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Feb. 25, 2021, 11:38 a.m. EST

Only 50 people are known to have contracted COVID-19 more than once — but new strains have medical experts on high alert

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Jaimy Lee

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A study published Feb. 24 in JAMA Internal Medicine found that testing positive for SARS-CoV-2 antibodies likely indicates protection from reinfection, though researchers also noted that the period of time in which protection is possible is unknown and that protection may also wane over time.

“Because you don’t know how long immunity will be induced, we have the possibility as the virus continues to mutate that it actually mutates to become a cold virus,” said Dr. Stanley Perlman, professor of microbiology and immunology at the University of Iowa. “That’s what we really hope.”

If this were to play out, the virus could be dulled until it simply becomes an annoying but no longer deadly common cold. Common colds, which are coronaviruses that haven’t been eradicated, can provide immunity for up to three years. People who were infected with SARS, or severe acute respiratory syndrome, also a coronavirus, had about three years of immunity .  

“Sterilizing immunity” is a term used to explain a type of immunity that means people cannot contract either a virus or the disease caused by a virus. That’s most likely not going to happen with SARS-CoV-2. What experts including Perlman are now wondering is if reinfections will cause less severe forms of the disease or be asymptomatic.

“That could well be what’s happening with people who have mild disease and get reinfected with severe disease,” Perlman said. “I think the protection is much longer. So if somebody comes out of an ICU and is otherwise normal, I think that they will be protected for years.”

What we know about reinfection rates in the U.S.

The federal government does not track reinfections, and so the number of reinfection cases in the U.S. is unknown. The page on the CDC website with information about reinfections was last updated Oct. 27. 

Some states have shared details about probable or confirmed reinfections upon request. 

California, for example, lists two confirmed cases of reinfection out of the 3.3 million people who have tested positive for the virus there, according to the state’s public health department. About 615 people in Colorado meet the CDC criteria for reinfection, according to a state spokesperson. “This is a very small percentage of all cases,” making up an estimated 0.15% of total cases in Colorado, she said in an email. In Washington state, there are 716 suspected reinfections, and one confirmed case.

The first documented case of reinfection in the U.S. occurred in a 25-year-old man in Reno, Nev., according to a study published in the Lancet medical journal in October. The individual tested positive in April, had two negative tests in May, and then tested positive again in June. 

His case was identified as part of a genomic sequencing program that had been set up in Nevada during the pandemic. (The only way to confirm a reinfection is to sequence both samples to ensure they have different mutations, which naturally occur as the virus spreads from person to person.)

“If we look at differences from the first sample compared to the original [ virus from Wuhan, China ] that are absent from the second … that sort of proves that they were different, that they had diverged, before they could have entered that person,” said Richard Tillett, a biostatistician for the Nevada Institute of Personalized Medicine and a co-author of the Lancet study. 

What to know about reinfection and vaccines

If SARS-CoV-2 isn’t going away, reinfection could become more likely, even if the virus changes shape to become less deadly or to cause less severe illness.

Vaccine developers like Johnson & Johnson /zigman2/quotes/201724570/composite JNJ -1.06% and Moderna Inc. /zigman2/quotes/205619834/composite MRNA +0.86% have said they are considering programs to develop COVID-19 boosters or vaccines that are administered on a regular basis into the future. 

“For the next several years, we’ll be getting a COVID-19 shot just like we get a flu shot,” J&J CEO Alex Gorsky told CNBC on Feb. 9. “We can all imagine a future where we’re living with this, but we can keep the science at pace with the virus.”

As of now, the CDC says that people who have been infected once with the virus should still get vaccinated, as long as they wait at least two months after a negative test. 

The late-stage clinical trials for both authorized vaccines did not study, for the most part, the impact of the vaccines on people who had previously been infected with the virus. But Pfizer Inc. /zigman2/quotes/202877789/composite PFE -1.28% , with German partner BioNTech /zigman2/quotes/214419716/composite BNTX -0.40% ,  and  Moderna  separately told the Food and Drug Administration during the regulatory review process that there are “limited” data suggesting people who have had the virus can be at risk for reinfection and could benefit from vaccination.

“We’ve seen some case reports here and there of people getting reinfected,” Dr. Tal Zaks, Moderna’s chief medical officer, said in January during an investor call. “But in a context of millions getting infected, I don’t think that is material.”

Some healthcare workers at Hackensack Meridian Health hospital system in New Jersey asked administrators if they should get vaccinated if they’ve already been infected. The short answer is yes, according to Dr. Daniel Varga, Hackensack’s chief physician executive. 

“We’re putting those people in the same PPE,” he said, “because you don’t know exactly how long and how effective their acquired immunity is.”

/zigman2/quotes/201724570/composite
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/zigman2/quotes/205619834/composite
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/zigman2/quotes/214419716/composite
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