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For New York musician Erica Mancini, COVID-19 made repeated appearances.
March 2020. Last December. And again this May.
“I’m stunned to know I could get infected forever,” said the 31-year-old singer, who is vaccinated and boosted. “I don’t want to get sick every month or every two months.”
But medical experts warn that as the pandemic drags on and the virus evolves, repeat infections will become more likely – and some people will be affected more than twice. Recent research suggests they may be at higher risk for health problems.
There is no comprehensive data on people who get COVID-19 more than twice, although some states collect information on reinfections in general. New York, for example, reports around 277,000 reinfections out of a total of 5.8 million infections during the pandemic. Experts say the real numbers are much higher because so many COVID-19 home tests go unreported.
Several public figures have recently been reinfected. US Health Secretary Xavier Becerra and Canadian Prime Minister Justin Trudeau said they had contracted COVID-19 for a second time, and US Senator Roger Wicker of Mississippi said he had tested positive for a third time. All said they were fully vaccinated, and Trudeau and Becerra said they had booster shots.
“Until recently it was almost unheard of, but now it’s becoming more common” to have COVID-19 two, three or even four times, said Dr. Eric Topol, director of the Scripps Research Translational Institute. “If we don’t come up with better defenses, we’re going to see a lot more of that.”
Why? Immunity to past infections and vaccinations wanes over time, experts say, leaving people vulnerable.
Also, the virus has evolved to be more contagious. The risk of reinfection was about seven times higher in Omicron variants compared to when Delta was most prevalent, research from the UK shows. Scientists believe the Omicron mutants, which now cause the vast majority of cases in the US, are particularly adept at evading immunity from vaccination or previous infections, particularly infection during the original Omicron wave. US health officials are considering modifying boosters to better accommodate recent changes in the coronavirus.
When Mancini first contracted COVID-19, she and her fiancé developed a fever and were ill for two weeks. She was unable to get tested at the time, but had an antibody test a few months later that showed she was infected.
“It was really scary because it was so new and we just knew people were going to die from it,” Mancini said. “We were really sick. I haven’t been this sick in a long time.”
She was vaccinated with Pfizer in spring 2021 and believed she would be protected from further infection, especially as she was previously ill. But while such “hybrid immunity” can provide strong protection, it doesn’t guarantee that someone won’t get COVID-19 again.
Mancini’s second fight, which took place during the huge Omicron wave, started with a sore throat. She initially tested negative but was still feeling ill as she drove to a gig four hours away. So she ducked into a Walgreens and did a quick test in her car. It was positive, she said, “so I just turned the car around and drove back to Manhattan.”
This attack was milder, with “the worst sore throat of my life,” a stuffy nose, sneezing, and coughing.
The last illness was even milder and caused sinus pressure, brain fog, light-headedness and fatigue. This one, which tested positive at home and was confirmed with a PCR test, hit despite her Moderna booster shot.
Mancini has no known health issues that could put her at risk for COVID-19. She takes precautions like masking at the grocery store and on the subway. But she doesn’t usually wear a mask on stage.
“I’m a singer, and I’m in these crowded bars and I’m in these small clubs, some of which don’t have a lot of ventilation, and I’m just around a lot of people,” said Mancini, who also plays the accordion and drums. “It’s the price I paid for doing a lot over the past few years. That’s how I earn my living.”
Scientists don’t know exactly why some people get reinfected and others don’t, but believe several things could play a role: health and biology, exposure to certain variants, how much virus is spreading in a community, vaccination status and behavior. British researchers found that people are more likely to be infected again if they are unvaccinated, younger or had a mild infection the first time.
Scientists are also unsure how quickly someone can become infected after a previous bout. And there is no guarantee that every infection will be milder than the last.
“I’ve seen it go both ways,” said Dr. Wesley Long, Houston Methodist pathologist. In general, however, breakthrough infections tend to be milder after vaccination, he said.
Doctors said getting vaccinated and boosted is the best protection against severe COVID-19 and death, and there is some evidence it also reduces the chance of reinfection.
At this point, there haven’t been enough documented cases of multiple reinfections “to really know what the long-term consequences are,” said Dr. Peter Hotez, Dean of Baylor University’s Department of Tropical Medicine.
But a large, new study using Veterans Affairs data, which has not yet been reviewed by scientific experts, offers some insight, finding that reinfection increases the risk of serious consequences and health problems such as lung problems, heart disease and diabetes compared to an initial infection. The risks were most pronounced when someone was ill with COVID-19, but persisted even after the acute illness.
After Mancini’s last fight, she struggled with dizziness, headaches, insomnia and sinus problems, although she wondered if that was more due to her busy schedule. In the last week she’s had 16 shows and rehearsals – and has no room for another COVID-19 iteration.
“It wasn’t fun,” she said. “I don’t want it again.”
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
