--:-- Sean Rameswaram: Okay, so I got COVID about a month ago, and I wouldn't recommend it, but I was relieved that it meant I'd essentially be immune for the summer. Right? That's how it works? No one seems to be sure anymore. Like, some people tell me, oh yeah man, you're good for three months, and other people tell me, I know someone who got it again in six weeks, and some people just laugh at me and are like, okay, yeah, you're immune for the summer, whatever you say, guy. I don't know what to believe anymore or who to believe anymore.
--:-- Sean Rameswaram: So on Today Explained, we're going to ask a scientist who's been studying Omicron reinfections in South Africa, no less, where Omicron was first reported to the World Health Organization. Answers, at least as far as we know, are coming up.
--:-- [Sound effects: Music plays]
--:-- Sean Rameswaram: Support for this show comes from ServiceNow. AI is only as powerful as the platform it's built into, don't you know? That's why it's no surprise that more than 85% of the Fortune 500 use the ServiceNow AI platform. Didn't know that. While other platforms duct tape tools together, ServiceNow seamlessly unifies people, data, workflows, and AI, connecting every corner of your business. And with AI agents working together autonomously, Anyone in any department can focus on the work that matters most.
--:-- Sean Rameswaram: I've never met an AI agent. Learn how ServiceNow puts AI to work for people at ServiceNow.com.
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--:-- Sean Rameswaram: We all have moments where we could have done better, like cutting your own hair. Oh, yikes. Or forgetting sunscreen so now you look like a tomato. Ouch. Could have done better. Same goes for where you invest. Level up and invest smarter with Schwab. Get market insights, education, and human help when you need it. Learn more at Schwab.com.
--:-- Andy Kindler: All right, today explained Ramas firm. I felt some degree of relief once I conquered COVID-19 about a month ago because I felt like, okay, maybe now I can go out in the world and not sweat this thing for a while. And I just want to acknowledge right out of the gate that not everyone feels that way. My name is Andy Kindler. I'm a stand-up comedian.
--:-- Andy Kindler: Andy, for example, who's been in quarantine since this started back in 2020. From March 11th on, I've been in my house in Los Angeles, completely masked up. I'm 65 years old. My wife is around the same age. She has asthma. I don't want to catch any version of COVID. I don't want short COVID. I don't want intermittent COVID. I want no form of COVID.
--:-- Andy Kindler: I mean, just to be clear here, I didn't want COVID either, but I did go see a friend's band when they were on tour, and I put myself in a situation where I could get COVID, and I did. Andy's not risking it.
--:-- Sean Rameswaram: We don't know what the long-term effects of all these things are going to be, and so, you know, like I told my wife, I don't want to fly to Cleveland to do a two night gig and make $2,000. Well, maybe I should say I make more $20,000 and then come back and bring a short form of COVID for her.
--:-- Andy Kindler: And Andy has found a way to sustain his career without leaving the house. I am. I do cameos. You can't get sick doing cameos. I do a voiceover on Bob's Burgers. You mean, do I have a medicine cabinet full of corpse moisturizers? Oh, yes. Do they make my skin soft as a baby? You decide. It's not greasy either.
--:-- Andy Kindler: If I do three or four episodes of Bob's Burgers a year, of course, now that's going to cause pressure on the people there to give me three or four. I'm being murdered to death. And I have pensions. I have pensions. I am very old. And then I have Social Security. who doesn't want to become 70 in this house?
--:-- Andy Kindler: Andy looks at people who've sort of reentered society, gone back to normal, and he's still kind of astonished. I was watching poker, world poker, and these famous poker players just sitting right next to each other. Are they insane? I mean, I can think of a few things they might be doing. One, they might have already had COVID like me, so they are not presently worried about getting COVID again because they may have had it recently.
--:-- Andy Kindler: Two, they might need the money. Three, they might be very sick of staying at home and willing to take the risk. Four, they might not have an immunocompromised wife. I'm all over it. I'm totally with them. They want to do that. They've all agreed. All of these idiots, all of these monsters have agreed to.
--:-- Andy Kindler: First of all, I think the lesson from COVID is that we should not be in proximity to other people at any point. Wow. But some people, some people live for that, Andy. some people just want to be around other people.
--:-- Andy Kindler: I'm on a plane. What do you do for a living? She's breathing. I travel around. I tongue kiss people for a living. You're going to be on a plane. You get on a plane. You're going to have COVID. If you haven't had it, you're going to have COVID.
--:-- Sean Rameswaram: Okay. Not sure there's anything we can discover that's going to convince Andy Kindler and his amazing wife to reenter society. But for everyone who is in some way, shape, or form, we wanted to answer one essential question, maybe two. How often can we get COVID after we've had it? And how much has the answer changed with the Omicron variants?
--:-- Juliette Pulliam: I'm Juliette Pulliam. I'm the director of SESIMA, which is the South African Center for Epidemiological Modeling and Analysis. And here in the room with me is Leroy, my dog, who you might hear in the background.
--:-- Juliette Pulliam: We decided to ask a scientist, and not just any scientist, a scientist in South Africa where Omicron was first reported to the World Health Organization. Yes, I'm here in South Africa in Stellenbosch, which is outside of Cape Town.
--:-- Juliette Pulliam: Juliet and her team have been studying reinfections for a while now. During the emergence of the beta variant, we decided to start looking at reinfections because it was something that was a big question at the time, and there were laboratory assays that were suggesting that beta was better at reinfecting people than the earlier variants.
--:-- Juliette Pulliam: So we have actually been monitoring for reinfections since January of 2021, and we developed a couple of methodologies that would allow us to track at the population level the rate of reinfections and to look at that through time and to see how it was changing We watched it throughout the tail end of the beta wave We watched the reinfections all through the delta wave And we basically were seeing that the reinfection rate remained pretty much constant when you account for things like the fact that there were more and more people eligible for reinfection because more people had been infected.
--:-- Juliette Pulliam: And then when Omicron came along, pretty immediately we saw a very different story. And we saw that there were a lot of reinfections and a lot more than were expected.
--:-- Juliette Pulliam: Did you find an answer to this question we've been asking ourselves for over two years now? How often can I get COVID-19? So we found that reinfections were much more common with Omicron variant than with the previous variants.
--:-- Juliette Pulliam: And one of the other things that we found that was really surprising to me, at least at the time, was that people were getting reinfected multiple times. So there were individuals in our study who we identified as having up to four infections.
--:-- Juliette Pulliam: Up to four? Yeah. So we can say that people were getting reinfected at a much higher rate during our Omicron wave in December than in the prior waves. Omicron is much better at reinfecting people than the prior variants.
--:-- Juliette Pulliam: There are some other studies that suggest that reinfections do occur within 60 days. 60 days. The other thing that I think is really important and isn't directly in our study is that the population level immunity in South Africa is currently very high.
--:-- Juliette Pulliam: Studies that were done right before the Omicron wave showed that there were about 70% of the population had immunity from either from vaccination or from natural infection. The studies that were done after the Omicron wave, so in mid-March, show that about 98% of the population seems to have some form of immunity to the virus.
--:-- Juliette Pulliam: And yet we just experienced a large resurgence following that mid-March study, which suggests that reinfections or infections of vaccinated people is essentially what's driving transmission within South Africa. Which certainly suggests that people are going to get Omicron multiple times. Yes.
--:-- Juliette Pulliam: So it's not in the published study, but we have been continuing to monitor the reinfections. And we have definitely seen individuals who were infected in December who have been infected again in the last month or so. And that's all Omicron. It's probably different sub-lineages of Omicron, but it is people getting infected again with the same variant.
--:-- Juliette Pulliam: And were the people in your study vaccinated and or boosted? Yeah, that's a great question. So when we started the study, there was no vaccination in the country, and it was rolled out sort of over the time frame that we were monitoring the reinfections.
--:-- Juliette Pulliam: By the time that Omicron came along, the total vaccination rate in the country, I think, was still less than 30%. So we aren't able to actually link the vaccination status to the reinfection status in the data set that we have.
--:-- Juliette Pulliam: Hmm. Okay, so this reinfection data isn't taking vaccination status or booster status into account. Do we have any idea how long immunity lasts? Is there any consistency in your study?
--:-- Juliette Pulliam: So I don't think we can say how long immunity lasts per se. There are other studies that have tried to address that. And the important thing that we can say from the South African experience is that the immunity that people have does appear to protect against severe disease.
--:-- Juliette Pulliam: So we just had a fairly major resurgence. The hospitalizations barely came up. The deaths barely came up. But the case numbers were pretty high. We attribute that to the fact that we have this high level of population immunity. So probably about 85% of the population has been infected.
--:-- Juliette Pulliam: And we also have a reasonable vaccination rate at this stage. And so combined, that equals a very high level of population immunity. Do the cases of COVID become less severe with second, third, fourth infections? That's the really important question.
--:-- Juliette Pulliam: And my feeling is yes. I think that we can see that in the population level data in South Africa and the fact that throughout the fourth wave, but also throughout this most recent resurgence, the hospitalizations and deaths have not gone up anywhere near as much as we would have expected.
--:-- Sean Rameswaram: Okay, that's a lot of useful data. But I wonder what it means for how we ought to behave in the world. I mean, as someone who is much more informed than most, who did this study, but also is operating in society more than our friend Andy Kindler, let's say.
--:-- Juliette Pulliam: If you were to get COVID this week, would you feel liberated for, you know, a couple of weeks after you recovered? I'm sure if I were to get COVID this week, I would feel really crummy. I know, but in the following weeks, would you feel a sense of... Of protection? Of protection, of freedom to sort of live in the world and not worry about being reinfected.
--:-- Juliette Pulliam: I guess I would be more confident than I am at the moment, not having been infected. At the same time, you know, when I have gotten boosted, I have felt more confident for a while after that as well.
--:-- Juliette Pulliam: What surprised you most from the research you did? The thing that surprised me the most originally was the fact that we were seeing people with more than two infections. What we're seeing now in South Africa is suggestive that we're going to be seeing this pattern for a long time because it doesn't seem that SARS-CoV-2 transmission has gone away, even though we have this high level of population immunity.
--:-- Juliette Pulliam: It seems like SARS-CoV-2 transmission is doing just fine, even though we have this high level of population immunity. And I think that sort of gives us a hint as to what it's going to look like in the future. The evidence so far, to me, points to a high probability that most people are going to get reinfected.
--:-- Juliette Pulliam: I suspect that it's going to keep circulating, probably infecting people multiple times, possibly even infecting people multiple times in the course of a year, and that the severity of the disease will hopefully continue to be much less.
--:-- Juliette Pulliam: And I think the really big question at this point is, what is the implication of reinfections for long COVID? And I don't think we have any data on that.
--:-- Juliette Pulliam: The most surprising thing you found was that people can get COVID over and over again, even as much as four times. Yes. We do not know how long immunity lasts. In some cases, it might be 90 days. In some cases, it might be 60 days. It could be more than that. it could be less than that. And it probably varies a lot.
--:-- Juliette Pulliam: It does seem that subsequent cases of COVID are less severe Yes And it sounds like people should just expect to get reinfected I think yes. Over the course of someone's lifetime, they should expect to have multiple SARS-CoV-2 infections. And if we're lucky, this continues to get less severe. Yes.
--:-- Juliette Pulliam: And we have no idea what any of this means for long COVID still. Exactly. But you know what? It's nice to hear that from a scientist and not just from like your friend who also got COVID two weeks ago. Right, yeah, sure. It's been really helpful. I really appreciate it. Thank you for your time.
--:-- Sean Rameswaram: Okay, sure thing.
--:-- Sean Rameswaram: Last summer, we did a show about where we might end up with this pandemic. And the guest more or less said this place we're at right now, reinfections, milder cases, was the ideal scenario. Exactly where we wanted to be.
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--:-- Sean Rameswaram: Yeah, well, I think it's been pretty clear for a while now that this virus is not going to be eradicated or eliminated. So it's not going to be like smallpox. It's not going to be like polio or measles. We're going to be living with this virus for a really long time.
--:-- Sean Rameswaram: So this virus is going to be what people call endemic, which means it's going to keep circulating. It might be another seasonal virus. So it might look something like the flu or the cold. It's probably going to be something that we hear about every year, but it's not necessarily something that's going to be like big news the way it is right now.
--:-- [Sound effects: Music plays]
--:-- Sean Rameswaram: In a moment, we're going to ask someone who studies viruses if she feels that way. Is this exactly where we want to be? It's Today Explained.
--:-- Dr. Deborah Fuller: Yeah, I think this is what we're talking about when we're eventually expecting a pandemic to become more of what we call an endemic. This is Dr. Deborah Fuller, professor of microbiology, University of Washington School of Medicine.
--:-- Dr. Deborah Fuller: She says we're not quite at that endemic stage yet. It's a state in which the virus's presence is kind of steady and predictable. Endemic doesn't necessarily mean that the disease is going to be rare or even necessarily mild. The infection rates could still be high. It's just that they're much more static and predictable.
--:-- Dr. Deborah Fuller: Right now, we're in a state where there's still a lot of unpredictability and potentially new variants emerging that can cause outbreaks and some increases in hospitalization. We want to get to is at that level of predictability. And once we get to that point, then we can actually control that. for example, through potentially annual vaccinations such as we have with the flu.
--:-- Dr. Deborah Fuller: Dr. Fuller is something of an expert in vaccines. So we asked her how we should be thinking about those older COVID vaccines many of us got in light of newer variants. People who are vaccinated are still getting Omicron, but then they have some Omicron immunity. Is that better than a vaccine since it's more recent?
--:-- Dr. Deborah Fuller: When you get vaccinated, the level of antibody you generate is much more consistent among the vaccinated people. When you get immunity as a result of infection, those antibody titers can be highly variable with some people getting really robust responses and some people very low responses.
--:-- Dr. Deborah Fuller: I think there was a study that shows there can be over a 200-fold difference in the amount of antibody. And so somebody, you know, when you have a range of people who've been previously infected and they go out and say, hey, you know, now I'm immune and then they get reinfected very quickly, they might have been an individual who developed very poor antibody responses to the first infection, making them more vulnerable to the second one.
--:-- Dr. Deborah Fuller: So those who are vaccinated are going to be at lower risk for reinfections than those who have gained immunity solely through infection and reinfection. Hmm. So broadly speaking, vaccination still gets you better antibody protection than just getting COVID.
--:-- Dr. Deborah Fuller: There is evidence that a combination of say if you were previously infected and then you got vaccinated or if you were vaccinated and you got exposed that that combination of sort of hybrid immunity is kind of what we calling it results in actually really robust responses and immunity that can potentially last longer and offer even better protection against the new variants that are emerging
--:-- Dr. Deborah Fuller: So as we see breakthrough infections come through, we might actually see actually that is facilitating the development of enhanced immunity in the population as a whole as we start to see this combination or hybrid immunity emerge.
--:-- Dr. Deborah Fuller: Okay, so the vaccines are still helping and they're working together with breakthrough infections to create an even better kind of immunity. Right. When we think about with the vaccines, they're very safe and effective. So it's really reassuring for those who are vaccinated.
--:-- Dr. Deborah Fuller: And in the rare cases that they do get a breakthrough, they're less likely to get issues like long COVID. So the vaccines are very effective. But one of the things we have to start thinking about is at the individual level. So you're vaccinated, and if you're relatively healthy and maybe not too old, even if you get a breakthrough infection, you come positive for COVID, there's a lower likelihood of developing long COVID or symptoms that are going to cause long-term issues.
--:-- Dr. Deborah Fuller: The real issue comes more at the societal level because what we're trying to do is get a control of a pandemic. And if people who are vaccinated are still able to get these breakthrough infections because we have these new variants, then that potentially puts at risk people who are immune compromised or elderly who don't necessarily respond as well to vaccination or whose immunity wanes much more quickly.
--:-- Dr. Deborah Fuller: And so as long as we have sort of this going on, then it can continue to perpetuate the virus and put at risk the possibility of a new variant emerging that completely dodges the immunity that has been induced by either prior infection or vaccination.
--:-- Dr. Deborah Fuller: And even with the amount of vaccine hesitancy we have in this country, will boosters that come out every year, even if only, what, 20, 30 percent of the population gets them, will they still be effective enough to keep us in this place we want to be?
--:-- Dr. Deborah Fuller: You know, with the flu vaccine, we do see, as an example, we do see that annual flu vaccinations helps to reduce the incidence of infection and death rate. And yet every year, probably only about 50% of the population actually goes and gets a flu shot on a routine basis. So flu is different from coronavirus in the sense that the rate of vaccination will likely have to be higher for helping to control that disease as compared to flu.
--:-- Dr. Deborah Fuller: But it still kind of provides an example that you don't necessarily need 100% of the population getting their booster immunizations to be able to control. If you get the majority of them, then you'll be able to control that disease.
--:-- Sean Rameswaram: I'm Sean Rameswaram. This is Today Explained.
--:-- Sean Rameswaram: Our show today was produced by John Ahrens, engineered by Paul Mounsey, fact-checked by Laura Bullard, and edited by Matthew Collette.
--:-- Sean Rameswaram: I'm Sean Rameswaram. This is Today Explained.
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