Features
Re-infections with Covid-19:
Are they distinct possibilities?
The headline of this article appeared with a different column yesterday due to a technical problem. We apologise to our readers for the inadvertent error – Editor
By Dr.B. J. C. Perera,Specialist Consultant Paediatrician
There has been considerable debate on whether reinfections implying repeated infections with the virus SARS-CoV-2 that causes the COVID-19 disease was occurring and whether such occurrences were even possible. A reinfection is a second, third or any subsequent infection with the same virus once a person has recovered from an initial index infection. Unscrambling of those contentions were obviously extremely important from public health as well as curative health perspectives. In the not too distant past, there were some suspicious cases of possible reinfections in other parts of the world but whether those were due to a persistence of the virus in the individual, reactivation of the same illness after some time in the person or whether these were due to new second infections could not be scientifically proven with certainty. Various types of conjectures and assumptions were quite rife in the face of the ambiguity of details on the topic of reinfections.
In the human health scenario, some viruses like measles or chicken pox viruses generate virtually life-long immunity and resistance to reinfections. Second infections with these viruses are extremely rare and are almost unheard of. In the other extreme, there are viruses like those that cause the common cold, with which reinfections are extremely common. There are examples of even certain other types of human coronaviruses that cause the common cold, with the propensity to cause multiple reinfections. From a public health perspective information regarding such immunological features of an infection are absolutely vital to facilitate the formulation and implementation of preventive measures.
Being able to say for sure that there is a reinfection by another strain of the same organism depends on how reliably one could say that it is not the same original index organism that is there in the second infection. It is not easy to detect alterations in the different strains of the same organism. However, a modern technological development has made this possible. It is a technique known as genome sequencing. Whole genome sequencing is the process of determining the complete sequence of the components of an organism’s genetic structure at a given time. This technique can be used to detect differences in the genetic make-up of different strains of the same organism. When an organism undergoes any form of mutation, the new mutant will have some differences in the genome from the original index strain.
There is now convincing evidence for at least two cases, one from Hong Kong and the other from the USA, of well-documented human reinfection with SARS-CoV-2 virus. These case reports invariably generate certain questions about how commonly reinfection may occur. The cases described here have different characteristics in terms of viral genetics, timeline of reinfection and the severity of the disease. Although we can learn quite a few things from the characteristics of these two cases, it is difficult to draw firm conclusions about the clinical and public health implications of these findings.
On August 24, researchers in Hong Kong announced the first confirmed instance of human reinfection with SARS-CoV-2. It was a 33-year-old otherwise healthy man living in Hong Kong who developed three days of respiratory symptoms and was diagnosed with COVID-19 on 26th March 2020. Following recovery, he was later PCR tested twice more for SARS-CoV-2 and both tests were negative. On 15th August 2020, he was tested for SARS-CoV-2 again as a part of re-entry screening when he returned to Hong Kong from Europe. That test result was positive. He had no symptoms at the time of the second positive result. Genome sequencing revealed that the viruses isolated in March and in August were from different genetic groups, leading the study authors to conclude that the patient had been infected twice.
In the second case, a 25-year-old otherwise healthy man living in Nevada, USA, developed a respiratory viral infection and was diagnosed with COVID-19 on 18th April 2020. The patient recovered and two PCR tests for SARS-CoV-2 performed in May were negative. Then at the end of May, the patient again developed respiratory symptoms and tested positive for SARS-CoV-2 in early June 2020. Genomic sequencing revealed that the viral isolates showed a number of genetic differences between the isolates. The authors of that report concluded that based on the degrees of genetic differences between the two isolates, these were two distinct infections.
There have also been recent news reports of one case of reinfection in Belgium and one in the Netherlands, diagnosed using genome sequencing, but the scientific details of those cases were not available at the time of writing this article.
What makes these reports of reinfection different from previous reports? There have been numerous reports of patients with possible reinfection prior to this one. In April, it was reported that hundreds of people in South Korea who had recovered from COVID-19 and were retested for SARS-CoV-2, had tested positive upon retesting. To help determine whether the patients in South Korea had indeed been reinfected and if they could transmit the virus, researchers attempted to culture SARS-CoV-2 from retest samples and traced the close contacts of those with positive retest results. The virus could not be cultured and there were no confirmed COVID-19 cases among contacts, suggesting that the detected virus was not alive. It was therefore thought that what was observed in South Korea was prolonged shedding of SARS-CoV-2, a phenomenon that is now well recognised.
The best way to establish proof of reinfection is to perform genome sequencing. The technique determines the order of chemical building blocks that comprise the genetic code of an organism. Although the genomes of different SARS-CoV-2 individual virus particles are very similar to each other and hence identified as SARS-CoV-2 and not as other viruses, some differences do occur. Those differences develop through mutations, or the substitution of one chemical building block for another, as genome copies are made. Mutations may be inherited by the next generation of virus particles, resulting in viral evolution as they accumulate over time. Genome sequencing can thus help to determine whether two populations of SARS-CoV-2 evolved separately from each other or whether one gave rise to the other. This principle can be applied to virus samples obtained from a single person at two different times.
Thousands of genome sequences of SARS-CoV-2 isolates from all over the world have been published in on-line databases. Comparison and analysis of these sequences has resulted in the characterization of several clades. A clade is a group of organisms that can be traced to a common ancestor and all common descendants. These clades of SARS-CoV-2 have geographic specificity in part because viral evolution has occurred after SARS-CoV-2 has been transported between continents. It has been found that viruses from one lineage, clade G, predominate in Europe and the United States, while clade L, the progenitor of clade G, predominates in Asia. In the case of the Hong Kong patient, genomic sequencing determined that the patient’s first infection was caused by a virus from clade V, while the second was caused by a virus from clade G. This strongly suggests that the patient was infected on two separate occasions, in different parts of the world.
Is the occurrence of reinfection surprising? The possibility of reinfection with SARS-CoV-2 has been widely argued. Several lines of evidence have been used to contend against it. Until the announcement from Hong Kong, evidence in support of reinfection had not been published. On the other hand, the occurrence of SARS-CoV2 reinfection is not surprising, based on experience with other infectious diseases. “Sterilizing immunity,” or complete protection from infection after immunologic priming by natural infection or vaccination is often an elusive target, either because short-term immunity is not fool proof or because immunity tends to wane over time. Evidence from animal studies demonstrate the possibility of SARS-CoV-2 reinfection despite immunologic priming. If reinfection is possible, why are the first cases of this are only coming up being reported now? Will there be more cases in the future? It is possible there have been other cases of reinfection that have not been detected or convincingly investigated. In essence, public health surveillance systems are not set up to identify cases of reinfection.
Based on current information, it is difficult to predict how commonly reinfection will occur, but it is useful to explore whether features of the Hong Kong and Nevada cases make those patients’ situations more or less applicable to other patients. As for timing of reinfection, it is unclear how much the time period between infections, 4.5 months in the case of the Hong Kong patient, and six weeks in the case of the Nevada patient, may have contributed to the patients’ risks for reinfection. Studies have shown that SARS-CoV-2 antibodies can decline rapidly within a few weeks or months of infection but again, the role that antibodies play in immunologic protection is unclear. It is possible these patients were poorly protected against reinfection and were reinfected as soon as they were next exposed to SARS-CoV-2. Generally speaking, immunologic protection induced by natural infection or vaccination tends to wane over time. Hence the possibility that an effective COVID-19 vaccine may need to be administered repeatedly in order to maintain sufficient immunity. It is possible that as travel restrictions ease and population movement increases, exposure to SARS-CoV-2 clades that have not been previously encountered may increase the risk of reinfection. Concerns have also been expressed as to whether immune enhancement may occur for SARS-CoV-2, and in particular, if vaccination against COVID-19 could precipitate severe disease if post-vaccination infection occurs. At this time, there is no evidence from human or animal studies that SARSCoV-2 infection can precipitate immune enhancement of the disease.
Clearly a lot more scientific information is needed before tangible conclusions can be arrived at. Our perceptions on the capabilities of this blight will change over time when more and more details and research evidence is brought to light in the course of time. However, in view of the mayhem that has so far been wreaked by the virus, time is perhaps at a premium. As time is of the essence, the onus is on dedicated researchers world-wide to unravel some of these mysteries as soon as possible.
by Dr Gotabhya Ranasinghe
Senior Consultant Cardiologist
National Hospital Sri Lanka
When we sought a meeting with Hon Dr. Ramesh Pathirana, Minister of Health, he graciously cleared his busy schedule to accommodate us. Renowned for his attentive listening and deep understanding, Minister Pathirana is dedicated to advancing the health sector. His openness and transparency exemplify the qualities of an exemplary politician and minister.
Dr. Palitha Mahipala, the current Health Secretary, demonstrates both commendable enthusiasm and unwavering support. This combination of attributes makes him a highly compatible colleague for the esteemed Minister of Health.
Our discussion centered on a project that has been in the works for the past 30 years, one that no other minister had managed to advance.
Minister Pathirana, however, recognized the project’s significance and its potential to revolutionize care for heart patients.
The project involves the construction of a state-of-the-art facility at the premises of the National Hospital Colombo. The project’s location within the premises of the National Hospital underscores its importance and relevance to the healthcare infrastructure of the nation.
This facility will include a cardiology building and a tertiary care center, equipped with the latest technology to handle and treat all types of heart-related conditions and surgeries.
Securing funding was a major milestone for this initiative. Minister Pathirana successfully obtained approval for a $40 billion loan from the Asian Development Bank. With the funding in place, the foundation stone is scheduled to be laid in September this year, and construction will begin in January 2025.
This project guarantees a consistent and uninterrupted supply of stents and related medications for heart patients. As a result, patients will have timely access to essential medical supplies during their treatment and recovery. By securing these critical resources, the project aims to enhance patient outcomes, minimize treatment delays, and maintain the highest standards of cardiac care.
Upon its fruition, this monumental building will serve as a beacon of hope and healing, symbolizing the unwavering dedication to improving patient outcomes and fostering a healthier society.We anticipate a future marked by significant progress and positive outcomes in Sri Lanka’s cardiovascular treatment landscape within the foreseeable timeframe.
by Fr. Emmanuel Fernando, OMI
Jesuit Fr. Aloysius Pieris (affectionately called Fr. Aloy) celebrated his 90th birthday on April 9, 2024 and I, as the editor of our Oblate Journal, THE MISSIONARY OBLATE had gone to press by that time. Immediately I decided to publish an article, appreciating the untiring selfless services he continues to offer for inter-Faith dialogue, the renewal of the Catholic Church, his concern for the poor and the suffering Sri Lankan masses and to me, the present writer.
It was in 1988, when I was appointed Director of the Oblate Scholastics at Ampitiya by the then Oblate Provincial Fr. Anselm Silva, that I came to know Fr. Aloy more closely. Knowing well his expertise in matters spiritual, theological, Indological and pastoral, and with the collaborative spirit of my companion-formators, our Oblate Scholastics were sent to Tulana, the Research and Encounter Centre, Kelaniya, of which he is the Founder-Director, for ‘exposure-programmes’ on matters spiritual, biblical, theological and pastoral. Some of these dimensions according to my view and that of my companion-formators, were not available at the National Seminary, Ampitiya.
Ever since that time, our Oblate formators/ accompaniers at the Oblate Scholasticate, Ampitiya , have continued to send our Oblate Scholastics to Tulana Centre for deepening their insights and convictions regarding matters needed to serve the people in today’s context. Fr. Aloy also had tried very enthusiastically with the Oblate team headed by Frs. Oswald Firth and Clement Waidyasekara to begin a Theologate, directed by the Religious Congregations in Sri Lanka, for the contextual formation/ accompaniment of their members. It should very well be a desired goal of the Leaders / Provincials of the Religious Congregations.
Besides being a formator/accompanier at the Oblate Scholasticate, I was entrusted also with the task of editing and publishing our Oblate journal, ‘The Missionary Oblate’. To maintain the quality of the journal I continue to depend on Fr. Aloy for his thought-provoking and stimulating articles on Biblical Spirituality, Biblical Theology and Ecclesiology. I am very grateful to him for his generous assistance. Of late, his writings on renewal of the Church, initiated by Pope St. John XX111 and continued by Pope Francis through the Synodal path, published in our Oblate journal, enable our readers to focus their attention also on the needed renewal in the Catholic Church in Sri Lanka. Fr. Aloy appreciated very much the Synodal path adopted by the Jesuit Pope Francis for the renewal of the Church, rooted very much on prayerful discernment. In my Religious and presbyteral life, Fr.Aloy continues to be my spiritual animator / guide and ongoing formator / acccompanier.
Fr. Aloysius Pieris, BA Hons (Lond), LPh (SHC, India), STL (PFT, Naples), PhD (SLU/VC), ThD (Tilburg), D.Ltt (KU), has been one of the eminent Asian theologians well recognized internationally and one who has lectured and held visiting chairs in many universities both in the West and in the East. Many members of Religious Congregations from Asian countries have benefited from his lectures and guidance in the East Asian Pastoral Institute (EAPI) in Manila, Philippines. He had been a Theologian consulted by the Federation of Asian Bishops’ Conferences for many years. During his professorship at the Gregorian University in Rome, he was called to be a member of a special group of advisers on other religions consulted by Pope Paul VI.
Fr. Aloy is the author of more than 30 books and well over 500 Research Papers. Some of his books and articles have been translated and published in several countries. Among those books, one can find the following: 1) The Genesis of an Asian Theology of Liberation (An Autobiographical Excursus on the Art of Theologising in Asia, 2) An Asian Theology of Liberation, 3) Providential Timeliness of Vatican 11 (a long-overdue halt to a scandalous millennium, 4) Give Vatican 11 a chance, 5) Leadership in the Church, 6) Relishing our faith in working for justice (Themes for study and discussion), 7) A Message meant mainly, not exclusively for Jesuits (Background information necessary for helping Francis renew the Church), 8) Lent in Lanka (Reflections and Resolutions, 9) Love meets wisdom (A Christian Experience of Buddhism, 10) Fire and Water 11) God’s Reign for God’s poor, 12) Our Unhiddden Agenda (How we Jesuits work, pray and form our men). He is also the Editor of two journals, Vagdevi, Journal of Religious Reflection and Dialogue, New Series.
Fr. Aloy has a BA in Pali and Sanskrit from the University of London and a Ph.D in Buddhist Philosophy from the University of Sri Lankan, Vidyodaya Campus. On Nov. 23, 2019, he was awarded the prestigious honorary Doctorate of Literature (D.Litt) by the Chancellor of the University of Kelaniya, the Most Venerable Welamitiyawe Dharmakirthi Sri Kusala Dhamma Thera.
Fr. Aloy continues to be a promoter of Gospel values and virtues. Justice as a constitutive dimension of love and social concern for the downtrodden masses are very much noted in his life and work. He had very much appreciated the commitment of the late Fr. Joseph (Joe) Fernando, the National Director of the Social and Economic Centre (SEDEC) for the poor.
In Sri Lanka, a few religious Congregations – the Good Shepherd Sisters, the Christian Brothers, the Marist Brothers and the Oblates – have invited him to animate their members especially during their Provincial Congresses, Chapters and International Conferences. The mainline Christian Churches also have sought his advice and followed his seminars. I, for one, regret very much, that the Sri Lankan authorities of the Catholic Church –today’s Hierarchy—- have not sought Fr.
Aloy’s expertise for the renewal of the Catholic Church in Sri Lanka and thus have not benefited from the immense store of wisdom and insight that he can offer to our local Church while the Sri Lankan bishops who governed the Catholic church in the immediate aftermath of the Second Vatican Council (Edmund Fernando OMI, Anthony de Saram, Leo Nanayakkara OSB, Frank Marcus Fernando, Paul Perera,) visited him and consulted him on many matters. Among the Tamil Bishops, Bishop Rayappu Joseph was keeping close contact with him and Bishop J. Deogupillai hosted him and his team visiting him after the horrible Black July massacre of Tamils.
Sri Lanka-Singapore Free Trade Agreement
By Gomi Senadhira
senadhiragomi@gmail.com
“You might tell fairy tales, but the progress of a country cannot be achieved through such narratives. A country cannot be developed by making false promises. The country moved backward because of the electoral promises made by political parties throughout time. We have witnessed that the ultimate result of this is the country becoming bankrupt. Unfortunately, many segments of the population have not come to realize this yet.” – President Ranil Wickremesinghe, 2024 Budget speech
Any Sri Lankan would agree with the above words of President Wickremesinghe on the false promises our politicians and officials make and the fairy tales they narrate which bankrupted this country. So, to understand this, let’s look at one such fairy tale with lots of false promises; Ranil Wickremesinghe’s greatest achievement in the area of international trade and investment promotion during the Yahapalana period, Sri Lanka-Singapore Free Trade Agreement (SLSFTA).
It is appropriate and timely to do it now as Finance Minister Wickremesinghe has just presented to parliament a bill on the National Policy on Economic Transformation which includes the establishment of an Office for International Trade and the Sri Lanka Institute of Economics and International Trade.
Was SLSFTA a “Cleverly negotiated Free Trade Agreement” as stated by the (former) Minister of Development Strategies and International Trade Malik Samarawickrama during the Parliamentary Debate on the SLSFTA in July 2018, or a colossal blunder covered up with lies, false promises, and fairy tales? After SLSFTA was signed there were a number of fairy tales published on this agreement by the Ministry of Development Strategies and International, Institute of Policy Studies, and others.
However, for this article, I would like to limit my comments to the speech by Minister Samarawickrama during the Parliamentary Debate, and the two most important areas in the agreement which were covered up with lies, fairy tales, and false promises, namely: revenue loss for Sri Lanka and Investment from Singapore. On the other important area, “Waste products dumping” I do not want to comment here as I have written extensively on the issue.
1. The revenue loss
During the Parliamentary Debate in July 2018, Minister Samarawickrama stated “…. let me reiterate that this FTA with Singapore has been very cleverly negotiated by us…. The liberalisation programme under this FTA has been carefully designed to have the least impact on domestic industry and revenue collection. We have included all revenue sensitive items in the negative list of items which will not be subject to removal of tariff. Therefore, 97.8% revenue from Customs duty is protected. Our tariff liberalisation will take place over a period of 12-15 years! In fact, the revenue earned through tariffs on goods imported from Singapore last year was Rs. 35 billion.
The revenue loss for over the next 15 years due to the FTA is only Rs. 733 million– which when annualised, on average, is just Rs. 51 million. That is just 0.14% per year! So anyone who claims the Singapore FTA causes revenue loss to the Government cannot do basic arithmetic! Mr. Speaker, in conclusion, I call on my fellow members of this House – don’t mislead the public with baseless criticism that is not grounded in facts. Don’t look at petty politics and use these issues for your own political survival.”
I was surprised to read the minister’s speech because an article published in January 2018 in “The Straits Times“, based on information released by the Singaporean Negotiators stated, “…. With the FTA, tariff savings for Singapore exports are estimated to hit $10 million annually“.
As the annual tariff savings (that is the revenue loss for Sri Lanka) calculated by the Singaporean Negotiators, Singaporean $ 10 million (Sri Lankan rupees 1,200 million in 2018) was way above the rupees’ 733 million revenue loss for 15 years estimated by the Sri Lankan negotiators, it was clear to any observer that one of the parties to the agreement had not done the basic arithmetic!
Six years later, according to a report published by “The Morning” newspaper, speaking at the Committee on Public Finance (COPF) on 7th May 2024, Mr Samarawickrama’s chief trade negotiator K.J. Weerasinghehad had admitted “…. that forecasted revenue loss for the Government of Sri Lanka through the Singapore FTA is Rs. 450 million in 2023 and Rs. 1.3 billion in 2024.”
If these numbers are correct, as tariff liberalisation under the SLSFTA has just started, we will pass Rs 2 billion very soon. Then, the question is how Sri Lanka’s trade negotiators made such a colossal blunder. Didn’t they do their basic arithmetic? If they didn’t know how to do basic arithmetic they should have at least done their basic readings. For example, the headline of the article published in The Straits Times in January 2018 was “Singapore, Sri Lanka sign FTA, annual savings of $10m expected”.
Anyway, as Sri Lanka’s chief negotiator reiterated at the COPF meeting that “…. since 99% of the tariffs in Singapore have zero rates of duty, Sri Lanka has agreed on 80% tariff liberalisation over a period of 15 years while expecting Singapore investments to address the imbalance in trade,” let’s turn towards investment.
Investment from Singapore
In July 2018, speaking during the Parliamentary Debate on the FTA this is what Minister Malik Samarawickrama stated on investment from Singapore, “Already, thanks to this FTA, in just the past two-and-a-half months since the agreement came into effect we have received a proposal from Singapore for investment amounting to $ 14.8 billion in an oil refinery for export of petroleum products. In addition, we have proposals for a steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million), sugar refinery ($ 200 million). This adds up to more than $ 16.05 billion in the pipeline on these projects alone.
And all of these projects will create thousands of more jobs for our people. In principle approval has already been granted by the BOI and the investors are awaiting the release of land the environmental approvals to commence the project.
I request the Opposition and those with vested interests to change their narrow-minded thinking and join us to develop our country. We must always look at what is best for the whole community, not just the few who may oppose. We owe it to our people to courageously take decisions that will change their lives for the better.”
According to the media report I quoted earlier, speaking at the Committee on Public Finance (COPF) Chief Negotiator Weerasinghe has admitted that Sri Lanka was not happy with overall Singapore investments that have come in the past few years in return for the trade liberalisation under the Singapore-Sri Lanka Free Trade Agreement. He has added that between 2021 and 2023 the total investment from Singapore had been around $162 million!
What happened to those projects worth $16 billion negotiated, thanks to the SLSFTA, in just the two-and-a-half months after the agreement came into effect and approved by the BOI? I do not know about the steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million) and sugar refinery ($ 200 million).
However, story of the multibillion-dollar investment in the Petroleum Refinery unfolded in a manner that would qualify it as the best fairy tale with false promises presented by our politicians and the officials, prior to 2019 elections.
Though many Sri Lankans got to know, through the media which repeatedly highlighted a plethora of issues surrounding the project and the questionable credentials of the Singaporean investor, the construction work on the Mirrijiwela Oil Refinery along with the cement factory began on the24th of March 2019 with a bang and Minister Ranil Wickremesinghe and his ministers along with the foreign and local dignitaries laid the foundation stones.
That was few months before the 2019 Presidential elections. Inaugurating the construction work Prime Minister Ranil Wickremesinghe said the projects will create thousands of job opportunities in the area and surrounding districts.
The oil refinery, which was to be built over 200 acres of land, with the capacity to refine 200,000 barrels of crude oil per day, was to generate US$7 billion of exports and create 1,500 direct and 3,000 indirect jobs. The construction of the refinery was to be completed in 44 months. Four years later, in August 2023 the Cabinet of Ministers approved the proposal presented by President Ranil Wickremesinghe to cancel the agreement with the investors of the refinery as the project has not been implemented! Can they explain to the country how much money was wasted to produce that fairy tale?
It is obvious that the President, ministers, and officials had made huge blunders and had deliberately misled the public and the parliament on the revenue loss and potential investment from SLSFTA with fairy tales and false promises.
As the president himself said, a country cannot be developed by making false promises or with fairy tales and these false promises and fairy tales had bankrupted the country. “Unfortunately, many segments of the population have not come to realize this yet”.
(The writer, a specialist and an activist on trade and development issues . )
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