This week, a very scary-sounding article went viral (“Get Ready for the Forever Plague”!), accompanied by a picture of an equally scary crow-faced plague doctor in a hoodie. “Just one infection can destabilize your immune system and age it by 10 years,” the journalist wrote. “As a consequence it is now possible to be reinfected with one of omicron’s variants every two to three weeks,” and “each reinfection confers no immunity.”
Let’s get this out of the way: None of that is true. The article was roundly criticized by numerous experts on Twitter as sloppy and error-ridden, and hyperbolic. But it clearly struck a nerve, because it taps into legitimate concerns about the stage of the pandemic we’re in.
I’ll refrain from nitpicking every claim in the article (see the expert threads for that). I think it’s worth diving into one of its central claims, though—that reinfection is possible again, and again, in rapid succession. This is both scaremongering, and contains some important bits of truth. Just as COVID precautions seem to be gone for good in many places, we are facing “ultra-contagious” omicron variants, BA.4 and BA.5. Cases are rising across the country yet again—and yes, a lot of the cases are reinfections, which are, at best, very annoying, and also can put people at risk for long COVID. So: How often can you get reinfected with COVID, and what immunity can you expect to have right now?
In the earlier phases of the pandemic, documented reinfections were rare. Prevailing wisdom was that an infection with the original variant or (for a brief period of time) being fully vaccinated could leave you reasonably sure that you were immune to COVID. In summer 2021, the delta variant and loosening precautionary measures brought routine breakthrough infections. And then, in late 2021, the first wave of omicron infected millions of Americans, including many who’d already grappled with previous variants.
Now, the BA.4 and BA.5 variants of omicron are driving a new wave, reinfecting people who’d just months ago had been infected with the original omicron. There’s no doubt about it: Reinfections are not only possible but common. You can be reinfected even if you’ve also been vaccinated and boosted—that is, “super immunity” against infection is no longer so super.
Exactly how quickly and how often reinfections happen is murkier. A few recent studies have shown it’s possible to get reinfected with another variant (or even another omicron subvariant) in as little as 20 days; back in January, Slate ran an account of a woman who was likely infected with delta one month and omicron the next. But these rapid reinfections still seem to be rare, and there are, as best as I can tell, no documented cases of people getting reinfected again one month, and then again the next, and then again the next. And while getting COVID “just” twice inside of a year might feel like a horror take on Groundhog Day, the “Forever Plague” author seems to be painting a picture of a nightmare world where the default human state is a constant state of SARS-CoV-2 infection. This is simply not the case.
Overall, our bodies are actually getting better at fighting off COVID. All else being equal, the immune system more deftly fends off the same pathogen—or variants of it—with each exposure. The ability of omicron’s spawn to dodge vaccine- and infection-induced antibodies is disappointing. But our immune systems’ defenses are not all-or-nothing. Even antibodies generated by other variants have retained some power to neutralize the heavily mutated omicron. And the immune system is much more than antibodies. T cells help subdue the virus after infection, reducing the severity of the disease and preventing death. The good news is the parts of the coronavirus that T cells recognize have remained largely unchanged since the virus burst onto the scene in 2019—which explains why the vaccines against that original strain have remained so effective at preventing hospitalization and death no matter which variant we encounter. To claim, as the “Forever Plague” author does, that the “each and every infection will damage your immune system regardless of how mild the symptoms” is an insult to immune systems.
The empirical data coming in right now supports these basic immunological principles. If a previous omicron infection conferred little or no immunity against future omicron infections, then you’d expect that each subvariant’s surge would reach similar or even greater heights—because each subvariant is increasingly more contagious—than the original early 2022 omicron peak. But testing data from New York shows that the BA.2 wave fell far short of the original omicron wave—both in terms of total infections and reinfections. The same patterns held in Portugal, France, and Italy. The U.K. testing data followed a similar pattern (though testing data with randomized sampling, which better controls for testing rates, suggests the BA.2 peak was higher, a separate analysis from the U.K. Health Security Agency suggests reinfections were relatively rare, and not driving the spike). Testing in South Africa, where the BA.4/BA.5 surge has already peaked, showed much lower levels of infections. This is consistent with a population fortified by prior immunity.
You could argue that testing data no longer reflects the true infection rate, as more people are testing from home or just not testing at all. This is where wastewater surveillance comes in, which doesn’t suffer from the vagaries of testing behavior. That data from the U.S. and Europe paints a similar picture. Yes, there are regional variations, but the omicron subvariant waves tend to fall short of the peak of the original omicron wave. So: While it’s definitely possible to get infected with omicron twice, not everyone does. And there’s no evidence that you can get immediately reinfected with the exact same strain (although that’s a surprisingly difficult question to answer, scientifically). It also seems unlikely that you’d get BA.4, then BA.5 or vice versa, given that they have similar mutations. Back-to-back reinfections are instances of really unlucky timing as various variants surge. You may have heard anecdotes about them, because with millions of cases, they will happen—a small percentage of a large number is still a large number, and stories about uncommon events tend to travel around quickly.
I suppose a future super-variant and astronomical case numbers could change this fact. I can’t predict the course of the pandemic—and experts are closely watching yet another omicron variant rapidly spreading in India—but I’m going to wager that semi-monthly reinfections are not going to become the norm.
Still, it’s bad that we have ongoing waves of reinfections even if they are every several months rather than every few weeks. Even mild infections can lead to long COVID; although how often this happens is still up for debate, trying to avoid infection at all is still a reasonable position one might choose to take, even as it feels like an increasingly uncommon one. The “Forever Plague” article resonated with many because it successfully conveyed the urgency of the pandemic when the zeitgeist is maddeningly blasé. Who cares if there are some errors, one might argue, if this article scares people into action? But I disagree. As others have noted, it’s possible to believe two things simultaneously: That COVID is an extraordinary public health crisis with unknown short- and long-term effects on human health, and that inaccurate facts used for fearmongering aren’t helpful. The seriousness of the pandemic speaks for itself, but manipulating a pandemic-weary public with despair-inducing lies isn’t the way to get them to listen.
Update, July 8th: This piece has been updated with additional context on the BA.2 waves in some countries.