For some, it may be tempting to throw caution to the wind after they’ve contracted and recovered from COVID-19. However, if you’re immunocompromised, you know things are never quite this simple. Reinfections can still cause severe disease and those with weakened immune systems may be at higher risk.
Here’s what to know about COVID-19 reinfection and how to stay safe this winter.
How Soon After Having COVID Can You Get Infected Again?
Research suggests that reinfection with COVID-19 — either with the same virus variant as the initial infection or reinfection with a different variant — are both possible, per the U.S. Centers for Disease Control and Prevention (CDC). In fact, even early reinfection within 90 days of the initial infection can occur.
Being infected with COVID-19 and having up-to-date vaccinations have both been shown to provide some protection against infection, but the immunocompromised may not mount a normal immune response to either. Your risk of reinfection is also affected by the COVID-19 variant circulating in your community.
“It depends upon the immune status of a person, how well of a response they made from the first infection, and if the virus has evolved away from what that person was infected with,” says infectious disease physician Amesh A. Adalja, MD, a Senior Scholar at Johns Hopkins Center for Health Security. “If you went from Delta to Omicron, there’s not going to be very much protection between those two.”
While it’s possible to be infected with the same variant of COVID-19, it’s not likely.
“It’s far less likely than being infected with a new variant, especially since we’re at a point where there are new variants coming out much faster,” says Saahir Khan, MD, PhD, Assistant Clinical Professor of Infectious Diseases at Keck Medicine of USC.
Are You at Higher Risk of COVID-19 Reinfection?
You could be more susceptible to COVID-19 infection, even after prior exposure, if you’re immunocompromised — since those with weakened immune systems may not mount a robust immune response to being infected.
“The immunocompromised are not going to build the same level of immunity post-infection as someone whose immune system is not impaired,” says Dr. Adalja. “It all depends on how immunosuppressed that person is and what arm of the immune system is suppressed, so it’s not going to be one size fits all for every immunocompromised person.”
You can think of it similarly to getting vaccinated: While you may get a certain level of protection from reinfection, it might not be as much protection as an immunocompetent individual.
“We know from measuring antibodies that immunocompromised people don’t generally mount as strong or as durable of an antibody response to both infection and vaccination,” says Dr. Khan. “There are other aspects of the immune system other than antibodies, but in general, we don’t expect the same strength and durability of immunity in an immunocompromised patient.”
Are Subsequent COVID-19 Infections Less Severe?
Although many people have anecdotally spoken about COVID-19 reinfections being milder than their primary infections, this isn’t a guarantee — especially if you’re immunocompromised. This statement is not meant to scare you, but to help you understand the research, so you can take precautions to stay protected and communicate the seriousness of COVID for you to loved ones.
In a population-level observational study published in The Lancet Regional Health – Europe, researchers analyzed COVID-19 reinfections in Serbia from 2020 to 2022 and found that 13,792 reinfections (5 percent) were recorded among 251,104 COVID-19 primary infections.
Reinfections were mostly mild (99 percent), while hospitalizations were uncommon (1 percent versus 3 percent in primary infection) and COVID-19 deaths were very rare (with a case fatality rate of 0.15 percent).
In this study, the researchers estimated the risk of reinfection to be:
- 0.75% at six months
- 1.36% at nine months
- 4.96% at 12 months
- 16.68% at 15 months
- 18.86% at 18 months
Most reinfections were recorded in January 2022, as they became more common with the advent of Omicron — but very few reinfections were severe.
Being over age 70, having one or more comorbidities, and having a severe or critical primary infection were significantly associated with severe reinfections.
“In general, second infections are milder than first infections — but if you’re someone who has risk factors for severe disease, there’s no guarantee that your second infection is going to be mild,” says Dr. Adalja. “There are still cases that occur in high-risk individuals where the second infection can be severe.”
Take, for instance, another study in The Journal of Investigative Medicine that looked at 17 cases of COVID-19 reinfection between January 1, 2020 and October 12, 2020. One immunocompromised patient had mild symptoms with the first infection but developed severe symptoms that resulted in death with the second infection. In this study, 68.8 percent of patients had similar severity during their second infection, 18.8 percent had worse symptoms, and 12.5 percent had milder symptoms.
It’s important to consider that the data was from a different period of the pandemic, in which vaccines were not yet available and the Omicron variant hadn’t emerged yet. Still, the results speak generally to the potentially unpredictable nature of a second infection.
“Each time you get COVID-19, it’s like a Russian roulette,” says Dr. Khan. “There’s a risk of severe COVID-19 that leads to you being in the hospital and then there’s a risk of longer-term complications like long COVID symptoms, blood clots, or other late complications. The more times you get infected, the more risk there is of one of those outcomes happening.”
Does Reinfection Increase My Risk of Long COVID?
In a pre-print study (meaning it hasn’t been peer reviewed yet) analyzing a database of 5.4 million patients from the Veterans Health Administration, researchers found that people reinfected with COVID-19 were twice as likely to die or have a heart attack as those who were only infected once. They were also much more likely to experience health issues of all kinds six months later, including those related to their lungs, kidneys, and digestive system.
This patient population has unique characteristics that may not apply to the general population. For instance, VA patients tend to be older men who have high rates of chronic conditions that may increase the risks for long COVID. Still, the results point toward the potential implications of reinfection on long-term health.
Meanwhile, more research is needed to determine if having long COVID can affect your risk of subsequent COVID-19 infection.
“It’s hard to say based on the data we have now,” says Dr. Khan. “There are some people who just have a mild prolonged cough and there are some people who have an extreme case of brain fog or chronic fatigue. It’s really hard to put all of long COVID into one bucket and say all patients have more or less risk of subsequent infection.”
What Can I Do to Protect Myself?
Rates of reinfection might change as new variants emerge, but vaccination remains the safest way to prevent future COVID-19 infections, hospitalizations, death, and long COVID. It’s key to stay up to date on your vaccines (which may include two or more doses and booster doses).
“Get the bivalent booster vaccine, if it’s been two months since your last COVID-19 vaccine or infection,” says Dr. Khan. “That’s the best thing you can do to protect yourself. Even though the response may not be as high in immunocompromised patients, it’s still very significant in terms of its reduction of risk.”
The bivalent booster is designed to target both the original strain of the COVID-19 virus as well as the Omicron variant. Also speak with your doctor about other preventive measures you can take — and what your treatment plan would be should you get infected.
For instance, AstraZeneca’s Evusheld contains tixagevimab and cilgavimab, two monoclonal antibodies that can be used to prevent COVID-19 before exposure in immunocompromised individuals. Evusheld is now unlikely to be effective against newer strains of COVID-19 in the vast majority of individuals, but your doctor may still recommend it after considering your individual risks and the prevalence of resistant subvariants in your region, per the National Institutes of Health.
Meanwhile, Paxlovid is an antiviral pill authorized for use in those at high risk for severe outcomes. It must be taken within five days of symptom onset, so it’s important to stay in close communication with your doctor as soon as you detect symptoms.
You may have heard of “Paxlovid rebound,” which is different from reinfection. The CDC defines COVID-19 rebound as a recurrence of symptoms or a new positive viral test after having tested negative. It has been reported to occur shortly after initial recovery. (Learn more about Paxlovid rebound and what it means for you.)
In a rebound case, the same virus causes symptoms or a positive test — it just hasn’t quite cleared your body yet.
“There’s a higher risk for rebound in immunocompromised people, because many studies have shown that virus tends to circulate longer in these patients,” says Dr. Khan. “The good news is that most rebounds are generally mild.”
On the other hand, COVID-19 reinfection occurs when you clear the virus but then get infected again (often months later). In this case, a different strain of COVID-19 causes the infection.
Beyond vaccination and preventive measures like Evusheld, the same tried-and-trued mitigation efforts you’ve followed throughout the pandemic will help to protect you from reinfection, including wearing a properly fitted mask when you’re in public places, cleaning and disinfecting surfaces that are touched a lot, and washing your hands regularly,
Improving ventilation indoors when you have visitors is also important. The CDC recommends:
- Opening windows to bring in fresh air from outside
- Setting your thermostat fan to “on” instead of “auto”
- Turning on a portable HEPA air cleaner
- Turning on ceiling fans
- Turning on the fan over your stove
- Turning on the fan in your bathroom
- Keeping fans on for an hour after people leave
“Take the same precautions we have been advised to take throughout COVID,” says Dr. Khan. These will help protect you not only from COVID-19, but also from other respiratory illnesses like the flu.
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Al-Aly Z, et al. Outcomes of SARS-CoV-2 Reinfection [pre-print]. Research Square. June 17, 2022. https://doi.org/10.21203/rs.3.rs-1749502/v1.
COVID-19 Rebound After Paxlovid Treatment. U.S. Centers for Disease Control and Prevention. May 24, 2022. https://emergency.cdc.gov/han/2022/pdf/CDC_HAN_467.pdf.
The COVID-19 Treatment Guidelines Panel’s Statement on Tixagevimab Plus Cilgavimab (Evusheld) as Pre-Exposure Prophylaxis of COVID-19. National Institutes of Health. January 10, 2023. https://www.covid19treatmentguidelines.nih.gov/therapies/statement-on-evusheld/.
Medić S, et al. Risk and severity of SARS-CoV-2 reinfections during 2020–2022 in Vojvodina, Serbia: A population-level observational study. The Lancet Regional Health – Europe. July 1, 2022. doi: https://doi.org/10.1016/j.lanepe.2022.100453.
Interview with infectious disease physician Amesh A. Adalja, MD, a Senior Scholar at Johns Hopkins Center for Health Security
Interview with Saahir Khan, MD, PhD, assistant clinical professor of infectious diseases at Keck Medicine of USC
Reinfection. COVID-19. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/clinical-considerations-reinfection.html.
Stay Safe When People Visit Your Home. COVID-19. U.S. Centers for Disease Control and Prevention. September 14, 2022. https://www.cdc.gov/coronavirus/2019-ncov/community/clean-disinfect/index.html.
Wang J, et al. COVID-19 reinfection: a rapid systematic review of case reports and case series. Journal of Investigative Medicine. May 18, 2021. doi: https://doi.org/10.1136/jim-2021-001853.