More Americans are catching the coronavirus for the second, third or even fourth time. And each time someone contracts COVID-19, they are rolling the dice on whether they will come down with serious health issues.
It’s a reinfection loop that is seizing the country with no immediate end in sight, and it is driven by a coronavirus variant scene that continues to quickly change.
The majority of Americans have had COVID-19 at some point in time, according to estimates from the Centers for Disease Control and Prevention. But with more than 120,000 new infections reported on average each day – a number that is sure to be a significant undercount as many rely on at-home tests – the pool of Americans who haven’t gotten COVID-19 is getting smaller while the number of Americans who are getting reinfected grows.
Of course, COVID-19 reinfection wouldn’t be a major issue if it did not come with additional health risks. But that isn’t the case.
Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis, says he decided to study reinfections after more of his patients started reporting getting COVID-19 again, and he wondered if getting reinfected adds any adverse health risks.
“The answer is absolutely, absolutely yes,” says Al-Aly, who is also the chief of research and development at the Veterans Affairs St. Louis Health Care System. “People need to really be aware that if they’ve previously been infected, it's still worth it to protect themselves from or to reduce the risk of getting reinfected.”
In a recent study, which hasn’t been peer reviewed yet, Al-Aly and other researchers found that people who had been reinfected had a greater chance of death, hospitalization, lung and heart problems, diabetes, fatigue, digestive and kidney disorders and mental health issues within six months of their last infection than those who had been infected once.
“Even if you've had it, having it again is certainly no cakewalk and absolutely adds risk,” Al-Aly says.
The study, which authors said was the first to characterize the health risks of COVID-19 reinfection to their knowledge, looked at health records from 250,000 veterans who had one COVID-19 infection and nearly 39,000 people who had one or more reinfection.
Among those with reinfections, roughly 36,400 people had two COVID-19 infections, about 2,260 had COVID-19 three times, and 246 had been infected four or more times.
Al-Aly says that hopefully the findings “will serve as a wake-up call to accelerate development of new vaccines that really reduce transmission.”
“I think more needs to be done here to gain a better and a deeper understanding of the situation of reinfection and health risks associated with this,” he adds.
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Hopes of Herd Immunity Fade
Two factors are required for traditional herd immunity, according to leading infectious disease expert Anthony Fauci. First, that the virus doesn’t change much, and second, that immunity is long-lasting. Neither of these has proven to be true of COVID-19.
“The big stumbling block with COVID is that history has already shown us: We've had five separate variants with five separate surges, and the immunity to coronaviruses is very self-limited and fleeting,” Fauci recently told the National Press Foundation.
Since the omicron peak in the U.S. in January, three different omicron subvariants emerged and quickly rose to become the dominant strains circulating. The most recent subvariant to rise to dominance, BA.5, is considered to be the most transmissible yet. Experts warn that those who contracted the original omicron strain over the winter are now susceptible to BA.5.
The coronavirus has “turned out to be a very clever virus in evolving and collecting mutations,” says Thomas Murray, an associate professor at the Yale University School of Medicine.
“As long as you have strains circulating that mutate to not be killed by the antibodies that you made from your previous infection, then you're not going to be able to achieve that herd immunity,” Murray says.
Though hopes for herd immunity are fading and infections and hospitalizations are increasing, many Americans seem to have moved on from COVID-19. Fewer Americans consider COVID-19 to be a major threat to public health, but an increasing number of people consider it to be a minor threat or not a threat at all, according to a recent poll.
“Even though we're still seeing plenty of people hospitalized and plenty of severe disease, it does seem like there's more of an acceptance that this is going to be with us for the long term,” Murray says.
Still, experts agree that the number of cases, deaths and hospitalizations are currently too high.
“Contrary to the myth that we are sliding into a comfortable evolutionary relationship with a common-cold-like, friendly virus, this is more like being trapped on a rollercoaster in a horror film,” Danny Altmann, a professor of immunology at Imperial College London, wrote in an opinion article this month titled “Where’s the herd immunity?”
“There’s nothing cold-like or friendly about a large part of the workforce needing significant absences from work, feeling awful and sometimes getting reinfected over and over again, just weeks apart,” Altmann continued.
So with reinfections becoming more common, what is the endgame for COVID-19?
“As long as the virus keeps evolving, then herd immunity is going to be very difficult to achieve, unless somebody can come up with a vaccine that protects against multiple variants, including the new ones that evolve,” Murray says.
Updated Vaccines Offer Glimmer of Hope
Food and Drug Administration experts last month told vaccine makers to update their shots as U.S. health officials plan to roll out the new boosters in the fall, pending regulatory authorization.
But vaccine trends don’t favor a high appetite for the shots.
According to CDC data, just 48% of people who are fully vaccinated have gotten their booster shot, and only 27% of those with their first booster shot have gotten a second.
Still, some are hopeful that with the right messaging, more people can be convinced to get the omicron-specific shots if they do gain authorization.
“If there is good evidence that these help more with the circulating variants than the existing available vaccines, I'm very hopeful that message can be portrayed and get the word out,” Murray says.
Moving forward, many have predicted that COVID-19 vaccines could become a yearly shot that is geared toward whatever variants are circulating – similar to the influenza vaccine.
“For that to happen, though, what you need to achieve is seasonality, or some sort of pattern,” Murray says. “And we just haven't gotten there yet.”
Instead, the U.S. is in a “transition period,” Murray says, in which it is waiting for such shots. In the meantime, more people will get infected with BA.5, but it isn’t likely that mitigation measures will come back in a big way.
Even with elevated infections and hospitalizations, Americans have shown little interest in bringing back mitigation measures like masking, despite the CDC recommending the majority of Americans consider the measure while in indoor public spaces.
“One of the challenges that we all face is that two and a half years into this … everybody is exhausted and sick and tired of COVID,” Murray says. “Unless you have significant changes, it's going to be really difficult to get people to start routinely masking again in indoor spaces. I just don't think there's an appetite for it.”
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