Complications in the diagnosis of Sars-CoV-2 disease (Covid-19) in fully vaccinated patients. Homicide by omission.

A former colleague, vaccinated twice with an mRNA vaccine in compliance with all guidelines, developed a sore throat, malaise, and aching limbs 5 months after the second dose (with enough, just minimally decreased neutralizing antibodies just before infection), which turned into a dry cough and other clinically relevant symptoms within 24 hours. Three of four PCR and/or RT-PCR tests were negative, as were four of five antigen tests of different reputable manufacturers. After an intensive search and consultation of an external colleague, the reason was found: a small focus of Sars-CoV-2 in the right sinus in a case of reduced ventilation due to a slightly curved nasal septum. With clearing the local virus cluster the patient began to recover slowly. Consequence: in persistent mild Covid-19 disease, even in vaccinated patients, focal viral reservoirs should be searched for as the might play a role in “long Covid” as well.