained genetic evidence of SARS-CoV-2.

The man recovered in isolation at home, and his symptoms cleared up nine days later. Two follow-up tests, on May 9 and May 26, confirmed he was negative for coronavirus infection.

That should have been the end of the story. But on May 28, he started to feel sick again.

By May 31, he went to an urgent care center complaining of a fever, headache, dizziness, cough, nausea and diarrhea. He got a chest X-ray and was sent home.

On June 5, he was having trouble breathing, and his body wasn’t getting enough oxygen to his tissues. He went to see his primary care doctor, who sent him to a hospital. Another chest X-ray indicated he had pneumonia, and he was admitted and treated with supplemental oxygen.

Once again, a nasopharyngeal coronavirus test came back positive.

Was it the same case of COVID-19, or did he have the disease twice?

Repeat coronavirus infections are thought to be rare, but they have been confirmed in patients in Hong Kong, Belgium and Ecuador. A team led by biostatistician Richard Tillett of the Nevada Institute of Personalized Medicine went to great lengths to see whether the Washoe County patient should be added to that list.

The fact that his positive coronavirus tests

Nevada COVID-19 director confirms he tested positive

CARSON CITY, Nev. (AP) — Caleb Cage, Nevada’s pandemic response director, said Monday that he tested positive for COVID-19 last week after developing flu-like symptoms during the prior weekend.

“I share my story with all of you now in hopes to remind Nevadans that the mitigation measures can work. The faster we can identify and contain cases, the more we can minimize spread to our friends, family, coworkers and loved ones,” Cage told reporters.

Following Cage’s diagnosis, which was first reported by the Nevada Independent last Friday, Gov. Steve Sisolak and members of his staff who had interacted with Cage were tested. The entire office transitioned to working from home and all of those tested received negative results.


Cage, who was heard coughing throughout an Oct. 7 call with reporters, said his symptoms had subsided and that he is continuing to work from home in line with the 14-day quarantine period recommended by public health professionals.

He said his diagnosis offered the governor’s office a hands-on opportunity to use the COVID Trace mobile app that Nevada rolled out in August to determine possible contacts and recommend individuals for testing. After Cage’s diagnosis, the governor’s spokesperson, Meghin Delaney, announced that Sisolak had tested negative.

Cage isn’t sure where he contracted the virus, but on an earlier press call, said his work schedule had precluded him from visiting businesses the state has gradually allowed to reopen. Cage said he and his family adhere to guidelines recommending social distancing and frequent hand-washing.

Nevada officials reported 569 new confirmed coronavirus cases and 3 new deaths on Monday. The number of new cases and the state’s positivity rate remain higher than in early September — before Sisolak announced plans to relax restrictions on gatherings and before the state task force loosened thresholds for “high risk” counties.

Nevada’s test positivity rate, as measured by a seven-day rolling average, is much higher than the World Health Organization’s 5% reopening threshold.

Officials reported the rate had increased to 10.4%, up from 6.6% on Sept. 18, but that level is below the 15.8% reported on July 8. The number of cases, averaged over the past week, has risen by about 559 per day. By comparison, during the last week in July, new cases rose by an average of 1,037 daily.

During the summer, a corresponding uptick in deaths followed an uptick in daily reported cases, but the current spike underway has yet to translate to an increase in deaths throughout Nevada.

Cage said, in general, health officials expect an increase in deaths and hospitalizations to be followed in four to five weeks by an increase in confirmed cases. It’s still too soon to draw conclusions about the apparent lack of a correlation between recent confirmed cases and deaths in Nevada, he said.

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Sam Metz is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

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Nevada Revokes Halt on Rapid Antigen Testing in Nursing Homes

A week later, however, Admiral Giroir cracked down on Nevada’s “illegal” prohibition on BD’s and Quidel’s tests, which he said had imperiled the residents and staff of nursing homes across the state. “They cannot supersede the PREP Act,” he said.

The false positives that had emerged, Admiral Giroir said, were not only expected but “actually an outstanding result.” No test is perfect, he said.

In the Nevada statement, Dr. Azzam reaffirmed his concerns with the number of false positives that had arisen. “If this laboratory data discrepancy had been reported to Dr. Giroir, we would hope he would have taken the same action as Nevada,” he said. “We too want more testing with rapid turnaround in Nevada, but the results of those tests must be accurate, as they affect clinical care.”

The state’s nursing facilities can resume use of BD’s and Quidel’s products, according to a new Nevada directive issued on Oct. 9. But Nevada’s department of health also recommended that all antigen test results, positive or negative, be confirmed by a laboratory test that relies on a slow but very accurate and reliable technique called polymerase chain reaction, or P.C.R. False negatives, officials noted, risk exposing healthy people in nursing homes to someone who is unknowingly contagious. False positives, on the other hand, could prompt the placement of a person who is well into a unit with sick people, also increasing the chance of infection.

“Both of these scenarios could result in causing harm to a population that we have collectively worked so hard to protect,” the directive said. State health officials, it said, would also continue to investigate the use of BD’s and Quidel’s products.

“We need to better understand the issue before encouraging mass use of such tools among our most vulnerable citizens,” Dr. Azzam said. “We are not saying the tests have no use, we are just saying pause for further review and additional training.”

In a statement, Admiral Giroir said he and his colleagues were “pleased” about Nevada’s reversal. “This serves as a valuable public policy discussion that benefits the public interest by deterring unilateral prohibitions or similar actions in other states or jurisdictions,” he said.

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Federal Official Threatens Nevada for Halting Rapid Tests in Nursing Homes

The leader of the nation’s coronavirus testing efforts condemned Nevada’s health department on Friday for ordering nursing homes to discontinue two brands of government-issued rapid coronavirus tests that the state had found to be inaccurate.

“Bottom line, the recommendations in the Nevada letter are unjustified and not scientifically valid,” Adm. Brett Giroir, an assistant secretary of Health and Human Services, said in a call with reporters on Friday. The state’s actions, he said, were “unwise, uninformed and unlawful” and could provoke unspecified swift punitive action from the federal government if not reversed.

The rapid tests, which were distributed to nursing homes around the country in August by the federal government, were supposed to address the months of delays and equipment shortages that had stymied laboratory-based tests.

“The important issue is to keep seniors safe,” Admiral Giroir said in an interview on Friday. Antigen tests, he added, were “lifesaving instruments” that had been called “godsends” by some nursing home representatives. About 40 percent of the country’s known Covid-19 deaths came from nursing homes, according to a New York Times analysis.

But Nevada officials had discovered a rash of false positives among two types of rapid tests, manufactured by Quidel and Becton, Dickinson and Company, that had been used in the state’s nursing homes. Both tests look for antigens, or bits of coronavirus proteins, and had been advertised as producing no false positives.

Among a sample of 39 positive test results collected from nursing homes across the state, 23 turned out to be false positives, the state reported. (The bulletin did not specify whether negative results from the antigen tests, of which there were thousands, had been confirmed, leaving the number of false negatives unknown.)

“I would consider that to be a significant number of false positives,” said Omai Garner, a clinical microbiologist at the University of California, Los Angeles.

Admiral Giroir contended that such rates of false positives are to be expected, and are “actually an outstanding result.” No test is perfect, he said.

He also said that the federal government expected the state to promptly rescind its unilateral prohibition, which he described as a violation of the Public Readiness and Emergency Preparedness Act.

An Aug. 31 guidance from Admiral Giroir’s office stipulated that PREP Act coverage “preempts” states from blocking the use of coronavirus tests that have been authorized by the Food and Drug Administration on people in congregate settings, like nursing facilities.

What Nevada has done is “illegal,” he said. “They cannot supersede the PREP Act.”

The federal government’s formal response to Nevada’s health department, dated Oct. 8 and signed by Admiral Giroir, portrayed the state’s officials as scientifically incompetent and their actions as “improper” under federal law. “Your letter can only be based on a lack of knowledge or bias, and will endanger the lives of our most vulnerable,” Admiral Giroir wrote.

Should the state hold its ground, “there can be penalties from the federal side,” he said in an interview on Friday, but declined to provide details.

Nevada Halts Use of Rapid Coronavirus Tests in Nursing Homes, Citing Inaccuracies

Kristen Cardillo, BD’s vice president of global communication, said the company was aware of the situation in Nevada and was “conducting thorough investigations.” She added that “based on the information in the directive and the total tests performed, we believe the rate of reported false positives is well within what we would expect for the BD Veritor System.”

Representatives for the Department of Health and Human Services did not respond to requests for comment.

Concerns have also been raised about the ability of antigen tests to accurately pinpoint infections, especially if administered during a period when a person harbors low levels of the coronavirus. BD’s test is advertised as having a false negative rate of 16 percent. Quidel’s is just above 3 percent. The directive from Nevada’s department of health did not report whether the negative antigen test results from nursing homes — there were nearly 3,700 such results — had been confirmed by P.C.R.

In a call with LeadingAge members on Monday, Adm. Brett Giroir, who has been leading the nation’s testing efforts, said antigen tests were “clearly a lifesaving option,” and for many facilities the best test available, given the delays, expenses and shortages that had plagued P.C.R. tests.

“It is perfectly acceptable for congregate care, particularly nursing homes, to use an antigen test, even if they are, quote, off-label,” Dr. Giroir said in the interview. “Just because they don’t have an authorization doesn’t mean they’re not good for it.”

In response to questions about false positives, Dr. Giroir reminded LeadingAge members that in places where the coronavirus is scarce, false positives should be expected to outnumber true positives and do not necessarily invalidate the usefulness of a test. “That’s a function of the way life is,” Dr. Giroir said.

The halt to antigen testing in Nevada’s nursing homes comes just days after health experts criticized the White House, which is now in the midst of a coronavirus outbreak, for a misguided overreliance on rapid testing. For months, officials used two products made by Abbott Laboratories, the ID NOW and the BinaxNOW, to test people without symptoms — another off-label use — while eschewing masks and physical distancing. In September, the White House also began distributing millions of BinaxNOW tests to communities across the country, including nursing homes around the country.

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Reyna Silver Signs Option Agreement for Medicine Springs Project in Nevada

Figure 1: Medicine Springs Location

Figure 1: Medicine Springs Location
Figure 1: Medicine Springs Location
Figure 1: Medicine Springs Location

Figure 2: Carbonate Replacement Deposit Model for Medicine Springs

Figure 2: Carbonate Replacement Deposit Model for Medicine Springs
Figure 2: Carbonate Replacement Deposit Model for Medicine Springs
Figure 2: Carbonate Replacement Deposit Model for Medicine Springs

Figure 3: NLR Exploration Results Medicine Springs

Figure 3: NLR Exploration Results Medicine Springs
Figure 3: NLR Exploration Results Medicine Springs
Figure 3: NLR Exploration Results Medicine Springs

NOT FOR DISSEMINATION IN THE UNITED STATES OR FOR DISTRIBUTION TO U.S. NEWSWIRE SERVICES

TORONTO and HONG KONG, Oct. 05, 2020 (GLOBE NEWSWIRE) — (“Reyna or RSLV”) is pleased to announce that it has entered into a Property Option Agreement with Northern Lights Resources Corp. (“NLR”) on the Medicine Springs silver-lead-zinc project (the “Medicine Springs Project”) located in Elko County, Nevada. The Medicine Springs Project comprises 149 unpatented Federal mineral claims covering 1,189 hectares located in the Ruby Mountains Valley just off the famous Carlin Trend.

The Agreement gives Reyna the ability to earn up to an 80% equity interest in the Project (initial 75% with option to purchase an additional 5%) (the “Option”) subject to expending a total of US$2,439,065 on the Project by December 31, 2023. Upon completion of the Option, Northern Lights and Reyna will enter a Joint Venture to continue exploration and development of the Medicine Springs Project, with Reyna acting as the project’s operator. No upfront payments in either cash or shares are due to either NLR or any other party. See below for the detailed terms.

“While Reyna Silver’s main focus will continue to be our flagship Guigui asset, for which we are awaiting permits to commence a 10,000 meter drill campaign this fall, we are delighted to add Medicine Springs to our portfolio of assets,” said Jorge Ramiro Monroy, President and CEO.   Medicine Springs is a Guigui-like CRD system with high-grade silver potential, which lies in Nevada’s CRD elephant country and we are eager to begin applying the same exploration model that led to Arizona Mining’s Taylor Manto and MAG Silver’s Cinco de Mayo discoveries. The Northern Lights team has done an excellent job developing the project to its current near-drill ready stage, which lets us hit the ground running.”

“Figure 1: Medicine Springs Location” is available at https://www.globenewswire.com/NewsRoom/AttachmentNg/6669eecf-7969-4d08-8495-284a455679fa

“Figure 2: Carbonate Replacement Deposit Model for Medicine Springs” is available at https://www.globenewswire.com/NewsRoom/AttachmentNg/5b835479-ba68-435c-9e1d-ee4d62bb9525

The Medicine Springs Project

The world-famous Carlin Trend runs just east of the Medicine Springs area and prior to acquisition by NLR in 2017, the area was explored for Carlin-style gold potential from 1986-2008 by companies including, US Minerals Exploration, Golden Phoenix, Cominco America and Silver Resources. This exploration work included mapping, sampling, geophysics (CSAMT and IP) and shallow RC drilling. A total of 125 RC holes were drilled on the Project claims (5,380 m with average depth of 43 m, with the deepest hole being 180 m). Limited gold mineralization was found, but significant silver-rich mineralization was cut in several holes including: 33 m @ 90 g/t