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What isn't really debated is the emergence of human variant incubators.. and top of the list are the immunocompromised:

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Kemp and colleagues analyzed SARS-CoV-2 sequences at 23 time points over 101 days.4 Viral diversification was limited during the first 2 months but subsequently increased after the patient received an infusion of convalescent plasma on days 63 and 65, leading to rapid shifts in the frequency of the different variants

Truong et al. recently described the cases of three patients with B-cell acute lymphoblastic leukemia (including one with B-cell aplasia) after the receipt of chimeric antigen receptor (CAR) T cells. These patients were found to have multiple escape variants over the course of persistent Covid-19 infection.

...Such convergent mutations have been reported in both immunocompetent and immunosuppressed populations.
https://www.nejm.org/doi/full/10.1056/NEJMsb2104756

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There is one other documented case of prolonged infection in a person with HIV -in that case the person was ART-naïve with profound immunosuppression and genome sequencing revealed only a single emergent mutation in spike (T719I) at day 53
https://www.medrxiv.org/content/10.1101/2021....228v1.full

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