Like many other New Yorkers, Domenica D’Ottavio received COVID-19 during the Christmas holidays. Her head was clogged with congestion, her body hurting; she coughed and got a fever.
But she also had another surprising symptom: relief.
“It was just a different feeling,” said D’Ottavio, who had been fully vaccinated and boosted before being infected. “You do not realize until it is over that you have walked around with a little bit of fear in the back of your mind.”
D’Ottavio still wears masks and takes a test before visiting her mother. But she also planned a “post-COVID” trip to Florida for her sister’s birthday and now goes to bars and on dates without thinking about the pandemic. She even swapped straws with a friend who had also recently recovered from COVID-19 so they could try each other’s drinks.
“We all feel like superheroes,” she said of her friends who have had breakthrough infections. “We all feel we can do anything.”
Nearly 800,000 new cases are reported in the U.S. each day, according to a New York Times database, most caused by the rapidly spreading omicron variant, and the true number of infections is likely to be much higher because so many cases are unreported. Although many people recover quickly, the increase in omicron poses a particular risk to the unvaccinated and has put a huge strain on hospitals and healthcare professionals.
However, among those vaccinated and boosted, it appears to be infected with the omicron variant also contributing to a psychological shift, as people realize that they have probably received at least a short-term natural boost to their immune system. Researchers call it “hybrid immunity”, which is the result of the combined protection of pre-existing vaccine antibodies and natural antibodies against a breakthrough infection.
Google searches for the term “super-immunity” have increased by 550% in the United States over the past three months, according to Google Trends data. Searches for “hybrid immunity” increased by 230% during that time.
While some doctors and immunologists agree that hybrid immunity offers an extra layer of defense against the virus, they call for caution, noting that the strength of this protection may vary from person to person and may decrease over time.
“It’s the best immunity you can get,” said Shane Crotty, a virus expert at the La Jolla Institute of Immunology in California. “But I would not think of hybrid immunity as being a force field that can completely stop it no matter what.”
Experts also warn against trying to get infected on purpose as a way to gain hybrid immunity. “I’m really worried that people are being intentionally infected so they can get to this ‘new normal,'” Drs. Celine Gounder, a specialist in infectious diseases at the Bellevue Hospital Center in New York. The virus is unpredictable and even young people can get very sick. “Something could go wrong and they could end up in the hospital,” she said. In addition, it is impossible to know who may develop long COVID-19 after an infection.
How much does hybrid immunity protect you?
The immunity boost of a natural infection can be equivalent to getting a fourth dose of vaccine, said Dr. Peter Chin-Hong, an expert in infectious diseases at the University of California, San Francisco. Hybrid immunity can also occur if you become infected before being vaccinated or a booster.
Here’s why. The first time you are vaccinated or infected with a virus, it takes your immune system some time to react. But your immune system has a long memory. It responds faster and increases more antibodies the next time it detects the virus. The effect appears to be even more pronounced in people who have been both vaccinated and infected.
A recent study showed that vaccinated healthcare professionals with breakthrough infections had significantly higher levels of antibodies compared to a vaccinated control group who had not had natural infections. Fikadu Tafesse, an immunologist at Oregon Health & Science University who helped conduct the research, said that although the study was conducted before the omicron wave, the results suggest a drastically increased level of protection after a breakthrough infection.
“Superimmunity may be an abuse, but we know that recent studies show that there is hybrid immunity, really because of immune players known as memory B cells,” said Anita Gupta, an adjunct assistant professor of anaesthesiology and intensive care at Johns Hopkins University School of Medicine. “When some of the short-lived immune cells disappear, these memory B cells will last for a while.”
But here’s the bad news: Exactly how much extra protection you get and how long it lasts will vary from person to person, said Akiko Iwasaki, an immunologist at Yale University. And a person who is immunocompromised or older or otherwise at higher risk for serious illness is likely to generate fewer antibodies than a young, healthy person, and their antibody levels may also drop faster.
It is also not clear whether the severity of the disease affects the level of hybrid protection. A person with severe symptoms may have been exposed to a larger amount of the virus, which would trigger more antibodies and thus more protection, Iwasaki said. A person who was asymptomatic may not have such a robust immune response to the virus and may be more susceptible to re-infection.
“Going back to 2019 behavior is a little too early,” Iwasaki said. “It’s really just playing the lottery, because you do not know how many antibodies you have generated.”
In the short term, recovering from a breakthrough infection means that you are “almost certainly” protected from serious illness after both vaccination and infection, said Dr. Adam Ratner, Director of the Department of Pediatric Infectious Diseases at Hassenfeld Children’s Hospital at NYU Langone.
However, there are not yet enough data on how much hybrid immunity protects you from a mild or asymptomatic breakthrough infection or from spreading the virus to others. And in the future, you may be susceptible to all new varieties that pop up. Some vaccinated people who were previously infected with the delta variant, for example, have been re-infected with omicron, said Jennifer Gommerman, an immunologist at the University of Toronto.
Can I party like it’s 2019?
Experts warned against paying more attention to COVID-19 precautions after recovering from a breakthrough infection. The number of Americans getting infected every day is still staggeringly high, and it is unknown whether the population builds up enough natural immunity to help us reach the day when the virus becomes a manageable part of daily life.
“Midsurge, it’s very hard to say that increasing risk makes sense to anyone,” said Dr. Paul Sax, an infectious disease expert at Brigham and Women’s Hospital and a professor at Harvard Medical School.
But for many of those who are young, vaccinated and otherwise healthy, recovery from a breakthrough infection can provide peace of mind. For at least the first three months after a breakthrough infection, if you are not at high risk for serious illness, you should feel confident about your level of protection, especially if you are boosted, said Ashish K. Jha, dean of Brown University School of Public Health.
“Can you get infected again? Yes, if someone in their most infectious moment hits you in the face again and again, maybe,” Jha said. But “a normal interaction in a restaurant or a bar” is probably safe, he said.
But other experts warned that even if you have hybrid immunity, your risk of becoming infected again – and potentially spreading the virus to others – is not zero. It is still a good idea to take precautions and get tested before spending time with vulnerable people.
“You have to remember that there are vulnerable people in society and we have to keep doing things like wearing masks,” Gounder said. “It’s not just about protecting yourself, it’s about protecting other people.”
Ilana Horowitz, a 44-year-old social worker in Tuckahoe, New York, said she, her wife and their 6-year-old twins all came down with COVID-19 in early January. She said she feels, at least in the short term, that she can provide “a sense of normalcy” to her children. She is no longer worried that they lack school or lack work to take care of them. “There’s definitely a freedom in that,” she said.
Patricia Piekarski, 40, an HR professional in Rockland County, New York, remembers how anxious she felt after her boyfriend had been exposed to the virus a few months ago. She remembered how she stumbled and cut her knee on the way to find a quick test and scanned the pharmacy corridors with blood seeping through a hole in her jeans.
But now that level of panic and worry is behind her. In early January, she and her boyfriend both had mild breakthrough infections and have since recovered. While still wearing a mask and taking her precautions, she now feels more secure by making plans to meet her brother’s new baby and eat indoors at restaurants. “I want to start texting friends and saying, ‘Hey, if anyone else had it, let’s hang out,'” she said.
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