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This survivor may have had Covid-19 twice

(CNN) Covid-19 first struck Jordan Josey around St. Patrick's Day, right as social distancing guidelines were rolling out across the country.

The 29-year-old lawyer from Macon, Georgia, was sick through Easter, before eventually clearing the coronavirus, developing antibodies and gradually building up his stamina again by early May.

He donated convalescent plasma on May 18 and received a letter two weeks later confirming that he was positive for coronavirus antibodies. A swab test around that time came back negative for the virus itself.

Life felt like it was returning to normal. He started jogging again and by late June, he felt confident enough to visit his family in South Carolina, where they played tennis and ventured out on a lake in a boat.

But then inexplicably he came down with Covid-19 symptoms again just before the Fourth of July.

He tested positive again

Josey's second round of Covid-19 rendered him almost entirely inactive for four weeks.

He and his internist aren't sure whether the virus was never fully defeated or whether he may have gotten reinfected, perhaps during his weekend trip to see his folks.

His doctor declined to comment for this story, citing concerns about patient privacy.

Whatever the underlying cause, Covid-19 rocked his world again. The disease stole his lung stamina again, but it also presented with symptoms that differed from his first case. It caused fatigue so severe his doctors tested him for mononucleosis. He lost his appetite and dropped weight.

"I couldn't walk up a flight of stairs or go for a walk in my neighborhood," he said.

He spent six weeks in total lockdown quarantine, fearful of passing the virus to others. Fortunately, none of the 15 or 20 people he was exposed to in late June tested positive.

"I joked (to the doctors) when I tested positive round two. I was like, 'Do y'all want to do a case study on me now?' And they were like, 'Probably.'"

Jordan Josey still suffers from shortness of breath.

Josey continued working in his job practicing law, but only because he could accomplish tasks much of the time while lying down in bed using his laptop. He worried, however, how people waiting tables or landscaping yards might have fared in similar situations, working on their feet all day without access to short-term disability protections.

"I would have lost my job," he said.

But his own case grew more complicated. He tested positive for antinuclear antibodies, a marker often associated with lupus. His lymph nodes visibly swelled around his neck.

A CT scan of his lungs didn't show any scarring, but he was still having trouble taking a full breath.

"In July, I would have been worn out just by talking. I wouldn't have been able to make it through the length of this phone conversation," he said in an interview. "I'm still on steroid inhalers to help keep the shortness of breath at bay."

His various treatments and supplies, including nebulizers, inhalers, breathing medications and a spirometer, keep multiplying.

"I literally told my wife I'm bound to just create a box that's like 'Covid treatment kit' or something," he said. "Let's not get rid of the stuff because I may need to pull it out again for a third time."

Science still emerging around possible reinfections

The fevers, shortness of breath and aches of Josey's apparent second case of Covid-19 were similar to what he felt after he first tested positive and developed his original course of symptoms.

Cases like his are rare.

"People are beginning to question if indeed reinfection does happen not too long after infection," said Dr. Susan Kline, a professor of medicine in the division of infectious diseases and international medicine at the University of Minnesota Medical School. "These reports that have come out have us questioning how many others this has happened to."

It can be common for some families of viruses to go latent and then reactivate. For instance, the varicella-zoster virus can cause chickenpox in children, go dormant and then reactivate as herpes zoster, or shingles, which causes painful rashes in adults.

Previous coronaviruses, such as SARS, MERS and seasonal cold bugs, tended not to do that, however. And it seemed unlikely SARS-CoV-2 would reactivate in previously sick people, though the science is still emerging, Kline explained.

"I don't think we have good evidence for that, but we can't rule out that possibility," she said.

Antibodies may not last long

The US Centers for Disease Control and Prevention in August issued new guidance explaining that those who test positive for coronavirus do not need to quarantine or get retested for up to three months as long as they do not develop symptoms again. In many cases, it's unclear if someone actually got Covid-19 twice.

The recommendations are "based on the latest science about COVID-19 showing that people can continue to test positive for up to 3 months after diagnosis and not be infectious to others," CDC spokesperson said in August.

The CDC's guidance came after a number of scientific studies produced evidence that coronavirus immunity may not be long-lasting.

They make Josey question what's next in his life.

"If you operate under that three-month rule, do I have any immunity right now, if any, and how long can I expect that to last?" he wondered. "I know that my antibody time from round two is probably coming to a close."

Antibodies may begin to fade just 20 to 30 days after Covid-19 symptoms first appear, one study released in July showed.

Recently, a man in Hong Kong tested positive twice, becoming the world's first officially documented case of coronavirus reinfection after scientists sequenced the genomes of the viral strains that sickened him.

And scientists from the University of Nevada at Reno and the Nevada State Public Health Laboratory reported on August 28 in a pre-print study that a 25-year-old man had tested positive with two distinctly different coronavirus infections.

He became the first official US case of reinfection.

In order to prove that Josey's second case of Covid-19 is also a distinct reinfection, scientists would need to perform genetic sequencing of virus samples to see if his second Covid-19 case emerged from a different virus strain, Kline said.

Remaining hopeful

To connect with others, he joined Survivor Corps, an online community for coronavirus survivors with now over 100,000 members sharing their experiences.

He is almost entirely back to normal now, but being rocked by illness is seared in his memory.

"When I look back on the year, like I'll be extremely thankful because I do have my life and I've got my health. I've still got a job, and I still have a place to live," Josey said. "A lot of people have been impacted by this and lost everything or lost a loved one."

Exasperated by the twists and turns of his journey, and unable to sleep one night in July, he posted in the Survivor Corps group. Responses poured in with other survivors offering encouragement and retelling what they were going through.

He felt buoyed.

"I try to stay patient and be grateful. They keep me grounded," he said. "I haven't felt isolated or alone."