Today, Explained - How often can you get Covid?

Episode Date: June 1, 2022

Does your immunity still last for months? We asked a researcher who has been studying omicron reinfections. This episode was produced by Jon Ehrens, edited by Matthew Collette, fact-checked by Laura Bullard, engineered by Paul Mounsey, and hosted by Sean Rameswaram. Transcript at vox.com/todayexplained   Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

Okay, so I got COVID about a month ago, and I wouldn't recommend it, but I was relieved that it meant I'd essentially be immune for the summer. Right? Right? That's how it works? No one seems to be sure anymore. Like some people tell me, oh yeah man, you're good for three months. And other people tell me, I know someone who got it again in six weeks.

And some people just laugh at me and are like, okay, yeah, you're immune for the summer, whatever you say, guy. I don't know what to believe anymore. Or who to believe anymore. So, on Today Explained, we're going to ask a scientist who's been studying Omicron reinfections in South Africa, no less, where Omicron was first reported to the World Health Organization. Answers, at least as far as we know, are coming up. Get groceries delivered across the GTA from Real Canadian Superstore with PC Express. Shop online for super prices and super savings. Try it today and get up to $75 in PC Optimum Points.

Visit Superstore.ca to get started. All right, today explained Ramesh Phirm. I felt some degree of relief once I conquered COVID-19 about a month ago because I felt like, okay, maybe now I can go out in the world and not sweat this thing for a while. And I just want to acknowledge right out of the gate that not everyone feels that way. My name is Andy Kindler. I'm a stand-up comedian.

Andy, for example, who's been in quarantine since this started back in 2020. From March 11th on, I've been in my house in Los Angeles, completely masked up. I'm 65 years old. My wife is around the same age. She has asthma. I don't want to catch any version of COVID. I don't want short COVID. I don't want intermittent COVID. I want no form of COVID. I mean, just to be clear here, I didn't want COVID either, but I did go see a friend's band when they were on tour

and I put myself in a situation where I could get COVID and I did. Andy's not risking it. We don't know what the long-term effects of all these things are going to be. And so, you know, like I told my wife, I don't want to fly to Cleveland to do a two-night gig and make $2,000. Well, maybe I should say I make more, $20,000, and then come back and bring a short form of COVID for her. And Andy has found a way to sustain his career without leaving the house.

I am, I do cameos. You can't get sick doing cameos. I do a voiceover on Bob's Burgers. You mean, do I have a medicine cabinet full of corpse moisturizers? Ooh. Yes. Do they make my skin soft as a baby?

You decide. It's not greasy either. If I do three or four episodes of Bob's Burgers a year, of course, now that that's going to cause pressure on the people there to give me three or four. I'm being murdered to death. And I have pensions. I have pensions. I am very old.

And then I have Social Security. Who doesn't want to become 70 in this house? Andy looks at people who've sort of reentered society, gone back to normal, and he's still kind of astonished. I was watching poker, world poker, and these famous poker players are sitting right next to each other.

Are they insane? I mean, I can think of a few things they might be doing. One, they might've already had COVID like me, so they are not presently worried about getting COVID again because they may have had it recently. Two, they might need the money. Three, they might be very sick of staying at home and willing to take the risk.

Four, they might not have an immunocompromised wife. I'm all over it. I'm totally with them. They want to do that. They've all agreed. All of these idiots have, no, I'm just kidding. All of these monsters have agreed to,

first of all, I think the lesson from COVID is that we should not be in proximity to other people at any point. Wow. But some people live for that, Andy. Some people just want to be around other people. There's social people out there.

I'm on a plane. What do you do for a living? She's breathing. Oh, I go around. I travel around. I tongue kiss people for a living. You're going to be on a plane. You get on a plane.

You get off the plane. You're going to have COVID. Or if you hadn't have it, you're going to have COVID. But look who has it. Andy Kindler and his amazing wife. This is the wrong attitude. Okay. Not sure there's anything we can discover that's going to convince Andy Kindler and his amazing wife to reenter society.

But for everyone who is in some way, shape, or form, we wanted to answer one essential question. Maybe two. How often can we get COVID after we've had it? And how much has the answer changed with the Omicron variants? I'm Juliet Pulliam. I'm the director of SESIMA, which is the South African Center for Epidemiological Modeling and Analysis. And here in the room with me is Leroy, my dog, who you might hear in the background. We decided to ask a scientist, and not just any scientist, a scientist in South Africa,

where Omicron was first reported to the World Health Organization. Yes, I'm here in South Africa in Stellenbosch, which is outside of Cape Town. Juliet and her team have been studying reinfections for because it was something that was a big question at the time, and there were laboratory assays that were suggesting that beta was better at reinfecting people than the earlier variants. So we have actually been monitoring for reinfections since January of 2021, and we developed a couple of methodologies that would allow us to track at the population level the rate of reinfections and to look at that through time and to see how it was changing. We watched it throughout the tail end of the beta wave. We watched the reinfections all through the delta wave. And we basically were seeing that the reinfection rate remained pretty much constant when you account for things like the fact that

there were more and more people eligible for reinfection because more people had been infected. And then when Omicron came along, pretty immediately we saw a very different story, and we saw that there were a lot of reinfections and a lot more than were expected. Did you find an answer to this question we've been asking ourselves for over two years now? How often can I get COVID-19? So we found that reinfections were much more common with the Omicron variant than with the previous variants. And one of the other things that we found that reinfections were much more common with the Omicron variant than with the previous variants. And one of the other things that we found that was really surprising to me, at least at the time, was that people were getting reinfected multiple times. So there were individuals in our study who we identified as having up to four infections.

Up to four? Yeah. So we can say that people were getting reinfected at a much higher rate during our Omicron wave in December than in the prior waves. Omicron is much better at reinfecting people than the prior variants. There are some other studies that suggest that reinfections do occur within 60 days. 60 days. 60 days. The other thing that I think is really important and isn't directly in our study is that the population level immunity in South Africa is currently very high.

Studies that were done right before the Omicron wave showed that there were about 70% of the population had immunity from either from vaccination or from natural infection. The studies that were done after the Omicron wave, so in mid-March, show that about 98% of the population seems to have some form of immunity to the virus. And yet we just experienced a large resurgence following that mid-March study, which suggests that reinfections or infections of vaccinated people is essentially

what's driving transmission within South Africa. Which certainly suggests that people are going to get Omicron multiple times. Yes. So it's not in the published study, but we have been continuing to monitor the reinfections. And we have definitely seen individuals who were infected in December who have been infected again in the last month or so. And that's all Omicron. It's probably different sub-lineages of Omicron, but it is people getting infected again with the same variant. And were the people in your study vaccinated and or boosted? Yeah, that's a great question. So when we started the study, there was no vaccination in the country, and it was rolled out sort of over the timeframe that we were monitoring the reinfections. By the time that Omicron came along, the total vaccination rate in the country, I think, was still less than 30%. So we aren't able to actually link the vaccination status to the reinfection status in the data set that we have. Okay, so this reinfection data isn't taking

vaccination status or booster status into account. Do we have any idea how long immunity lasts? Is there any consistency in your study? So I don't think we can say how long immunity lasts per se. There are other studies that have tried to address that. And the important thing that we can say from the South African experience is that the immunity that people have does appear to protect against severe disease. So we just had a fairly major resurgence. The hospitalizations barely came up, the deaths barely came up, but the case numbers were pretty high. We attribute that to the fact that we have this high level of population immunity. So probably about 85% of the population has been infected. And we also have a reasonable vaccination rate at this stage. And so combined, that equals a

very high level of population immunity. Do the cases of COVID become less severe with second, third, fourth infections? That's the really important question. And my feeling is yes. I think that we can see that in the population level data in South Africa and the fact that throughout the fourth wave, but also throughout this most recent resurgence, the hospitalizations and deaths have not gone up anywhere near as much as we would have expected. Okay, that's a lot of useful data. But I wonder what it means for how we ought to behave in the world. I mean, as someone who is much more informed than most, who did this study, but also is operating in society more than our friend Andy Kindler, let's say, if you were to get COVID this week, would you feel liberated for, you know, a couple of weeks after you recovered?

I'm sure if I were to get COVID this week, I would feel really crummy. I know, but in the following weeks, would you feel a sense of... Of protection? Of protection, of freedom to sort of live in the world and not worry about being reinfected. I guess I would be more confident than I am at the moment, not having been infected. At the same time, you know, when I have gotten boosted, I have felt more confident for a while after that as well. What surprised you most from the research you did?

The thing that surprised me the most originally was the fact that we were seeing people with more than two infections. What we're seeing now in South Africa is suggestive that we're going to be seeing this pattern for a long time because it doesn't seem that SARS-CoV-2 transmission has gone away, even though we have this high level of population immunity. It seems like SARS-CoV-2 transmission is doing just fine, even though we have this high level of population immunity. And I think that sort of gives us a hint as to what it's going to look like in the future. The evidence so far, to me, points to a high probability that most people are going to

get reinfected. I suspect that it's going to keep circulating, probably infecting people multiple times, possibly even infecting people multiple times in the course of a year, and that the severity of the disease will hopefully continue to be much less. And I think the really big question at this point is, what is the implication of reinfections for long COVID? And I don't think we have any data on that. The most surprising thing you found was that people can get COVID over and over again, even as much as four times. Yes. We do not know how long immunity lasts. In some cases, it might be 90 days. In some cases, it might be 60 days. It could be more than that. It could be less than that.

And it probably varies a lot. It does seem that subsequent cases of COVID are less severe. Yes. And it sounds like people should just expect to get reinfected. I think, yes, over the course of someone's lifetime, they should expect to have multiple SARS-CoV-2 infections. And if we're lucky, this continues to get less severe. Yes. And we have no idea what any of this means for long COVID still.

Exactly. But you know what? It's nice to hear that from a scientist and not just from like your friend who also got COVID two weeks ago. Right. Yeah, sure. It's been really helpful. I really appreciate it. Thank you for your time. Okay, sure thing. Last summer, we did a show

about where we might end up with this pandemic. And the guest more or less said this place we're at right now, reinfections, milder cases, was the ideal scenario, exactly where we wanted to be yeah well i think it's been pretty clear for a while now that this virus is not going to be eradicated or eliminated so it's not going to be like smallpox it's not going to be like polio or

measles we're going to be living with this virus for a really long time so this virus is going to be what people call endemic which means it's going to keep circulating. It might be another seasonal virus. So it might look something like the flu or the cold. It's probably going to be something that we hear about every year, but it's not necessarily something that's going to be like big news the way it is right now. In a moment, we're going to ask someone who studies viruses if she feels that way. Is this exactly where we want to be? It's Today Explained. Support for Today Explained comes from Ramp.

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to speak to an advisor free of charge. BetMGM operates pursuant to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. Today Explained, we're back. Dr. Juliet Pulliam in South Africa just told us we can get reinfected a lot with Omicron, like as much as four times, maybe more, maybe less.

We don't really know how long immunity lasts, but it does look like reinfections are less severe. And we were wondering how we should feel about that. Is this the ideal scenario? Is this where we wanted to land? Yeah, I think this is what we're talking about when we're eventually expecting a pandemic to become more of what we call an endemic. This is Dr. Deborah Fuller, professor of microbiology, University of Washington School of Medicine. She says we're not quite at that endemic stage yet. It's a state in which the virus's presence is kind of steady and predictable. Endemic doesn't necessarily mean that the disease is going to be rare or even necessarily mild. The infection rates could still be high. It's just that they're much more static and predictable. Right now, we're in a state where there's still a lot of unpredictability and

potentially new variants emerging that can cause outbreaks and some increases in hospitalization, we want to get to is at that level of predictability. And once we get to that point, then we can actually control that, for example, through potentially annual vaccinations, such as we have with the flu. Dr. Fuller is something of an expert in vaccines, so we asked her how we should be thinking about those older COVID vaccines many of us got in light of newer variants. People who are vaccinated are still getting Omicron, but then they have some Omicron immunity. Is that better than a vaccine since it's more recent? When you get vaccinated, the level of antibody you generate is much more consistent among the vaccinated people. When you get immunity as a

result of infection, those antibody titers can be highly variable with some people getting really robust responses and some people very low responses. I think there was a study that shows there can be over a 200-fold difference in the amount of antibody. And so somebody, you know, when you have a range of people who've been previously infected and they go out and say, hey, you know, now I'm immune, and then they get reinfected very quickly, they might have been an individual who developed very poor antibody responses to the first infection, making them more vulnerable to the second one. So those who are vaccinated are going to be at lower risk for reinfections than those who have gained immunity solely through infection and

reinfection. So broadly speaking, vaccination still gets you better antibody protection than just getting COVID. There is evidence that a combination of, say, if you were previously infected and then you got vaccinated, or if you were vaccinated and you got exposed, that that combination of sort of hybrid immunity is kind of what we're calling it, results in actually really robust responses and immunity that can potentially last longer and offer even better protection against the new variants that are emerging. So as we see breakthrough infections come through, we might actually see actually that is facilitating the development of enhanced immunity in the population as a whole as we start to see this combination or hyperimmunity emerge.

Okay, so the vaccines are still helping and they're working together with breakthrough infections to create an even better kind of immunity. Right. When we think about with the vaccines, they're very safe and effective. So it's really reassuring for those who are vaccinated. And in the rare cases that they do get a breakthrough, they're less likely to get issues like long COVID. So the vaccines are very effective. But one of the things we have to start thinking about is at the individual level. So you're vaccinated, and if you're relatively healthy and maybe not too old, even if you get a breakthrough infection, you come positive for COVID,

there's a lower likelihood of developing long COVID or symptoms that are going to cause long-term issues. The real issue comes more at the societal level because what we're trying to do is get a control of a pandemic. And if people who are vaccinated are still able to get these breakthrough infections because we have these new variants, then that potentially puts at risk

people who are immune compromised or elderly who don't necessarily respond as well to vaccination or whose immunity wanes much more quickly. And so as long as we have sort of this going on, then it can continue to perpetuate the virus and put at risk the possibility of a new variant emerging that completely dodges the immunity that has been induced by either prior infection or vaccination. And even with the amount of vaccine hesitancy we have in this country, will boosters that come out every year, even if only, what, 20, 30 percent of the population gets them,

will they still be effective enough to keep us in this place we want to be? You know, with the flu vaccine, we do see, as an example, we do see that annual flu vaccinations helps to reduce the incidence of infection and death rate. And yet every year, probably only about 50% of the population actually goes and gets a flu shot on a routine basis. So flu is different from coronavirus in the sense that the rate of vaccination will likely have to be higher for helping to control that disease as compared to flu. But it still kind of provides an example that you don't necessarily need 100% of the population getting their booster immunizations to be able to control.

If you get the majority of them, then you can be able to control that disease. So we opened the show with myself admitting that now that I got COVID a few weeks ago, and it sucked for about two or three days, but I'm lucky enough to be a healthy person, I feel this great sense of relief that I can reenter society. But then we spoke to this comedian, Andy Kindler, who I think represents a lot of people out there who don't necessarily feel that much relief right now because he lives with someone who has asthma and other people out there know or are immunocompromised people. What would you say to all those people who don't feel like this is ending over or any less anxiety-inducing at this particular juncture? The efforts are,

you know, are underway to try to make better vaccines, not just ones that will protect against future variants, but also ones that work better in the immune compromise in the elderly. The other area that I think is important to think about is not just vaccines, but there's a whole new toolbox of antivirals that are well underway in terms of being developed that are particularly being designed with these people in mind, with the idea that, hey, you know, we know that if you get a vaccine, you may not respond as well to the vaccine. So what happens if you get COVID and you're at higher risk of going in the hospital? We need drugs that will be able to treat those most effectively. And there have been some recent

oral drugs that have been FDA approved, particularly for, say, elderly or immune compromised. If they become positive for COVID, they're the most likely to have it recommended that they can take that and that helps their body to fight off that virus. And for all the people out there who get this thing and then rip off their masks and, you know, jump into the most crowded club they can find, do you think they're insane or do you think that's a reasonable response? I think that I would say to those people, just think about not just yourself because you're thinking about yourself. Oh, well, I don't care. I'm healthy and whatever. I'm going to be fine. I'm okay with getting sick for a few days and recovering. It's just a bad cold.

But think about your community and think about the fact that if we can actually work together to protect not just ourselves, but those around us, and especially the most vulnerable, then we can save lives that way and also help to accelerate the end of the pandemic. There's always risk. Nothing's 100%. And so, you know, it's best to be cautious. Dr. Deborah Fuller, Department of Microbiology, University of Washington, not Washington State University. Confuse the two at your own risk. Our show today was produced by John Ahrens, engineered by Paul Mounsey, fact-checked by Laura Bullard, and edited by Matthew Collette. I'm Sean Ramos-Verm. This is Today Explained. Thank you.