A viral reprise: when COVID-19 strikes again and again

COVID-19 made repeat appearances for New York musician Erica Mancini.

March 2020. Last December. And again in May.

“I’m bummed to know that I might be infected forever,” said the 31-year-old singer, who has been vaccinated and boosted. “I don’t want to get sick every month or every two months.”

But medical experts warn that repeated infections are becoming more likely as the pandemic continues and the virus develops — and some people are sure to be hit more than twice. Emerging research suggests they are at greater 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 about 277,000 reinfections of the 5.8 million total infections during the pandemic. Experts say the actual numbers are much higher because so many home COVID-19 tests go unreported.

Several public figures have recently been reinfected. US Secretary of Health and Human Services Xavier Becerra and Canadian Prime Minister Justin Trudeau said they had COVID-19 for the second time, and Mississippi Senator Roger Wicker said he tested positive for the third time. All reported being fully vaccinated, and Trudeau and Becerra said they had received booster shots.

“Until recently it was almost unheard of, but now it is becoming more common” to get COVID-19 two, three or even four times, said Dr. Eric Topol, head of the Scripps Research Translational Institute. “If we don’t come up with a better defense, we’ll see a lot more of this.”

Why? Immunity to previous infections and vaccination 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 with Omicron variants compared to when Delta was most prevalent, research from the United Kingdom shows.

Scientists believe that the Omicron subvariants that now cause the vast majority of U.S. cases are particularly adept at evading immunity from vaccination or previous infections, especially infection during the original Omicron wave. US health officials are considering whether boosters should be modified to better match recent changes in the coronavirus.

The first time Mancini got COVID-19, she and her fiancé had a fever and were sick for two weeks. She couldn’t be 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 dying from it,” Mancini said. “We were really sick. I hadn’t been this sick in a long time.”

She was vaccinated with the Pfizer-BioNTech injections in the spring of 2021 and thought to be protected against another infection, especially because she had been ill before. But while such “hybrid immunity” can provide strong protection, it doesn’t guarantee someone won’t get COVID-19 again.

Mancini’s second fight, which took place during the huge wave of Omicron, started with a sore throat. She tested negative at first, but still felt nauseous 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 turned the car around and drove back to Manhattan.”

This attack turned out to be milder, with “the worst sore throat of my life”, a stuffy nose, sneezing and coughing.

The most recent illness was even milder, causing sinus pressure, brain fog, dizziness and fatigue. Which, positive on a home test and confirmed with a PCR test, hit despite her Moderna booster injection.

Mancini has no known health problems that put her at risk for COVID-19. She takes precautions such as masks in the supermarket and on the subway. But on stage she usually doesn’t wear a mask.

“I’m a singer, and I’m in these crowded bars and I’m in these little clubs, some of which don’t have much ventilation, and I’m just around a lot of people,” said Mancini, who also plays accordion and percussion. “That’s the price I’ve paid for doing a lot over the years. That’s how I earn my living.”

Scientists aren’t sure why some people get re-infected and others don’t, but they think several things may be involved: health and biology, exposure to certain variants, how much virus is spreading in a community, vaccination status and behavior. British researchers found that people were more likely to get infected again if they were unvaccinated, younger or had a mild infection the first time.

Scientists are also not sure how quickly a person can become infected after a previous attack. And there’s no guarantee that each infection will be milder than the last.

“I’ve seen it go both ways,” said Dr. Wesley Long, a Houston Methodist pathologist. In general, however, breakthrough infections that occur after vaccination are milder, he said.

Doctors said getting vaccinated and boosted is the best protection against severe COVID-19 and death, and there’s some evidence that 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 tropical medicine school.

But a large, preliminary study with data from the US Department of Veterans Affairs provides some insight. The study, which has not yet been reviewed by peers, shows that reinfection increases the risk of serious consequences and health problems such as lung problems, heart disease and diabetes compared to a first infection. The risks were most pronounced when someone was sick with COVID-19, but also persisted after the acute illness.

After Mancini’s last fight, she started experiencing dizziness, headaches, insomnia and sinusitis, though she wondered if it was more due to her busy schedule. In the past week, she’s had 16 shows and rehearsals — and has no room for another COVID-19 reprise.

“It wasn’t fun,” she said. “I don’t want to have it again.”