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Journal of Infection https://www.journalofinfection.com/action/showPdf?pii=S0163-4453%2820%2930781-7 Pre-proof, accepted manuscript Main points Whether SARS-CoV-2 infection confers immunity to reinfection is uncertain The ‘second wave’ of transmission offered an opportunity to examine this We observed no symptomatic reinfections in a cohort of healthcare workers This apparent immunity to re-infection was maintained for at least 6 months Further studies are required to define immunological mechanism(s) and durability Also Immunity to seasonal coronaviruses is (probably) maintained for up to 12 months The study N = 11,103 healthcare workers, documented evidence of previous infection status First wave March to April 2020 Second wave October to November 2020 Newcastle and North Tyne RT-PCR testing, all HCWs with symptoms, since early March 2020 Extensive IgG antibody testing, 937 / 11,103 Infected group N = 1,038, with evidence of previous infection (positive PCR and/or Ab) Non infected group N = 10,137 without (negative Ab, without positive PCR) Endpoint analysis, symptomatic SARS-CoV-2 infection Up to 20th Nov 2020 2,243 HCWs underwent PCR testing for symptoms 128 had previous confirmed SARS-CoV-2 infection 2,115 had not had previous infection In those previously infected, median of 173 (IQR: 162-229) days from first positive PCR/antibody result Previous infection group Test positivity rates, 0% (0 out of 128) No previous infection group Test positivity rates, 13.7% (290 out of 2,115) (less than 0.0001 2 test) One in 10,000 Asymptomatic PCR screening N = 481 HCWs With past infection N = 106 Positivity rate = 0% (0 out of 106) Without past infection N = 375 Positivity rate = 5.9% (22 out of 375) Conclusion Immunity is maintained for at least 6 months Infection appears to result in protection against symptomatic infection in working age adults, at least in the short term. This is consistent with The low rates of reinfection reported in the literature The reported ability of vaccines to protect with high efficacy against symptomatic SARS-CoV-2

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