By this point in the pandemic, you’ve likely had COVID-19 at least once. Maybe twice. Perhaps even three times, as some unfortunate Canadians have experienced, all while this virus evolved to become increasingly savvy at infecting us.
It’s clear that reinfections from this coronavirus are the norm, much like with those behind the common cold. Unfortunately, that also means early speculation about one-and-done bouts of COVID-19 offering immunity against future infections has long gone out the window.
What’s more hazy is just how often you can get infected with SARS-CoV-2 and whether future infections will always be milder than the first, as the virus finds a way into our bodies over and over again.
Reassuringly, scientists say that for most healthy adults — including those with extra protection from vaccination — COVID-19 infections should get easier to deal with as your immune system gains repeat training on how to handle this particular pathogen.
A transmission electron micrograph of SARS-CoV-2, isolated from a patient. Scientists say the virus is capable of reinfecting humans again and again. But just how often can it happen, and will it feel milder each time? (National Institute of Allergy and Infectious Diseases)
“Your first infection with COVID is probably — not invariably but probably — going to be the worst,” said infectious diseases specialist Dr. Allison McGeer, a professor at the University of Toronto’s Dalla Lana School of Public Health.
“And then as you get more and more exposed to it, you get better and better protections.”
Coronaviruses strike repeatedly
After months or even years of avoiding the virus entirely, it might come as a surprise that COVID-19 can hit you more than once.
Early in the pandemic, some scientists spouted hopes around herd immunity — that if enough people caught COVID-19 or were vaccinated against it, collective immunity against infection would reach a threshold where the virus wouldn’t be able to find new human hosts.
Unfortunately, that’s not easy with a coronavirus.
First identified in humans in the 1960s, viruses in this family have likely been striking us repeatedly for centuries. SARS-CoV-2 is just the newest kid on the block.
“Four of those other family members cause about 30 per cent of our common colds, and they reinfect us routinely,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore.
“We’ve all had multiple bouts of other coronavirus infections, and that’s where this virus was always headed. So reinfections are not something to be surprised about.”
They were rare, though, throughout the early part of the pandemic. SARS-CoV-2 is hitting people again and again at this point, two-and-a-half years in, partly because we’re giving it the chance.
“This would have been happening much more frequently had we not all been staying at home and keeping our distance,” McGeer said. “It’s not that the virus is doing anything different than the virus would have done before; it’s that we’re behaving differently.”
Scientists say reinfections were rare throughout the early years of the pandemic in part because people were largely staying home, whereas more socializing is now giving the virus a chance to spread. (Marc-André Turgeon/CBC/Radio-Canada)
Layer in ever-more-contagious variants that are capable of dodging the front-line soldiers of our immune systems, and you’ve got a recipe for reinfections on a more regular basis. What’s unclear is just how often this virus will strike.
Four long-studied seasonal human coronaviruses seem capable of reinfecting people every 12 months, according to research published in Nature Medicine that involved scientists tracking a group of healthy adults for more than 35 years.
But unlike that seasonal pattern, SARS-CoV-2 remains erratic — more of a constant roller-coaster than one big surge and drop in any given year.
In Canada and multiple other countries, a seventh wave is now underway, fuelled by yet another immune-evasive Omicron subvariant, BA.5. It’s happening in the summer months — well before the typical cold and flu season — and not long after earlier waves driven by other members of the Omicron family tree.
McGeer, like many close COVID watchers, still isn’t sure what path this virus will take in the long term.
“Are we probably going to settle into winter activity? Yes, eventually, but maybe not for another year or two,” she said. “Is it for sure that we’re going to? Nope.”
Reinfections usually not worse than the first
What several experts who spoke to CBC News are more certain about is that subsequent COVID-19 infections should feel milder than the first. That doesn’t mean a walk in the park, necessarily, but at least not as rough as your body’s first encounter with this virus.
“From all the literature I’ve seen, when reinfections do happen with increasing frequency, they’re not usually worse,” said Angela Rasmussen, a virologist with the University of Saskatchewan’s Vaccine and Infectious Disease Organization in Saskatoon. “And that’s exactly what you’d expect, because that’s how the immune system works.”
There are a couple of ways to train your immune system to fight off this virus faster and smarter. One is being exposed to SARS-CoV-2 directly, which comes with all the potential health consequences of an infection.
The other is getting vaccinated, allowing your body to learn about this particular pathogen without facing those risks. (Consider that option like a martial arts lesson, rather than scrapping it out in a surprise fist fight.)
Erin Wilson, a fitness teacher and actor in Halifax, has caught COVID-19 twice — the first time last December and again in July. Both times the virus hit her hard, leading to fatigue, coughing and chest congestion, but she says the second time around felt a little easier. (Mark Crosby/CBC)
If you’re vaccinated and catch COVID-19, the virus might still get by your immune system’s first line of defence — your neutralizing antibodies — and sneak into your cells, Rasmussen said.
“Immediately your memory T-cells from your vaccination are going to say, ‘Whoa, I’ve seen that guy before; time to go out and start killing these cells that are infected with it,'” she explained.
In other words, a well-trained immune system can’t prevent infection, but it can often rapidly control it. That means an invader that might have once wreaked havoc simply doesn’t get that chance.
So far, that’s been the experience for Erin Wilson, a fitness teacher and actor in Halifax, who recently caught COVID-19 again after first getting infected last December. (She’s also vaccinated.)
The first round left her exhausted and in bed for days, “completely incapacitated.” Her next bout wasn’t pleasant — and several days in, she was still battling chest congestion, a cough, and fatigue — but she did notice it was a little easier.
“The second time around did not knock me out as much,” Wilson said.
Not every reinfection will be ‘benign’
So, if you’ve already gotten through COVID-19 at least once before, should you throw caution to the wind and catch it again and again? Not exactly.
The virus doesn’t treat everyone equally, stressed Adalja, from Johns Hopkins. “What we’re learning is that not every second infection or third infection is going to be benign — and that’s particularly going to be true when you’re dealing with higher-risk populations.”
One study focusing on U.S. veterans — who are mostly older men — found reinfections in that group appeared to come with a higher risk of death or hospitalization.
The paper, which hasn’t yet been peer-reviewed, made headlines in recent weeks. But several experts, including Adalja, cautioned against reading too much into its early findings, which may not apply to the general population.
However, while repeat infections should feel milder for most healthy individuals, he said it’s important to keep in mind your shifting risk factors for severe disease.
“Maybe there’s somebody who gained a lot of weight and became obese, or developed diabetes in the ensuing time, or developed some other condition that puts them at higher risk,” Adalja said. “Maybe they become immunocompromised — all of that’s going to play a factor.”
One study focusing on U.S. veterans — who are mostly older men — found reinfections in that group appeared to come with a higher risk of death or hospitalization. But several experts cautioned against reading too much into its early findings. (Ben Nelms/CBC)
In the elderly or in people who are immunosuppressed, medical professionals expect to see a range of poorer outcomes tied to severe reinfections, said Dr. Sameer Elsayed, a professor at Western University in London, Ont., and a consultant on infectious diseases, internal medicine and medical microbiology at the London Health Sciences Centre and St. Joseph’s Health Care London.
That could include lung damage directly caused by the virus, he said, all the way to issues such as the aggravation of “long COVID” symptoms from a prior infection or serious secondary infections from bacteria or fungi — particularly in those individuals who require admission to an intensive care unit.
“This latter example is also similar to asthmatics who may require repeated hospitalizations for something that is seemingly as simple as a common cold,” Elsayed said. “These repeated infections cause lung damage and may potentially lead to premature death depending on their severity, but we don’t see this with otherwise healthy people who keep getting common colds year after year.”
So as we all face the possibility of repeat COVID-19 infections through our lifetimes, your personal risk of serious illness could change over time — and the burden of reinfections from this ever-evolving virus won’t be felt equally.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
