72-YEAR-OLD BATTLED COVID FOR 613 DAYS ACCUMULATING OVER 50 MUTATIONS; KNOW SIGNS OF PERSISTENT INFECTION

As global health authorities start re-evaluating the changing course of the coronavirus, concerns are rising over the emerging surges in new cases reported in parts of Asia. India, though not experiencing a wave, saw a slight rise in active COVID-19 cases last week, prompting renewed caution in major southern states.

In 2025, COVID-19 pandemic has largely transitioned from being a global emergency to a controlled endemic to some extent, but the virus still continues to be a persistent health concern. As per the Union Health Ministry, up to mid-May 2025, there are 257 active COVID-19 cases in different states, mainly Kerala, Tamil Nadu, and Maharashtra.

As the world continues to navigate the evolving landscape of COVID-19, remarkable cases of persistent infections provide critical insights into the virus’s behavior, especially in vulnerable individuals. One such remarkable case is that of a 72-year-old Dutch man who fought COVID-19 for a record 613 days, during which time the virus raked up more than 50 mutations. This rare medical experience has lessons to teach the world about global health, particularly when new strains and long-term infections test existing protocols.

Longest Documented COVID-19 Infection

In February 2022, amidst the worldwide spread of the Omicron variant, a 72-year-old male with underlying hematological disorders was admitted to Amsterdam University Medical Center. He was diagnosed with myelodysplastic/myeloproliferative overlap syndrome and lymphoma and had a severely impaired immune system. Although he had received three doses of Moderna mRNA vaccines, his body did not develop any detectable antibodies, most probably because of his cancer therapies, especially the immunosuppressive medication rituximab.

Throughout the subsequent 613 days, the man continuously tested positive for COVID-19, so his case became the longest uninterrupted SARS-CoV-2 infection on record. Throughout those days, the virus far developed within him, garnering over 50 new mutations, an exceptionally large quantity relative to the typical infection's approximate two per month mutation average.

What Are Persistent COVID-19 Infections?

Chronic infections, particularly among immunocompromised individuals, provide a context where the virus can continuously replicate and evolve. This guy's chronic infection gave Omicron the opportunity to evolve a distinct set of mutations different from what is normally observed in other cases of COVID. These mutations may assist the virus in evading immune mechanisms, thus rendering such infections a probable source of new variants of concern.

Although mutations are a natural consequence of viral replication, the widespread changes seen in this patient are a reminder of how long-term infection can serve as an incubator for evolutionary changes in the virus. Researchers closely follow such patients to learn how SARS-CoV-2 could evolve and inform treatments and prevention efforts.

The patient underwent multiple COVID-19 treatments, including sotrovimab, a monoclonal antibody authorized by European regulators. Unfortunately, none produced a significant clinical response, partly because he could not pause his cancer therapies that suppressed his immune system further. Despite initial respiratory symptoms like cough and low oxygen levels, his COVID symptoms eventually subsided, yet the virus persisted in his system.

He also experienced complications like bacterial pneumonia that necessitated further hospitalization. Interestingly, his death occurred as a result of complications of his pre-existing blood disorders and not because of COVID-19 itself.

Signs of Persistent COVID-19 Infection

Chronic COVID-19 infection must be entertained in prolonged detection of the virus, particularly in immunocompromised patients or those on immunosuppressive treatments. Presentations include persistent positive COVID testing after the usual recovery time, repeated respiratory symptoms, or secondary infections such as pneumonia.

Physicians should be watchful for such patients, as long-term infections affect not only individual cases but also create threats for viral mutation and community spread.

Distinguishing and recognizing chronic COVID infections is important for controlling the pandemic's subsequent chapters, avoiding the development of new variants, and protecting international health.

2025-05-20T13:06:57Z