If You’ve Never Had COVID, Are You a Sitting Duck?

If You’ve Never Had COVID, Are You a Sitting Duck?

I am on a mission to preserve the most valuable item in my home: my fiancé, who has never had COVID. Through sheer luck and a healthy dose of terror, he made it through the first pandemic year without getting sick. Shielded by the J&J vaccine and a Moderna booster, he dodged infection when I fell ill last November and coughed up the coronavirus all over our cramped New York City apartment. Somehow, he ducked the Omicron wave over the winter, when it seemed as though everyone was getting sick. And in the past few months, he has emerged unscathed from crowded weddings, indoor dinners, and flights across the country.

At this point, I worry about how much longer it’s going to last. People like him—I think of them as “COVID virgins”—are becoming a rare breed. Just yesterday, President Joe Biden thinned their ranks by one more person. The Institute of Health Metrics and Evaluation suggests that as of earlier this month, 82 percent of Americans have been infected with the coronavirus at least once. Some of those people might still think they’re never had the virus: Asymptomatic infections happen, and mild symptoms are sometimes brushed off as allergies or a cold. Now that we’re battling BA.5, the most contagious and vaccine-dodging Omicron offshoot yet, many people are facing their second, third, or even fourth infections. That reality can make it feel like the stragglers who have evaded infection for two and a half years are destined to fall sick sooner rather than later. At this point, are COVID virgins nothing more than sitting ducks?

The basic math admittedly doesn’t look promising. Most of the people getting infected right now seem to be coming down with the illness for the first time, even though they are a distinct minority. Nationally, we don’t have good data on who is getting COVID, though in New York, first infections seem to be  happening at five times the rate of reinfections. Part of why those who haven’t gotten COVID seem to be at a higher risk of infection is that taking into account all other factors—vaccination, age, behaviors—they lack the immunity bump conferred by a bout with the virus, no matter how fleeting that bump may be. On its own, this would suggest that these people are in fact sitting ducks who can’t avoid infection short of hunkering down in total isolation.

The experts I talked with agreed that the risk of infection is currently high. “We are finding now that with the more transmissible variants, it’s becoming more and more difficult to avoid infections,” Robert Kim-Farley, an epidemiologist at UCLA, told me. “However, it’s not inevitable.” Richard Bright, the CEO of the Rockefeller Foundation’s Pandemic Prevention Institute, was less certain. “Honestly, it might be inevitable, the way the virus has continued to change,” he said.

Still, they reiterated that we still don’t quite know just how at risk those who haven’t had COVID are—especially when BA.5 seems to be reinfecting so many people. “I don’t know if I would call them sitting ducks, necessarily,” Bright said, “but I would say every one of us is more vulnerable.” The unvaccinated are still the most vulnerable by far, especially to more severe outcomes. But even this far into the pandemic, it’s hard to know exactly why some vaccinated and boosted people have gotten sick while others haven’t—good pandemic behaviors might come into play, along with luck. Scientists are still investigating the role of other factors, including whether genetics might be protecting the immune systems of people who haven’t gotten COVID.

Nevertheless, all of the experts argued that COVID virgins should still try to avoid infection. Above all, they should get up-to-date on vaccination and boosters. Once those layers of protection are in place, they should continue to be prudent—especially in crowded, indoor settings—but unless they are medically vulnerable, they don’t have to take more precautions than anyone else, Kim-Farley said.

The guidance for this group is the same as it is for everybody else largely because immunity by infection is protective, but only to an extent. BA.5, for one, seems to be able to reinfect people who were previously sick, sometimes even those who just a few months ago had an earlier version of Omicron. At this point, an infection from a year ago, let alone two, might not mean much immunologically. “People shouldn’t rely on prior infection, because it just is not as effective as prior vaccination,” Kim-Farley said. And though “hybrid immunity”—which results when a person gets sick and is then vaccinated, or vice versa—is thought to confer a good amount of protection, “that kind of assertion may be challenged” now that so many reinfections are occurring, the Yale epidemiologist Albert Ko told me.

The ultimate problem with people viewing themselves as sitting ducks is that this is the exact attitude epidemiologists do not want us to have. It can foster a “why bother?” demeanor, negating all public-health efforts to stop transmission and discouraging personal efforts to protect oneself. In other words, it promotes COVID fatalism, which is appealing because it offers relief from the daily anxiety and behavioral compromises of pandemic life by assuming that an infection is a question of when, not if. This notion can be liberating for those who have never gotten infected—and presumably it is part of the reason so few are left: Many people have already adopted a “meh” attitude toward COVID, not letting the fear of an infection get in the way of living their lives.

Even this late in the game, you should really try to avoid getting COVID if you can. Having to take precautions can be frustrating after so many months of pandemic life, but getting sick can be extremely unpleasant, even if you are vaccinated and boosted. There’s the risk of long COVID, yes, but those who escape it can still feel terrible for several days, if not weeks, Bright said. These infections don’t usually lead to hospitalization or death, but they’re no walk in the park either, especially for the elderly and the immunocompromised. And as COVID continues to mutate, you definitely want to forestall a second infection, or a third down the line. The consequences of repeated infections and their potential to cause long COVID or other health issues are not yet known. And, of course, the tenets of COVID 101 are still true: Even if your infection is mild, you can still spread it to someone who could have it much worse.

The grim reality is that as long as the virus shows no signs of abating, the number of COVID virgins will continue to shrink. Grappling with this reality will be a lot less stressful if we reframe the way we talk about getting COVID. Instead of fretting about the virus as something that could come for you, focus on what to do when it does. Those who are vaccinated and boosted may still be ducks sitting in the crosshairs of infection, but in all likelihood they won’t die or get severely ill, especially if they are young and healthy. “That’s what we care most about,” Ko said. The people who haven’t gotten sick should remember that they have already won—vaccines, in tandem with the treatments that are now available, means that it’s far better to get sick now than it was a year or two ago.

When I told my fiancé that he would probably get COVID but should definitely still try not to get COVID, he described the situation as “Kafkaesque.” Indeed, these are absurd and illogical times. But at the very least, focusing on what is within our control can help us regain a modicum of sense. Short of total isolation, people may not be able to do much to avoid the coronavirus forever, but there’s still plenty they can do to escape the worst when it does come for them.

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