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My third COVID-19 infection: Why reinfection can be anything but mild

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As the pandemic approaches its third anniversary, most people are well and truly bored with COVID-19. With so many of us having recovered from at least one COVID-19 infection, not to mention being vaccinated and/or boosted, it is seductive to believe that catching it again won’t matter.

I’ve been to pubs and parties, packed myself onto public transport without a facemask, and entertained various guests with ‘colds’. But having just experienced COVID for the third time, I am regretting letting my guard down.

This is particularly true in the Omicron era, where we’re encouraged to believe that COVID-19 is ‘nothing but a minor sniffle’ and we must ‘learn to live with the virus’. I too have been enjoying largely living life as if the pandemic never happened in recent weeks and months. I’ve been to pubs and parties, packed myself onto public transport without a facemask, and entertained various guests with ‘colds’. But having just experienced COVID for the third time, I am regretting letting my guard down.

I am not advocating a return to full or even partial lockdowns; I desperately want my kids to continue attending school, and I don’t think pubs or restaurants need to stop serving customers indoors either. But as evidence mounts that northern hemisphere countries could experience a new wave of COVID-19 infections as winter approaches, combined with the return of influenza and other everyday illnesses, the onus is on everyone to do what they can to keep themselves – and each other – healthy.

COVID-19 reinfection

This latest bout of COVID-19, was my third in less than three years. The first, in March 2020, was characterised by a persistent cough and chest pains; the second, in June 2021, by fatigue and loss of taste and smell (I still suffer from “parosmia”). Having recovered from these infections, and been vaccinated, and boosted – twice – I had assumed that were I to catch it again, any illness would be negligible.

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Ever since the rise of Omicron, scientists have talked about its relative mildness – particularly in healthy people who have been vaccinated, like me. But my third experience of COVID-19 has been my worst yet.

Part of the problem, I think, is that the medical description of “mild illness” is at odds with the normal perception of “mild”, such as with mild weather or mild cheese. When doctors and scientists talk about “mild COVID-19”, what they mean is “not severe enough to cause breathing difficulties”.

This time, I experienced various “cold-like” symptoms – sore throat, sneezing, runny nose – but it was the feverishness and headaches that immobilised me in bed for three days, unable to cook, do anything for my kids, or work. Fortunately, I am gradually starting to feel better, but my experience of “mild COVID” was easily on par with flu – an illness I previously vowed never to catch again. The possibility of going through it all again next year, assuming that’s what ‘living with coronavirus’ means, is already filling me with dread.

Waning immunity

Whereas at the start of the pandemic, nobody had any immunity to SARS-CoV-2, nearly three years on, everyone’s immune systems are on a slightly different learning curve.

Unfortunately, current COVID-19 vaccines still only top-up people’s immune protection for a limited period before their antibody levels begin to drop. They will still be largely protected against severe disease and death, but waning antibodies increase individuals’ susceptibility to reinfection.

Although at the extreme end of the spectrum, reinfections tend to be less severe than people’s first brush with SARS-CoV-2, data from the UK’s Office for National Statistics have suggested that the proportion of people reporting symptoms during reinfection varies according to which variants they have been infected with before. When they were infected, relative to their last COVID-19 infection or vaccination, could also influence their symptom severity, because levels of protective antibodies gradually diminish over time.

Then there’s how much virus someone is exposed to. According to Ben Krishna, a postdoctoral researcher in immunology and virology at the University of Cambridge, UK, infection with a higher dose of virus (say, if someone with COVID-19 sneezes in your face) could enable higher levels of virus to gain a foothold in the body before the immune system manages to stamp them out, resulting in more severe symptoms.

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Booster campaign

My last COVID-19 booster was in June, so I was surprised to have come down with it again so soon. My experience shows that boosters do not offer total protection from the disease even though they are very effective in preventing severe disease and death. COVID-19 vaccines have had a massive impact on people’s risk of being hospitalised with or dying from the disease, and are the reason many countries have largely been able to return to normal life, without hospitals being overwhelmed.

Unfortunately, current COVID-19 vaccines still only top-up people’s immune protection for a limited period before their antibody levels begin to drop. They will still be largely protected against severe disease and death, but waning antibodies increase individuals’ susceptibility to reinfection.

Unlike the COVID-19 waves we experienced during 2020 and 2021, where a single variant, such as Delta, rapidly outcompeted all others and spread across the world, virologists are currently tracking the growth of multiple subvariants

The rationale for some countries launching COVID-19 booster campaigns in the coming weeks and months is to temporarily boost antibodies, reducing the risk of a sharp increase in severe cases, precisely when hospitals are likely to be grappling with a spike in influenza admissions. It is therefore important to take up the offer of a booster vaccine, if you are offered one, but it won’t make you invincible.

Viral evolution

Then there’s the issue of increasingly immune-resistant subvariants. Although the WHO hasn’t assigned any new Greek letters since Omicron, the subvariant that’s making me sick is likely very different to the one that infected my husband in early March, which was itself quite different to the original BA.1 version of Omicron that emerged in November 2021. The number of new, and potentially worrying Omicron subvariants in circulation right now, is unprecedented.

Unlike the COVID-19 waves we experienced during 2020 and 2021, where a single variant, such as Delta, rapidly outcompeted all others and spread across the world, virologists are currently tracking the growth of multiple subvariants, each carrying overlapping changes to the spike protein, which SARS-CoV-2 uses to grab onto, and infect human cells. Crucially, these mutations affect the ability of antibodies to recognise the virus and block it from infecting us.

If you are unfortunate enough to be reinfected, it is still likely that your infection will be mild. But mild doesn’t necessarily mean trivial. Not everyone has the benefit of sick pay, or a partner who can take over all childcare duties while their other half quarantines in bed.

Although vaccination and previous COVID infections have left us with other weapons against the virus, its ongoing evolution and individuals’ waning immunity means that even people who caught COVID-19 in May or June, when the BA.4 and BA.5 Omicron subvariants took off, could be susceptible to reinfection with the newest crop of subvariants, assuming they continue to spread.

Disruptive illness

If you are unfortunate enough to be reinfected, it is still likely that your infection will be mild. But mild doesn’t necessarily mean trivial. Not everyone has the benefit of sick pay, or a partner who can take over all childcare duties while their other half quarantines in bed. Even for those lucky enough to have these things, the risk of Long COVID still looms large.

COVID-19 isn’t just about individual risk. There are still plenty of people in our communities who risk being hospitalised, or developing lasting disability, if they catch COVID-19 – even if they’ve been vaccinated. This includes people who may look relatively young and healthy. Living life as if there’s no pandemic is risky – for everyone.

It is also unsustainable. Widespread absences due to COVID-19, flu, or any other infection, risks there being too few teachers, delivery drivers, healthcare staff and other essential workers to keep society running as normal.

Everyone wishes for a return to normal life, but behaving as if there is no COVID-19 will have consequences. Relative normality is another matter. With a few common-sense precautions – such as avoiding mixing with people if you are unwell; wearing a good quality facemask in crowded indoor spaces if local case numbers are high (particularly if you are unwell); taking a COVID-19 test if you can; getting a booster vaccine if you are offered one; and keeping indoor spaces ventilated – we can all help to keep everyone protected.

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HIV/AIDS progress in Brazil

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03:08

December 1 is World AIDS Day,  a time to raise awareness and show support for those living with AIDS or HIV, the virus that causes AIDS.

Treatment of HIV/AIDS has come a long way since the first cases became public in the 1980s.

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And Brazil is one country that led the way; its pioneering programs to identify and treat patients recognized the world over.

In recent years, however, the country’s progress has shown to be slipping.

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Early RSV season primarily impacts infants

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Dear Doctors: What can I do to protect my baby from RSV? What are the symptoms? People are talking about a “tripledemic,” and it has my husband and me worried. We’re both vaccinated for the flu and COVID-19, and we are being super careful when we’re out and about. What else can we do?

Dear Reader: RSV is short for respiratory syncytial virus. It’s a common winter virus that can affect people of any age. In most cases, RSV infection causes mild symptoms similar to the common cold. However, infants and children younger than 2, whose immune systems are still developing, are at increased risk of becoming seriously ill.

RSV is the most common cause of pneumonia in infants and young children in the United States. It is also the leading cause of bronchiolitis in that age group. That’s a lung infection in which the smallest airways become inflamed and swollen, and an increase in mucus production impedes air flow into and out of the lungs.

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This year, as with the flu, RSV season has arrived early. Hospitals throughout the U.S. are reporting a surge of serious infections among infants and younger children.

The virus enters the body through the airways and the mucous membranes. It can remain viable on hard surfaces — such as a doorknob, night table or dinnerware — for several hours. It can also persist on softer surfaces, such as a tissue or the skin. Someone can become infected by breathing in the viral particles that remain airborne following a cough or a sneeze, or by touching their mouth, nose or eyes after direct contact with contaminated droplets.

Someone who is sick with RSV typically remains contagious for between four and eight days. However, due to their still-developing immune systems, it’s possible for infants to continue to spread the virus for several weeks, even after symptoms of the disease have abated. There is no vaccine for this virus, and no targeted treatments. Prevention relies on the same precautions you use to avoid any respiratory illness. That is, keep your baby away from people who are ill, avoid close contact with people outside your home and be vigilant about hand hygiene.

Symptoms of RSV arise between three and six days after infection. They can include a runny nose, sneezing and coughing, fever, a decrease in appetite and lung congestion that can cause wheezing. These symptoms tend to be progressive, arriving in stages as the body mounts its attack against the virus. But in very young patients, the first, and sometimes only noticeable, symptoms of RSV can be increased fussiness, a decrease in activity and difficulty breathing.

Treatment for RSV consists of managing symptoms. The specific avenue of care depends on a child’s age, general health and symptoms. In infants, treating RSV includes a focus on adequate hydration and remaining alert for any signs of problems with breathing. The majority of RSV infections run their course in a week to 10 days. Parents of younger infants should check with their pediatricians for guidance on treatment, particularly medications. If your child has difficulty breathing, isn’t drinking enough fluids or has worsening symptoms, call your health care provider right away.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.

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AIDS Memorial Quilt comes to Palm Beach County

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PALM BEACH COUNTY, Fla. — The largest piece of community folk art in the world, a tribute to victims of AIDS, is on display in Palm Beach County.

Now through Dec. 15, three different panels of the NAMES Project AIDS Memorial Quilt, often known as the AIDS Quilt, will be on display at three different Palm Beach County Public Library locations.

The quilt is a giant tribute to the lives of people who have died due to AIDS or AIDS-related causes.

The quilt weighs around 54 tons and was started in the 1980s during the early years of the AIDS pandemic.

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Three different panels of the AIDS Quilt will be on display at three different Palm Beach County Public Library locations through Dec. 15.

The AIDS Memorial Quilt is comprised of nearly 50,000 panels containing 91,000 names of the men, women and children who lost their lives to the immune system disease.

The blocks, which make up the panels, are stitched by individuals in communities across the nation, including one librarian right in Palm Beach County.

Katrina Brockway, a librarian at the Hagen Ranch Road Branch Library, said she feels it brings tragedy a bit closer to home.

Katrina Brockway, librarian at the Hagen Ranch Road Branch Library discusses the AIDS Quilt visit
Librarian Katrina Brockway explains the impact of seeing the AIDS Quilt in person.

“It becomes so much more personal when you see these quilt panels and all of these people who were loved and didn’t have the same opportunity to escape this,” Brockway said. “So you can remember them, what they went through, and what their loved ones have gone through.”

Visitors can see the quilt panels during normal library hours at the library’s main branch on Summit Boulevard at the Jupiter branch and at the west Boca Raton branch.

Click here for the library’s hours and more information on upcoming AIDS events at the library.

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