If you’re fully vaccinated and have recently recovered from COVID, you’re probably wondering if it’s safe to resume some of the riskier activities you may have avoided since the pandemic began.
We know that vaccination continues to provide strong protection against hospitalization and death. Throw in the extra immunity conferred from a breakthrough infection and you’re about as protected against the coronavirus as you can get. Infectious diseases specialists have labeled the combination of vaccination plus infection-conferred immunity as “hybrid immunity,” and say it’s the highest form of immunity against SARS-CoV-2.
There are unknowns, like how the protection gained after an omicron infection compares with that of delta. But doctors generally agree that, for some time, vaccinated people who’ve recovered from COVID are likely protected from reinfection and from transmitting the virus to others.
The coronavirus will continue to mutate and new variants will likely emerge that could potentially skirt part of our immunity, according to Amesh Adalja, an infectious diseases expert and senior scholar at the Johns Hopkins University Center for Health Security. Reinfections will eventually happen — even in people with hybrid immunity — but those future infections are likely to be mild, thanks to all the immunity they’ve built.
“For those types of people, they should really have no concerns about going back to their normal activities, at least for a period of several months,” Adalja said. “And even after that period, if they are susceptible to getting a reinfection, that reinfection is going to be really mild.”
How protected are you after a breakthrough infection?
Vaccines provide us with a great immune response specifically targeted at the spike protein on the coronavirus — the part of the virus that attaches to our cells. Evidence shows that vaccine-induced immune response continues to do a great job of keeping people out of the hospital. Scientists are still learning about omicron infections, given that the variant — though now on the decline — is still new.
“We tend to think if you’ve been infected, you have a good 90 days of which you are to have some level of protection — and that’s probably the case [with omicron], but we need to be absolutely sure,” said Carlos del Rio, a professor of medicine, global health and epidemiology at Emory University.
A preprint study from Hong Kong found that breakthrough infections from omicron elicited a broad antibody and T-cell response that works well against other variants — alpha, beta, gamma, delta. The antibodies that your immune system produces during an infection are everywhere in your body, including in the nasal cavity, which is our first line of defense when we inhale virus particles.
Centers for Disease Control and Prevention guidance states that recently recovered people are well protected for three months. Some data suggest that protection is even more durable — seven to eight months, sometimes longer, said Adalja.
Keep in mind that immunity isn’t a one-size-fits-all sort of thing. Most people with hybrid immunity will have strong resistance against serious illness — including those who have health issues that put them at risk for COVID, like obesity or diabetes, according to Adalja. Individuals who are immunocompromised — including those who’ve had a stem cell or organ transplant — will need to be safeguarded, since some may not mount a strong immune response after vaccination or infection.
For others without underlying issues, antibody levels will wane over time and reinfections will occur (just as they do with other respiratory viruses). “Don’t assume that just because you got infected once, you won’t get it again,” del Rio said. Still, cell-mediated immunity will continue to protect most people from severe disease, hospitalization and death.
So, can I go back to normal?
We aren’t in a place where life will be like it was before the pandemic. Everyone will still have to look at their own risk tolerance. The vast majority of people with hybrid immunity are going to have incredible protection against COVID, especially when it comes to severe outcomes, for several months. Because of this, people with hybrid immunity can feel a bit safer doing indoor activities in the immediate future, said Monica Gandhi, an infectious diseases specialist at University of California, San Francisco.
People who are severely immunocompromised will always have to be careful, similar to how they were advised to behave in prior respiratory virus seasons, Adalja said. If this is you, continue to take protective precautions.
Everyone in the entire population also has a responsibility to look after those who are immunocompromised, even after they’ve recovered from a breakthrough infection. This means taking measures to ensure their safety, like wearing masks in public and around those you know who are at risk, getting boosted (or vaccinated) if you haven’t already, and avoiding contact with people if have any signs of illness.
Those who’ve been relying on rapid tests to visit at-risk family members can probably have some peace of mind during the initial weeks after they have recovered, del Rio added. “But if you have access to tests, test yourself,” he said.
Since we aren’t going to be able to eliminate the coronavirus, we all will likely remain at risk to contract it throughout our lifetimes, according to Adalja. The goal now, he said, is to keep any such illness mild. This primarily is done through vaccination and boosting. Hybrid immunity also can contribute (but, obviously, don’t try to get infected on purpose or throw all caution to the wind).
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.