September 16, 2025, 1:03 pm | Read time: 4 minutes
There are now numerous cases of long-lasting aftereffects of a COVID-19 infection. These are referred to as long COVID symptoms, which continue to trouble those affected even after recovery. However, the story of a man recently covered in a scientific report is unique. The patient suffered from an acute COVID-19 infection for about 750 days, which is more than two years. This gives him an unfortunate record. FITBOOK author Laura Pomer delved deeper into the topic and spoke with the study leader and an external expert.
The Longest Case of an Acute COVID-19 Infection Worldwide
The case study documents the longest known SARS-CoV-2 case to date.1 The patient suffered from a coronavirus infection for more than two years without interruption. It was the same infection the entire time—not multiple new infections. The aim of the study was to trace how the virus developed and changed in the body during this exceptionally long period.
The reason the pathogen could survive and adapt in the body for so long was primarily due to the advanced HIV disease of the 41-year-old patient, which had severely weakened his immune system. However, such persistent infections may not only have implications for the vulnerable patients themselves. The authors also aimed to determine whether the changes might pose a threat to others.
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Details of the Study
The team led by study author Dr. Bill Hanage assumes that the patient contracted his consequential COVID-19 infection in May 2020. By March 2021, he had already been suffering from the disease for about ten months. Between that time and July 2022, researchers took a total of eight throat swabs. During this period, the patient had not received HIV therapy and could not access medical care for his COVID-19 symptoms (respiratory symptoms, headaches, body aches, and weakness).
The researchers subjected the throat samples to genetic analyses. It was found that the virus followed a uniform evolutionary path in the patient’s body. In technical terms, this is referred to as a monophyletic cluster, meaning all viruses descended from a single original virus strain. They continued to evolve in the patient’s body without a new variant being introduced from outside.
During the course of the infection, scientists detected 68 so-called “consensus” mutations and 67 “subconsensus” mutations. “Consensus” mutations are changes that occur in all virus copies of the sample, thus prevailing throughout the virus population. “Subconsensus” mutations, on the other hand, appear only in part of the virus population. Their presence suggests, according to the authors, that different virus variants existed simultaneously in the patient’s body and competed with each other.
Spike Protein Mutations That Matched Later Omicron Variant
The researchers find it particularly interesting that some mutations occurred at locations in the virus genome that later became significant in connection with the Omicron variants. In the spike protein, there were ten mutations at exactly the same positions that later became relevant for Omicron. Nine of these ten mutations were already known before November 2021.
Furthermore, the researchers note that many of the substitution sites found were rare in global databases. Therefore, it is assumed that these mutations arose directly in the patient’s body. They were likely due to the virus’s specific adaptation to this one host. In other words, it had probably adapted so strongly to the host’s body that it lost the ability to infect other people.
Significance of the Findings
The results show how the SARS-CoV-2 virus can evolve over a long period in a single person. They also provide insights into how new virus variants might emerge. In layman’s terms, such persistent infections could serve as breeding grounds for new virus variants. “The study adds to the evidence that many, if not all, major variants have arisen from such persistent infections,” said study leader Dr. Bill Hanage to FITBOOK. At the same time, he emphasizes that the vast majority of similarly prolonged infections do not produce such variants.
In any case, the observations are a cautionary example of the importance of treating chronic infections. Severely immunocompromised patients must be closely monitored in order to also reduce potential risks to the general population. It is of utmost importance to raise awareness among doctors that such persistent infections exist. “Monitoring should be improved, especially in regions where it is currently inadequate,” warns Dr. Hanage. Of course, the appropriate treatment depends on the individual case and the reasons for the immunosuppression. In the case of HIV, it is known that effective antiretroviral therapy can strengthen the immune system and help fight viruses more effectively. The patient in the case report had not received such therapy. “There are also several effective antiviral therapies against the coronavirus,” the researcher emphasises. The patient’s suffering could likely have been shortened.