Can you get COVID-19 twice a month? Reinfections and rebounds

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Cough, sore throat, fever and chills: Not yet! When a positive COVID-19 test comes back, you may feel like you just got it.

Over time, immunity wanes and new virus variants appear. Thus, reinfections are certainly possible. But can you catch COVID-19 twice in just 1 month?

Although this specific scenario is quite unlikely, the risk of re-infection increases. In this article, we discuss what we know so far about COVID-19 reinfections.

Generally, a number of factors contribute to COVID-19 reinfections. These include:

  • emergence of new variants of coronavirus
  • natural waning immunity acquired through vaccination or previous infections
  • decrease in COVID-related precautions such as mask-wearing and physical distancing

According to Centers for Disease Control and Prevention (CDC), we are still learning a lot about COVID-19 reinfections. This includes how quickly reinfection can occur.

Before the arrival of the Omicron variant, reinfections were not so common. Researchers in a May 2022 study looked at reinfections from the start of the pandemic up to Omicron. Overall, they found that the risk of reinfection was 6.7% within 18 to 22 months after a first infection.

However, now Omicron and its subvariants have changed the landscape of reinfections. Here’s what the search found.

Pre-Omicron reinfections

Reinfections were not that common before Omicron. Research found that protection against reinfection typically lasted at least several months.

A 2021 study examining PCR test data from 2020 found that a previous infection still gave about 80% protection 6 months after a first infection.

A February 2022 study introduces vaccination into the mix. The researchers looked at the effect of vaccination on reinfection from December 2020 to September 2021.

Immunity against prior infection waned after 1 year in unvaccinated individuals. However, in people vaccinated after having COVID-19, immunity remained high, even if a previous infection was more than 18 months old.

Post-Omicron reinfections

Viruses can change over time, and that’s certainly true with this coronavirus. As the changes accumulate, they can make it easier for a virus to escape immunity generated by vaccination, previous infection, or both.

A July 2022 studystill in preprint, looked at the protective qualities that a pre-Omicron infection offered:

  • Reinfection with another pre-Omicron virus: The effectiveness of a pre-Omicron infection against another pre-Omicron infection was 85.5%. The researchers estimated that this would reach less than 10% in 32 months.
  • Reinfection with Omicron: The efficiency of a pre-Omicron infection versus an Omicron infection was significantly lower at 38.1%. The researchers estimated that this would reach less than 10% within 15 months.

A June 2022 study examined the protection against prior infection and vaccination provided on symptomatic infections with the “original” variant of Omicron (BA.1) or its first subvariant, BA.2. Overall, there was no difference in protection between those vaccinated, those who had previously had an infection, or both.

Omicron BA.4 and BA.5

The new BA.4 and BA.5 Omicron subvariants are now the main drivers of COVID-19 in the USA. They are also very good at evading the immune system.

A July 2022 study investigated the neutralization of BA.4 and BA.5 by antibodies from vaccination or previous COVID-19 infection. Neutralizing antibodies prevent the virus from binding to a host cell.

Antibodies from vaccinated people had a harder time neutralizing these subvariants. Neutralization was also weaker with antibodies from people who had a previous infection, including BA.1, the ‘original’ Omicron variant that was dominant in late 2021 and early 2022.

Another one July 2022 study supports this. The researchers found that the neutralization of BA.4 and BA.5 was lower than that of BA.1 or BA.2 in vaccinated people and those who had already had an infection.

This means that if you had COVID-19 during the first or most recent (BA.2) Omicron wave, reinfection with BA.4 or BA.5 is now possible. However, it is still quite likely that you are well protected at this stage.

Researchers in a July 2022 studystill in preprint, found that while the efficacy of a pre-Omicron infection against symptomatic BA.4 or BA.5 infections was only 15.1%, it was still quite high (76.1%) if you have ever had an Omicron infection.

COVID-19 reinfections appear to be less severe than first infections. A 2021 study looked at the risk of serious illness or death from reinfection. Compared to first infections, reinfections have a 90% less risk of serious illness or death.

A April 2022 study also found that COVID-19 reinfections carried a lower risk of death than first infections. As with early infections, age, sex, and underlying health conditions were risk factors for severe disease from reinfection.

However, there is evidence that reinfections may increase the risk of lasting health effects. A June 2022 studystill in preprint, found that, compared to first infections, reinfections increased the risk of:

  • problems with:
    • the lungs, cardiovascular system and many other organ systems
  • hospitalization
  • dead from any cause

These effects were observed regardless of vaccination status. The level of risk was also found to increase with the number of infections reported by study participants.

A limitation of this study is that it may not reflect risk in the general population. The researchers focused on people using Veterans Affairs (VA) health care resources. Thus, the population studied is more likely to be older and male, and to be in poorer health.

Paxlovid is an antiviral drug that doctors prescribe to treat mild to moderate COVID-19 in people at high risk of severe disease. To be effective, Paxlovid must be started within 5 days of the onset of symptoms.

Rebounds of COVID-19 have been reported after treatment with Paxlovid. Although it is still not known why this happens, it is possible that the coronavirus is not completely eliminated from the body when taking Paxlovid, allowing it to replicate again after treatment ends.

Increasing reports of these rebounds prompted the CDC to issue a health notice. In that advisory, the CDC noted that Paxlovid rebounds:

  • can occur in anyone, regardless of their vaccination status
  • usually occur between 2 and 8 days after treatment with Paxlovid
  • are characterized by a new positive COVID-19 test after having previously tested negative, which may also include a return of mild symptoms
  • often go away on their own after a median of 3 days without additional antiviral therapy

Rebounds after Paxlovid are rare. A June 2022 study found that of 483 people treated with Paxlovid, only 4 (0.8%) had a rebound. Another study from June 2022, still in preprint, found a higher bounce rate: approximately 3.5% within 7 days of treatment.

People who rebound from COVID-19 after Paxlovid may also be able to spread the infection to others. A small study of May 2022still in pre-publication, involving 10 people documented transmission to family members during rebounds.

The amount of virus during a rebound was also similar to what it was before Paxlovid treatment. The researchers said these results confirm that people who rebound should isolate until their symptoms disappear.

COVID-19 rebounds can also occur without taking Paxlovid. A June 2022 research paper mentions anecdotal reports of rebounds in people who have never taken Paxlovid. The authors note that Omicron may take longer to clear up in some people than earlier virus variants.

Can you catch COVID-19 a third time in a row?

Yes. A study published in March 2022 reported an increased risk of reinfections due to Omicron. Within the study population, the researchers noted that an increase in third infections was observed from November 2021.

The researchers said people who had a third infection had their first infection early in the pandemic and a second infection during the Delta variant wave. Their third infection was from Omicron.

What is the best way to prevent reinfections?

The best way to avoid getting COVID-19 reinfections is to continue to take steps to protect yourself, including:

  • stay up to date about your COVID-19 vaccines
  • wearing a properly fitted mask when in public, especially indoors
  • wash your hands frequently
  • avoid crowded areas or poorly ventilated spaces
  • try to stay 6 feet away from other people outside your household

How long should you quarantine after reinfection with COVID-19?

According to CDC, we know little about the risk of transmission during COVID-19 reinfections. Overall, it’s best to err on the side of caution and assume you can pass the virus on to others.

A study from July 2022 found that viral shedding (i.e. the contagious period) in people infected with Omicron can last for up to 10 days.

It is therefore a good idea to self-isolate and quarantine for at least 10 days or until you are symptom-free and test negative for COVID-19.

How soon will boosters targeting Omicron variants be available?

According to Food and Drug Administration (FDA)boosters targeting Omicron are expected to be available from fall 2022. The FDA has also recommended that a BA.4 and BA.5 component be included in this booster.

Modern announced that its Omicron booster produces a significantly higher neutralizing antibody response against BA.4 and BA.5 than its current booster.

Pfizer-BioNTech reported that compared to their current booster, their Omicron booster gave higher levels of neutralizing antibodies against BA.1. Neutralizing antibodies for BA.4 and BA.5 were present but to a lesser extent.

The risk of reinfection with COVID-19 increases. For this reason, you may hear of more and more people in your life getting COVID-19 for the second time, sometimes soon after their first infection.

The latest reinfections are largely due to the Omicron BA.4 and BA.5 subvariants, which can evade immunity to vaccines and previous infections. Things like naturally waning immunity and reduced COVID-19 precautions also contribute.

Reinfections of COVID-19 are generally less severe than first infections. However, some research indicates that repeated infections increase the risk of health problems later. As such, it is important to continue to take steps to prevent COVID-19.

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