For the past two Christmases, Ana Siqueira has received the same unwanted gift: covid-19. And so has her husband.
But the second time, Siqueira, 57, a children’s book author and Spanish teacher from Palm Harbor, Fla., had checked all the boxes. She wore a mask in public, practiced social distancing and was vaccinated and boosted, but thinks she caught covid anyway during a family trip to see her daughter in Seattle. Most of the family got swept up with infections, she said.
Although statistically rare, virus reinfections have been rising recently, leading some states to track them separately. Infectious-disease experts say getting covid more than once will lose its novelty for Americans. Time and the virus are both working against people’s defenses, they said.
Immunity developed from a previous infection fades over time. As the coronavirus pandemic enters its third year, many people who once had natural immunity have lost it. Protection provided by vaccines also wanes, and even before that happens, infections are possible among vaccinated and boosted individuals.
The coronavirus, meanwhile, is mutating to more infectious forms such as the delta variant and, more recently, the highly transmissible omicron variant.
For Siqueira, her first bout included nausea, a low fever for a week and anxiety. “I also felt weak and fainted twice. … I felt very sleepy and tired for almost a month,” she said.
The second time: nausea and nasal congestion. “I didn’t even think I had covid,” Siqueira said. “My nausea lingered for about two weeks.”
An unvaccinated man in Texas with underlying health conditions previously diagnosed with covid-19 was the first omicron-related death identified in the United States. The Centers for Disease Control and Prevention in an August study found that “being unvaccinated was associated with 2.34 times the odds of reinfection compared with being fully vaccinated,” using data from Kentucky for May and June 2021 — and that was before the delta or omicron variants had taken hold.
In a separate study from December, the CDC investigated 43 of the earliest omicron variant cases in the United States and found that six, or 14 percent, involved reinfections. The CDC defines a reinfection as when someone tests positive for the coronavirus again more than three months after a previous positive test. States including Louisiana, Minnesota, Oklahoma and Washington have begun to publish reinfection statistics after seeing large spikes in their populations last year.
Among the factors that can predict whether someone might be reinfected: the time since being vaccinated and changes to the virus.
“You put the two together, and you have more and more reinfections,” said Frank Esper, a pediatric infectious-disease specialist at the Cleveland Clinic.
“As it stands right now, people who have had the infection or people who have received the vaccination do show substantial protection against hospitalization or repeat infection,” Esper said. “However, it doesn’t last forever. It goes down over time, and it goes down quicker if a new variant or new strain shows up which is completely different from the other strains, which is what omicron is.”
Oklahoma reported 148 reinfections in January 2021, a monthly total that grew to 1,213 in September. Washington state officials reported 4,404 reinfection cases from September to Dec. 26, of which 60 percent involved unvaccinated patients. Louisiana reports more than 47,000 reinfections out of more than 1 million cases since the start of the pandemic.
Health officials say these numbers probably underrepresent the true total for reinfections, because people with the coronavirus may be asymptomatic or may not be tested.
“COVID-19 reinfections do occur but are rarely identified. People with a reported reinfection make up 1.7% of all reported cases of COVID-19,” the Washington state health department says. “This is likely lower than the actual number of reinfections, but we do not have sufficient information to estimate the actual amount at this time.”
At a White House briefing Friday, Anthony S. Fauci, chief medical adviser to President Biden on the coronavirus, said most reinfections involve a different variant and that it is “extremely unlikely” to get the same strain more than once.
“There are reinfections, but it is unlikely that, if you mount a good immune response, at least over a period of several months, it is extremely unlikely that you will be reinfected with the same variant,” said Fauci, the director of the National Institute of Allergy and Infectious Diseases. “We’ve seen infections, but those are mostly in people who have been infected with alpha who then wind up getting infected with beta or reinfected with omicron.”
William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center in Nashville, said reinfections are bound to occur because “this is not a virus that produces a durable, lifetime protection like measles does.” The coronavirus and its variants could be sticking around indefinitely, managed like the flu with a regularly updated vaccine, he said.
“There are a lot of people who would literally like to put covid behind them, to forget about it, and it will be difficult to get them to understand that they and their children will be coping with covid like we cope with influenza on an annual basis,” Schaffner said.
For Kevin Metz, his first infection was heralded in October 2020 by a burning sensation on his skin, followed later by a nagging cough, trouble breathing and sleeping, and other symptoms, requiring a cortisone inhaler. The second bout in recent weeks felt more like a “bad head cold,” he said.
Metz, 54, a party rental company owner from Yardley, Pa., and his wife have both been diagnosed with covid twice. His wife thinks she caught it the first time after visiting a niece and passed it on to Metz, and Metz thinks he caught the virus the second time from a friend at a basketball game over Christmas and passed it to his wife, he said. He and his wife are vaccinated but not boosted, Metz said.
During the most recent illness, Metz said, symptoms were “not feeling as severe,” though it was still four or five days of nausea, coughing, sore throat and a runny nose. After recovering, Metz felt newly protected from the virus and in the mood for an island vacation, “but we didn’t wind up going anywhere.”
“Once we got it, I’m like: ‘We’re free now, we can go anywhere,’ ” he recalled.
“She was a little more concerned about it,” Metz said of his wife.
Ryan Hodgson caught covid for the second time over the Christmas holiday. Hodgson was at a restaurant that checked vaccination records and wore a mask at his table when he wasn’t eating or drinking; a friend who was there didn’t get sick.
“It blows my mind that with the cautions I was taking — I do everything by the book, everything — I still got covid,” said Hodgson, 47, who runs a leadership development business in Seattle.
After his first covid illness in April 2020, marked by deep chest pain and other symptoms, Hodgson resumed hiking, weightlifting, hot yoga and running.
“The first run I tried to do was like torture, because it lingered, that chest pain,” Hodgson recalled. “The second time, I’d had both covid vaccines and the booster and … it was similar body aches, similar fever, more headaches, a little cough that I had for a little while, but it didn’t go into my chest.”
“I have a lot of people saying it’s milder now,” Hodgson said. “It’s not mild.”
When health-care professionals use the term “mild,” they mean a patient did not have to be hospitalized and can recover at a home. But even patients with a mild case can suffer symptoms that lay them low for a few days.
Not even actor Josh Canfield, who lasted 21 days on “Survivor: San Juan del Sur,” could escape the covid double-whammy.
The first time it hit, in March 2020, Canfield said he was sick for about a week with two really bad days: “I couldn’t get off of the couch and had a fever, body aches, chills, heat flashes and intense fatigue. I lost my sense of taste and smell, which lasted for about three weeks.”
This month, he got covid again, despite two Pfizer doses and a Moderna booster shot.
“This one lasted around five days and included a constant runny nose, lots of sneezing, and overall just felt like a bad cold,” Canfield, 40, said.
Do people take more chances, or act more cautiously, after living through covid twice?
“I definitely feel more liberated because I think this means I won’t get it again for at least a little while since I have the antibodies,” Canfield said, adding that he still follows rules on mask-wearing. “Obviously, I’m not a scientist so I don’t know for sure, but it seems that way. … I don’t have as many worries now in regards to social distancing.”
Siqueira, on the other hand, said: “With so many new strains always popping up, I still don’t feel 100 percent secure. I still wear my mask and social distance.”