"I took it off most of the time 'cause I felt comfortable": unmasking, trusted others, and lessons learned from a coronavirus disease 2019 reinfection: a case report

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 reinfection prevalence is unknown. It is essential to understand reinfection symptoms and, importantly, the lived experience.

Case presentation: Case study design is the best method for understanding this contemporary pandemic and rare occurrence of reinfections. A 19-year-old White Non-Hispanic woman presented with presumed severe acute respiratory syndrome coronavirus 2 reinfection 6 weeks after initially mild symptomatic infection and consistent repeat negative results. Real-time reverse-transcription polymerase chain reaction from saliva was used for detection. Twice-weekly saliva samples were collected (a) before initial infection, (b) resumed on day 10 after initial infection until reinfection was detected, and (c) resumed on day 10 post-reinfection. A 1.5-hour virtual interview was conducted, transcribed, and independently analyzed by two researchers. Four themes emerged: (1) perceived invincibility or inevitability and subsequent immunity increases risk of transmission via inconsistent preventive behaviors; (2) normalcy desires, trusted others, and implicit social pressures to not wear masks and distance increase one's coronavirus disease 2019 risk; (3) physical symptoms are more severe with reinfection compared with first infection; and (4) mental health sequelae (trauma and stigma) are more severe and enduring than physical health outcomes.

Conclusions: Unmasked social interactions contradicting public health recommendations were rationalized by social circle members with heavy reliance on feeling asymptomatic, lacking a positive test (testing negative or not testing), or attributing symptoms to allergies. Stigma of testing positive and consequences of not conforming to social group behaviors is overwhelming and creates pressure to take risks. This case study provides insights and lessons learned relevant for public health messaging and continued preventive behaviors.

Keywords: COVID-19; Case report; Decision-making; Risk-taking; Social pressure; Stigma.