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The first time this Seattle-area man thought he would die from COVID-19 was in late March. Chest pounding and fever rising, he collapsed in his nursing home room.

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鈥淟aid there on the floor for like 45 minutes,鈥� said the man, whose identity he’s chosen to keep anonymous. 鈥淎nd then I woke up. Couldn鈥檛 get up. I turned on my side as much as I could so I could have something to draw my breath in.鈥�

His heart pumped at 120 beats per minute, approaching dangerous levels for a man in his 60s who also suffers from asthma, emphysema, and chronic obstructive pulmonary disease.

鈥淚 could actually see my chest beating, moving from this,鈥� he said. 鈥淎t that point I鈥檓 terrified. I was terrified. It鈥檚 like what鈥檚 going on with me. Why am I overheated and why am I sweating?鈥�

Medics rushed him to Swedish. Doctors hooked him up with oxygen and shocked his heart to restore its normal rhythm. A nasal swab confirmed the coronavirus had latched onto his lungs, infecting them with COVID-19.

Other patients in the hospital were testing positive too.

鈥淎t that point, I heard a doctor yell, 鈥楨verybody mask up. Mask up.鈥� And, that was basically the beginning of this pandemic in Seattle.鈥�

It took more than 50 days, multiple rounds of steroids, and inhalers to get him out of the hospital. He returned to normal life for some time. Then in July, about four months after his first COVID infection, he started gasping for air again.

鈥淚鈥檓 like getting sick. And I鈥檓 feeling like the very first time I had it.鈥�

He went back to Swedish, where infectious disease physician, Doctor Jason Goldman, examined him.

鈥淚 had an immediate clinical suspicion that he was re-infected because of the time that had passed,鈥� Dr. Goldman said.

through genetic sequencing, making him one of about 15 confirmed cases in the world. It showed the man caught two different versions of the coronavirus. The first one in March resembled the original strain from Wuhan, China. In July, he was infected with a slightly evolved strain that came over from Europe.

鈥淚 think this is something that most experts were anticipating. I thought that in Washington state, where we had some of the first infections in the country, we might see the first re-infections as natural immunity would start to wane.鈥�

Dr. Goldman prescribed the patient dexamethasone, a steroid that helped quiet inflammation in his airwaves. He also received remdesivir, the antiviral medication recently approved by the Food and Drug Administration as a treatment for COVID-19.

It seems the man鈥檚 immune system was also better prepared, Dr. Goldman said, leading to a less intense infection.

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鈥淓ven though the patient got sick again, the virus was detectable again — it was a totally different strain — the immune system at least worked enough that the disease was not so severe the second time around,鈥� Dr. Goldman said. 鈥淭he patient recuperated quite quickly.鈥�

A handful of re-infected patients, however, have had different outcomes. A 25-year-old-man in Nevada was sicker the second time. An 89-year-old woman in the Netherlands, who was also undergoing chemotherapy, died during her second bout with COVID.

鈥淲hat鈥檚 happening in these one or two cases where the second infection is more severe? That remains to be seen,鈥� Dr. Goldman said. 鈥淏ecause there are so few cases around the world where this is happening, I don鈥檛 think we have a real thorough understanding of the patterns.鈥�

The Swedish Hospital system is investigating at least five more local cases of possible re-infection, and there could be dozens more across the state. University of Washington Medicine Virologist Dr. Alex Greninger is studying some of them, including the case of the Seattle patient.

鈥淪ome of these re-infections studied really do indicate that even if you have been infected鈥� I think there鈥檚 a low chance, but there鈥檚 a chance that you still are at risk,鈥� Dr. Greninger said. 鈥淓ven if you have some immunity, that immunity declines over time.鈥�

Greninger said it also raises some concerns about how effective a vaccine will be. Overall, he still feels good about the current clinical trials.

鈥淔rom the phase 1, phase 2 studies things look good there,鈥� Dr. Goldman said. 鈥淚 think we should feel positive about the vaccine. I think the question will always be, 鈥榟ow long that immunity lasts?鈥欌��

Re-infected survivors are a part of finding that answer.