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COVID: The Risks Ahead (Part 1: Reinfections)

A colorized image of SARS-CoV-2, seen from an electron microscope

Written by Ethan Thio ‘22

Edited by Melinda Li ‘22

As a young and healthy (read: lucky) person, I want to start with how I think many young, healthy people feel right now.

We’re tired of COVID.

Restrictions are exhausting and anxiety-inducing, compounded by the very real and valid sense that we are missing out on the prime of our life. This is only worsened by the blatant hypocrisy we often see from political leaders, the lack of significant societal or political support for COVID mitigation (work to try to slow transmission of COVID, as well as help to those who are infected), and a significant anti-vaccine contingent of society.

We know that people are vulnerable, but it feels unfair that we have to bear the burden of slowing down transmission when others don't. We think we are boosted, and/or vaccinated, and/or healthy, and therefore we will be fine. Also, heck, there are so many other huge problems in our world, not to mention our personal lives. Moving on from COVID feels right, and in many cases, it can feel necessary.

And when you hear from public health experts that everyone is “likely to get infected,” it’s so damn easy to just throw up your hands and say what’s the point? If I’m going to be okay after an infection, and other people can’t protect themselves by getting a shot, why do I have to self-impose restrictions on my life?

This series is not intended to diminish the very real sacrifices that so many people have made to try to slow the spread of COVID. The costs are real and manifold. I sympathize very deeply with being tired of COVID, of wanting to go back to pre-COVID life. I also don’t mean to judge people’s decisions, or prescribe some specific way individuals should live their lives. These are profoundly personal decisions, with a host of concerns I can’t even begin to consider, not to mention address. This series does not intend to shame those who take more COVID risks, who live their lives with COVID as a smaller concern. I really do understand.

But at the same time, part of me thinks that people are making decisions without fully understanding the risks at play, both to themselves, and society at large. This series is going to be depressing. I apologize in advance, but it’s something I’ve wanted to write for a while. When Omicron hit the world, I was thrown for a loop. I thought, as many did, that vaccines would protect us completely, and we would be moving on from this pandemic. But boy was I wrong. So I did what I always seem to do when I get hooked on something - I spent several hours every day reading about COVID. I don’t say this to brag, or to give myself any undeserved level of credibility. I’m a senior in college, I’m no expert. But I mention it because I do believe I’ve accumulated some understanding about this topic, and I urge you to fact-check me. I’ve provided the sources I’ve used to write this series, and I totally realize that I could be missing the mark at times. This article will assess existing evidence and attempt to extrapolate. I think the extrapolations are reasonable, you may disagree, and that’s entirely valid. I welcome disagreement, and honestly, I want to be wrong on any/all of this. This article does not aim to rehash most of the mainstream public health discourse. Vaccines work. High-quality masks (genuine, well-fitting N95, KN95, KF94, FFP2, etc) work. I realize that in our hyper-polarized environment, those two statements may be contested, but I’m going to write this article with the understanding that they aren’t. If you strongly disagree with those two statements, this article probably isn’t for you. This article also does not aim to be a prescriptive plan for addressing problems that for sure will exist. I simply aim to conduct a US-focused analysis of what we now know about the potential risks we face. In short, this isn’t perfect, but it was the best a college senior could do. :)

This entire series will revolve around a scenario I will pose to you here about future societal attitudes towards the pandemic. Let’s say that in the near future, almost all states and the federal government give up on any level of COVID mitigation. Mask mandates, vaccine mandates, capacity limits, subsidized testing, free or reduced-price masks, mass vaccination drives, COVID briefings, large-scale public health messaging, all gone. Almost all healthy people give up on masking and testing because they believe the risk to themselves is nonexistent and they largely have moved on from COVID. People think it’s “just like a flu,” and people coughing at the grocery store no longer elicit side-eyes. COVID numbers aren’t covered in the news every day. Vaccination rates stagnate, and uptake of boosters and potential new vaccines is limited. People go back to the pre-pandemic normal of going to school and work even if they have the sniffles or a cough. Societies fail to implement systemic mitigation such as better building ventilation, air filtration, etc. because of the belief that COVID is or will become “endemic.” I feel like this scenario is possible, if not likely. Not only that, I think it’s the reality in a lot of places in America already.

There are four reasons why I am concerned about the scenario I posed.

1. Reinfections, or the possibility of getting COVID a second, third, etc. time even after vaccination. This is inextricable from my second concern, which is

2. Variants, or the simple fact that viral mutation has already and will likely continue to lead to new variants that may be more transmissible (more contagious/spread more easily), virulent (cause more severe disease), or evade immunity (our immune response from vaccines/natural immunity) more effectively. The danger of constant reinfection from novel variants isn’t just limited to acute illness, it is likely going to worsen my third concern,

3. Long COVID, or the significant long-term suffering endured by many who are infected by SARS-COV-2 (the virus that causes COVID-19), linked to multi-system organ damage and other complex factors not fully understood by science (yet!). This is all going to do further damage to my final concern,

4. Shattered healthcare systems, or the simple fact that the successive COVID waves we have already endured have devastated our healthcare workers, with retiring and resignation meaning our healthcare systems will be weaker in the future if we do not act. The convergence of the above three factors threatens to place even more pressure on both inpatient (hospital) and outpatient (clinic, non-hospital) care.

This all sounds really depressing. It is. In many ways, it’s a pessimistic scenario. But here’s the thing - it’s possible, maybe even probable, and if we have learned anything over the last 2 years, blind hope doesn’t make COVID go away. But I believe that we can avoid these significant, possible concerns by first acknowledging their enormity. By understanding the threat we face, we can make decisions about what countermeasures, if any, we should adopt against it. Let’s get into it.

1. Reinfections

I think it’s really easy to think that COVID is a one-and-done type of deal, because that’s how a lot of challenges are in life. But what we have learned over the last few years is that COVID definitely does not fall into that camp.

1. Reinfections are commonplace.

A reinfection is when someone becomes infected with COVID after already being infected with COVID before. According to the BBC, who referenced the UK government’s COVID Dashboard, “4% of the 14.8 million positive tests recorded so far” are reinfections, with reinfections rising sharply during the Omicron wave. “From representing around one in 100 daily cases up to November, reinfections now make up one in 10.”

Even back before Omicron, reinfections were observed in the US. A study conducted in 2020 on 1,574 healthcare workers found that 2.4% were reinfected.

But Ethan, that was before vaccines. That’s true. Unfortunately (or fortunately, if you’re a glass-half-full type of person), vaccination protects against, but does not eliminate the chance of reinfection. A study by the CDC notes that “being unvaccinated was associated with 2.34 times the odds of reinfection compared with being fully vaccinated.” The fact that vaccination has a protective effect is good, no question. But the reality is reinfection is possible, even after vaccination. While it is less likely, it’s not extremely unlikely. In the study, 50 vaccinated individuals, compared to 179 unvaccinated individuals, became reinfected. I am no epidemiologist, so I can’t credibly opine on the statistical power of this study or any other. I solely aim to paint with broad strokes here. What I hope is clear is that reinfection is a very possible, if not probable outcome given enough time and circulating virus. A driver of this is waning (decreasing with time) immunity to the virus. Our immune systems don’t seem to be able to put up the same fight against COVID if it’s been a while since we’ve encountered it, whether through infection or vaccination. The CDC and FDA recommended boosters for many in the United States due to waning immunity from the initial vaccine series, as well as documented increased effectiveness against new circulating variants. I think this helps illustrate the fundamental reality - we don’t have durable immunity to this virus.

To support this assertion, a study in the Lancet notes that antibody (blood proteins that recognize pathogens and constitute a major part of our immune response) levels decline and chances of reinfection increase with time. You might think that, maybe we need vaccination and two bouts with COVID, then we can’t get COVID again. I’m not aware of serious research on people who have had COVID more than twice given that COVID has only existed for about 2 years, but anecdotal accounts show that getting reinfected after a reinfection and vaccination is possible.

One unfortunate, 20-year old, double-vaccinated student nurse in the UK has caught COVID four times already. What I hope this anecdote and other similar cases illustrate is that COVID isn’t a one-and-done deal, and probably not a two-and-done deal either. There are lots of studies that demonstrate the existence of reinfections, and it’s likely that you now or soon will know of people who have unfortunately tested positive for COVID more than once. If we can continue to catch COVID, even if it is less likely due to immunity, that means we could be subject to several reinfections over our lifetimes. And you don’t have to take my word for it.

In an interview with NPR, Yale evolutionary biologist Jeffrey Townsend notes that “reinfections are not just possible, they're pretty much inevitable.” Townsend and his team estimate that “people will be reinfected every year or two with SARS-CoV-2.” In the few months following an infection, the risk of being infected is low, but it increases with time. The impact of this reality could be profound. Vulnerable people, such as immunocompromised individuals (people with weakened immune systems), the elderly, and many others will have to deal with higher levels of circulating virus than we might think, because presumably healthy people will continue to get infected and spread it through the community. Again, I am not an expert, and I can’t credibly assert the nuances of this circulation. All I’m saying is that in the absence of mitigation measures, reinfection and associated high levels of circulating virus will probably, or almost certainly, occur. I feel like this is a logical assertion based on the reality of what we know of how transmissible this virus is. As such, it’s going to be incredibly hard, if not impossible, for vulnerable individuals to “wait COVID out” if their goal is avoiding infection. If we can get reinfected due to waning immunity, this virus is contagious enough to find those who are susceptible and infect them if precautions are not taken.

2. COVID is a dangerous disease, especially to the vulnerable

But why do I think this is a concern? The common cold reinfects us too, right? I will talk about long COVID later, but we don’t really know the long-term effects of successive COVID reinfections. Let’s think about this here. I’m a 21 year old male.

If life expectancy for the average American male is 75.1 years, and we go by Townsend’s estimate that I would get COVID every 1 or 2 years, let’s just split the difference and say I get COVID every 1.5 years. Given that I have a projected 54 years of life left, I am on track to get infected by COVID 36 times before I die. That’s a lot of COVID. Given that one infection can cause long COVID, it’s hard for me to believe that getting COVID 36 separate times doesn’t pose risk for long-term health consequences. Also remember - Townsend is estimating that we all get COVID every one or two years. Even if the risk of long-term health consequences is small on an individual basis, if we are subjecting the whole world to this, then the ultimate outcome will be a lot of long-term health issues. A small percentage of a very large number (the entire human population of the world) is a large number! Even if you don’t buy that, the risk to vulnerable people is serious.

As of February 16, 2022, over 923 thousand Americans have lost their lives to COVID-19. The common refrain is that most of these deaths occurred before the vaccine was available. However, in the period from June 2021 through January 2022, time in which vaccines were generally available to nearly all adult members of the public, there were 288,866 deaths from COVID-19. This is a staggering number of people.

Obviously the comparison is not perfect, but for a sense of the scale of this mass death, 405,399 American service members lost their lives in World War II. Recall that America’s involvement in WWII also lasted almost four years, compared to the eight months it took for COVID to take a comparable number of lives. A common response to this horrific reality is that most of these people are unvaccinated. I disagree with anti-vax individuals, I think vaccination is crucial, and those who intentionally avoid vaccination are almost always making a serious mistake that endangers themselves, their loved ones, as well as society at large. But at the same time, these are people. We shouldn't become callous to death, even if the people who die made decisions we disagree with or put themselves at higher risk. It is one of our most basic jobs, as a society, to try to prevent sickness and death.

But let’s narrow the focus to vaccinated individuals. The vaccine, while highly effective against severe disease and death, is not perfect. This publication is based out of Rhode Island, and coincidentally, the Rhode Island Department of Health does a great job of collecting data about breakthroughs (infections that occur despite vaccination).

293 people in Rhode Island have died from a breakthrough case of COVID-19 as of February 16, 2022. This is a significant number of people.

For contrast, in the 2018-2019 flu season, a moderately severe flu season in Rhode Island, 39 people died of the flu. Certainly the comparison is not perfect. One might argue that a flu season is not as long as the year or more that vaccines for COVID-19 have been available, and that other flu deaths could have occurred outside the flu season.

However, the flu is a largely seasonal disease, and it’s unlikely that many flu deaths would occur outside of flu season. With this in mind, it’s a coarse comparison, but an instructive one. Significantly more people (over seven times as many) have died from COVID-19 over the past year or so even when vaccinated compared to deaths in a moderately severe flu season. What makes this comparison even more concerning is that flu deaths include both vaccinated and unvaccinated individuals, while the 293 breakthrough COVID deaths necessarily only include vaccinated individuals. And it’s not like everyone gets their flu shot.

During the 2018-2019 flu season, 56.3% of adult Rhode Islanders were vaccinated for the flu. This fact only heightens the disparity between flu deaths and breakthrough COVID deaths. If we only counted breakthrough flu deaths, I think it would be reasonable to believe that the number would be less than the 39 Rhode Islanders who unfortunately died of the flu, because that total includes all people, regardless of vaccination status. This only further highlights the mortality (death) risk of COVID-19, and means that the difference between COVID and flu mortality could be even greater than the numbers have captured. To be fair though, I can’t find data specifically on breakthrough flu deaths, so theoretically it’s possible that all 39 Rhode Island flu deaths were breakthrough cases. But I think that the relatively low flu vaccination percentage makes it reasonable to think that at least one or some of the 39 were unvaccinated. We also have to consider that COVID breakthrough deaths have occurred during a period (2021-2022) in which masking and other transmission mitigation measures have been utilized in Rhode Island. Sure, universal masking and social distancing have not been the reality on the ground, but there certainly has been some degree of mitigation over at least some part of 2021 and 2022. Compare that with 2018-2019, when effectively no mitigation measures were taken. Public masking, behavioral changes (some people avoiding crowds, etc), weren’t just rare, they were essentially nonexistent. With all of this in mind, I think it’s reasonable to posit that the separation between flu and breakthrough COVID mortality could be even starker than the numbers show due to vaccination and mitigation measures taken against COVID. In short, the risk that COVID poses to vulnerable populations is significant, especially when compared to the flu.

What I hope this analysis shows is COVID can be deadly. Even after vaccination, COVID is a disease that causes significantly more mortality than the flu. This is absolutely a dangerous disease. We can’t forget that. This risk is clearly concentrated in vulnerable populations, who, even after vaccination face higher risk of mortality. As one example, solidorgan transplant recipients (people who undergo surgery to replace organs such as their kidneys or liver with those of a donor) are 485 times more likely than an average US adult to die from a breakthrough COVID infection. It’s also important to understand that death or going back to your initial baseline of health are not the only two possible outcomes of a COVID infection.

COVID affects a variety of organ systems, and “can make a weak heart beat erratically, turn a manageable case of diabetes into a severe one, or weaken a frail person to the point where they fall and break something.” Vulnerable people may survive a COVID infection, but their independence, their health, and their quality of life may be significantly impacted either from the direct effects of the infection (ie: damage/scarring to lungs), or the second-order effects such as worsened diabetes or broken bones, as Ed Yong notes. This loss isn’t captured by hospitalization or death figures. As such, the true burden of COVID in terms of both morbidity (the amount of associated disease/health problems) and mortality is likely to be significant.

What I hope this low-level, slapdash epidemiology illustrates is that COVID still presents a significant, acute risk to vulnerable people, even after being vaccinated. These are likely your friends, your parents, people in your family, your neighbors, you get the idea. Conditions that make people more vulnerable to COVID are not rare. The CDC lists a litany of medical conditions that put people at higher risk of severe outcomes from COVID, ranging from obesity to diabetes to cancer to smoking. The list is pretty long. If we look at just one of those conditions, diabetes, the CDC states that 10.2% of the entire US population has been diagnosed with diabetes. That’s a lot of people, and I hate to say it, but America isn’t exactly famous for having an incredibly healthy population. I do agree that the individual risk posed by each of these conditions (such as diabetes) will not be as severe as the risk faced by solid organ transplant recipients. The CDC estimates that the odds of severe outcomes from a breakthrough COVID infection were 1.47 times as high for people with diabetes compared to those without diabetes. While this certainly isn’t close to the risk faced by organ transplant recipients, we can’t ignore the risk posed by diabetes because so much of America has diabetes, not to mention the long list of other health conditions that put people at higher risk from COVID. As stated previously, even if a small percentage of people with diabetes have severe outcomes from COVID, a small percentage of a very large number (all Americans who have diabetes) is still a large number. Additionally, it’s not like vulnerable people can only have one medical condition. People can have diabetes, be overweight, and smoke, and this likely multiplies the risk they face from COVID. In short, COVID is not the flu. Even if somehow everyone you love and care about is young, healthy, and vaccinated, the truth is that we all get old and sick eventually.

3. Reinfections can still cause severe disease

Alright. So I’ve outlined that COVID reinfections are common, and that COVID is a serious disease. Let’s connect these two ideas and assess the future impact. One could argue that reinfections are milder than primary (initial) infections, and pose little risk to those who have immunity from prior infections or vaccinations. One might argue then that future COVID mortality is going to be very limited, as once nearly everyone catches COVID, those who survive will be protected. Apart from the fact that this again callously overlooks vulnerable individuals who will suffer morbidity and mortality from just one COVID infection, observed COVID reinfections have not been universally mild.

Data on reinfections is limited, but in the state of Washington, 49 reinfections resulted in deaths since September 1, 2021. What is clear is that reinfections are not uniformly benign, and can lead to significant, deleterious consequences.

A study from Qatar is promising, with reinfections having “90% lower odds of resulting in hospitalization or death than primary infections.” However, this wasn’t a universal observation.

A meta-analysis (merging of separate studies) of 577 COVID reinfections in 22 countries found that “a higher Intensive Care Unit (ICU) admission rate was observed in reinfection compared to first infection (10 vs 3).” Ten patients also passed away from their COVID reinfection.

A preprint studying reinfected individuals in Bangladesh notes that “severity of reinfection included asymptomatic (12.9%), mild (8.9%), moderate (66.3%), and severe (11.9%).” Sampling bias, or the possibility of a non-representative sample studied in any of the papers referenced here, could affect the significance of these results, and I don’t mean to generalize any of these statistics to the broader population.

Broadly though, if I was pressed, I tend to side with the first Qatar study stating reinfections are probably going to be generally milder. That’s my sense from most of the reading I’ve done, and it aligns with my limited knowledge of immunology. Given increased immunity to COVID thanks to an initial infection, even if it has waned, it makes sense that the second infection will be less severe. However, what I think this fails to take into account is the possibility that people will be in worse health when they get infected a second, third, fourth, etc. time. As I mentioned previously, one COVID infection can worsen existing chronic conditions and cause health problems in and of itself. Even if that isn’t the case, people get older over time, and a reinfection necessarily must occur when a person is at an older age compared to when they got COVID for the first time.

Old age is a huge risk factor for having a more severe or even deadly case of COVID. According to the CDC, someone who is 65-74 years old is 65 times more likely to die of COVID compared to an 18-29 year old. This risk only increases as one gets older. Further, as people age, they often develop chronic health problems. They get diabetes, hypertension, heart problems, lung problems, the list goes on. Why do I mention this? The promising Qatar study referenced earlier showing 90% lower odds of hospitalization or death from reinfection was conducted over a period spanning from “February 28, 2020, and April 28, 2021.” Within this sample, they define a reinfection as the “first PCR-positive swab obtained at least 90 days after the primary infection.” As such, the interval between infections ranges from 3 months to around a year at most. This isn’t a very long stretch of time. If you only follow people for several months, their age and overall health may not have changed much. Therefore, the risk of severe disease in a reinfection may be lower than the risk of severe disease from a primary infection thanks to immunity. But what if your reinfection comes several years later after your first COVID infection? Remember, COVID is here to stay, and we’re projected to get infected every year or two. What if one of your annual/biannual reinfections comes after you’ve gotten a diabetes diagnosis, after you’ve developed heart problems, or after you’ve had to start taking a steroid medication that weakens your immune system? People get older, they get sicker, that is life. In these cases, I would imagine that reinfections could be equal or more severe than primary infections because despite immunity, people’s overall health is worse. It’s also important to realize how these notions of vulnerability are inseparable from socioeconomic status and other factors. For example, diabetes is more dangerous if it isn’t controlled by medications. People who cannot afford health insurance, visits to the doctor, or prescriptions for their diabetes medication may be more prone to uncontrolled diabetes and the litany of health problems associated with that. All of that may make them more prone to severe outcomes of COVID.

It’s crucial to understand that when we talk about vulnerable people, this is not a static group. I really believe this is a misconception that young and healthy (lucky) people like myself have. When you’re young, healthy, and feel invincible, it’s easy to think vulnerable individuals are a group totally separate from you. But the truth is, youth and health are by definition transient conditions. Someone could be young and healthy when they COVID for the first time, but vulnerable two years later due to a new health problem. I mentioned it earlier, but I’ll say it again, we will all become vulnerable to COVID at some point, no matter how healthy or lucky we are. You can eat a vegan, whole food diet, you can run marathons, you can be blessed with great genes, and you can have perfect health throughout. Nonetheless, if you’re lucky, you will still get old, putting you at high risk of complications from COVID. Further, you can also get unlucky. People can get cancer, autoimmune problems, and a whole host of health issues at any age simply due to bad luck. Given that, I find it hard to believe that in a world where COVID continues to circulate at a high level due to reinfections, severe disease and death won’t also follow.

To be clear, I do not mean to say that reinfections are the end of the world, but nor do I think it’s clear at the moment that they will be a non-issue. The reality is, we have documented evidence of reinfections causing severe disease, despite the immunity afforded by infection. Unlike for some other infectious diseases, immunity to COVID wanes and is insufficient to completely prevent severe disease and death, and this is concerning because people’s health naturally worsens with time. This means they become more vulnerable with time, causing the risk that reinfections pose to increase with time. I don’t think this risk has been adequately appreciated.

4. What does this mean?

What is the ultimate outcome here? The fact that we have already observed reinfections causing severe disease and even death means that immunity alone is insufficient to fully protect against adverse outcomes. Even if people survive their first bout with COVID, they are at risk of a second, or third, or fourth, or fifth bout of COVID that could have serious health consequences given waning immunity to the virus and declining health over time. We know COVID is a dangerous disease. As such, the ramifications of reinfections if we do not control transmission concern me. Given the scenario I posed at the beginning of this article, with no attempts at mitigation, the virus will continue to see high spread in communities due to the existence of reinfections, circulating repeatedly through healthy individuals, and increasingly, infecting and reinfecting vulnerable individuals. In my eyes, this admittedly pessimistic but certainly possible scenario here forces vulnerable people to decide between two bad choices. They could either isolate indefinitely due to persistently high prevalence of COVID in their community. Or, if they decide to forgo isolation, vulnerable people could likely catch COVID once, twice, thrice, or more, which could lead to severe disease, the worsening of existing chronic conditions, and/or death at any point along the line. Even for less vulnerable people, this worst case scenario of recurrent reinfections and high viral transmission is not harmless. I will discuss long COVID later, but as stated previously, we don’t know the long-term effects of successive reinfections. In a worst-case scenario, each reinfection is like playing Russian roulette, with “losers” getting long COVID. An ever-increasing number of healthy people become disabled with long COVID as the accumulated damage of two, three, four, five, six COVID infections piles up.

There are a number of factors that could impact this “worst case scenario”, and I obviously don’t know the likelihood of the scenario I’ve posed. But what I think is clear is that the likelihood of this scenario isn’t zero, and probably not very close to zero either, given what we know about the virus.

I think that the constellation of issues I’ve outlined shows that the future does not seem promising in the absence of widely available, effective therapeutics, enhanced vaccines, or other major changes. I’ll cover counterarguments in the last article in this series, but briefly, even if you believe that major pharmaceutical innovations are on the horizon, it’s unclear how long the interim period before they are widely available will last. Further, their cost, their side effects, their interactions with other drugs, and the difficulty/complexity of manufacturing them at scale are entirely unknown. Pessimistically, I could argue that all four could be significant, severely limiting the positive impact of these advances. There’s a reason why there is a proverb that states “an ounce of prevention is worth a pound of cure.” To be clear, I believe in modern medicine and the wonders of biomedical research. I honestly believe that better solutions to COVID are coming. But even with that belief, the risk to vulnerable individuals is here and now and will persist. These potential pharmaceutical miracles will arrive at some undefined point in the future, and because of that, I think it’s prudent to assess risks and “worst-case scenarios,” as I have here.

In closing, reinfections are likely to become a common occurrence, facilitated in part by waning immunity to SARS-COV-2. This likely means the virus will continue to circulate at high levels even after vaccinations and infections. The virus, even after vaccination, has caused a significant number of deaths, easily outstripping that of a moderately severe flu season. While data on reinfections supports the idea that they are generally milder, this mildness is not ironclad. Some studies disagree, and crucially, our data is necessarily constrained to a short period of time given the novelty of COVID-19. Our research cannot yet take into account the fact that people become older, sicker, and more vulnerable to COVID with time. These reinfections also may cause additional health consequences to healthy and vulnerable individuals along similar mechanisms to long COVID. Given this, it’s hard to imagine that acute COVID will not continue to be a public health problem in the coming years. This series does not intend to moralize, but I think it’s worthwhile to pause and consider how our response to this problem now will affect our society in the future.

As UK Ambassador Matthew Rycroft said, and this sentiment has been echoed by many historical figures, “How a society treats its most vulnerable – whether children, the infirm or the elderly – is always the measure of its humanity.” I worry that if we normalize putting vulnerable people at risk of severe disease and death from COVID due to our resignation to mass infection and reinfection, we will have no problem normalizing other instances of disease, death, or other deleterious consequences, because they hurt “someone else.” It’s a slippery slope, and one that threatens to render us less empathetic to suffering, and therefore less able to prevent the suffering of those around us. And even if you’re completely selfish, the truth is that this risk isn’t always going to be consigned to “someone else.” We will all be vulnerable, given enough time. Ultimately, I think decreasing the suffering of others is what gives life meaning, and without it, who are we as people?

Enough moralizing. It’s possible though that you don’t really agree with any of my points on impact. It’s possible that reinfections will get milder and milder and rarer and rarer, as accumulated immunity means that we can fight off the virus more effectively. You might think that the surge in reinfections is largely Omicron-specific, and once we get through Omicron, reinfections will become rare again. I don’t have the expertise to completely counter those arguments, apart from what I’ve covered here. I think it’s somewhat reasonable to believe in a sunny future. I also want to emphasize - while the content and tone of this article may seem alarmist, my goal is not to instill panic or push some kind of agenda. But what I hope this first article, and series as a whole, makes clear is that risk remains. Rather than ignoring that risk, I think we should work to understand it, and decrease it if possible.

On that note, let’s move to why I think this sunny future argument, while reasonable, loses some of its strength. Variants.

Works Cited (not in order)


Cavanaugh AM, Spicer KB, Thoroughman D, Glick C, Winter K. Reduced Risk of Reinfection with SARS-CoV-2 After COVID-19 Vaccination — Kentucky, May–June 2021. MMWR Morb Mortal Wkly Rep 2021;70:1081-1083. DOI: icon.



Wamsley L. American Life Expectancy Dropped By A Full Year In 1st Half Of 2020. NPR [Internet]. 2021 Feb 18; Available from:


COVID-19 Deaths Among Older Adults During the Delta Surge Were Higher in States with Lower Vaccination Rates [Internet]. Kaiser Family Foundation; Available from:


Roxby P. Covid-19: How many people have been infected more than once? BBC [Internet]. Available from:


Yong E. COVID-Hospitalization Numbers Are as Bad as They Look. The Atlantic [Internet]. 2022 Jan 12; Available from:


Rycroft M. How a society treats its most vulnerable is always the measure of its humanity. [Internet]. Available from:


Public health experts say most of us will get COVID-19. What does that mean? NPR [Internet]. 2022 Jan 12; Available from:


Akinbami LJ, Biggerstaff BJ, Chan PA, McGibbon E, Pathela P, Petersen LR. Reinfection With Severe Acute Respiratory Syndrome Coronavirus 2 Among Previously Infected Healthcare Personnel and First Responders. Clinical Infectious Diseases. 2021 Nov 15;ciab952.


Islam MdZ, Riaz BK, Akbar Ashrafi SA, Farjana S, Efa SS, Khan MA. Severity of COVID-19 reinfection and associated risk factors: findings of a cross-sectional study in Bangladesh [Internet]. Infectious Diseases (except HIV/AIDS); 2022 Jan [cited 2022 Feb 16]. Available from:


Abu-Raddad LJ, Chemaitelly H, Bertollini R. Severity of SARS-CoV-2 Reinfections as Compared with Primary Infections. N Engl J Med. 2021 Dec 23;385(26):2487–9.


Townsend JP, Hassler HB, Wang Z, Miura S, Singh J, Kumar S, et al. The durability of immunity against reinfection by SARS-CoV-2: a comparative evolutionary study. The Lancet Microbe. 2021 Dec;2(12):e666–75.


Doucleff M. The future of the pandemic is looking clearer as we learn more about infection. NPR [Internet]. 2022 Feb 7; Available from:


Dhillon RA, Qamar MA, Gilani JA, Irfan O, Waqar U, Sajid MI, et al. The mystery of COVID-19 reinfections: A global systematic review and meta-analysis. Annals of Medicine and Surgery. 2021 Dec;72:103130.


Davis N. The UK student nurse who has caught Covid four times. The Guardian [Internet]. 2022 Jan 21; Available from:


America’s Wars. Department of Veterans Affairs. Available from:


COVID Breakthrough Cases. RIDOH. Available from:


Flu. RIDOH. Available from



General Population Vaccination Coverage: Influenza. CDC. Available from:


Reported COVID-19 Reinfections in Washington State. Washington State Department of Health. Available from:


Daily Updates of Totals by Week and State. CDC. Available from:


Risk for COVID-19 Infection, Hospitalization, and Death By Age Group. CDC. Available from:


Surprising consequences of uncontrolled diabetes. UCI Health. Available from:


Qin CX, Moore LW, Anjan S, Rahamimov R, Sifri CD, Ali NM, et al. Risk of Breakthrough SARS-CoV-2 Infections in Adult Transplant Recipients. Transplantation. 2021 Nov;105(11):e265–6.



National Diabetes Statistics Report. CDC. Available from:


U.S. Health in International Perspective: Shorter Lives, Poorer Health. NIH. Available from:


Yek C, Warner S, Wiltz JL, Sun J, Adjei S, Mancera A, et al. Risk Factors for Severe COVID-19 Outcomes Among Persons Aged ≥18 Years Who Completed a Primary COVID-19 Vaccination Series — 465 Health Care Facilities, United States, December 2020–October 2021. MMWR Morb Mortal Wkly Rep. 2022 Jan 7;71(1):19–25.

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