Who knew?

The future of the pandemic is looking clearer as we learn more about infection

What is this mysterious thing called "infection" that so flummoxed are greatest minds?

During the early days of the pandemic, scientists and doctors were concerned that being infected with SARS-CoV-2 might not trigger a strong immune response in many people – thus an infection might not provide long-term protection.

Not just scientists were concerned, but doctors, too!

"Immunity to Covid-19 could be lost in months, UK study suggests," a headline from The Guardian alerted back in July 2020. "King's College London team found steep drops in patients' antibody levels three months after infection," the story warned.

Oh, no! steep drops were found in patients" antibody levels three months after infection!!!

But before you start lining up your fourth booster and duct taping over the gaps in your doors, it turns out the immune system operates with Covid-19 pretty much like it does with every other coronavirus.

But that idea was based on preliminary data from the laboratory — and on a faulty understanding of how the immune system works.

Oh. We had a "faulty understanding of how the immune system works" a year and a half ago?

Now about a year and a half later, better data is painting a more optimistic picture about immunity after a bout of COVID-19. In fact, a symptomatic infection triggers a remarkable immune response in the general population, likely offering protection against severe disease and death for a few years.

I guess we're pretty lucky we're getting "better data" now in contrast to the prior hundred years or so when I guess infections were still a complete mystery possibly caused by mischievous spirits or perhaps witches.

If you're under age 50 and healthy, then a bout of COVID-19 offers good protection against severe disease if you were to be infected again in a future surge, says epidemiologist Laith Abu-Raddad, at Weill-Cornell Medical-Qatar. "That's really important because eventually, every one of us will get infected," he says. "But if reinfections prove to be more mild, in general, it will allow us to live with this pandemic in a much easier way."

Every one of us will get infected?

How very red-state of them.

NPR goes on to note studies that demonstrate that we do in fact have a working immune system.

Abu-Raddad and his team have been tracking reinfections in Qatar for more than a year. In one study, the team analyzed about 1,300 reinfections among more than 350,000 people in Qatar. They found that a prior COVID-19 infection reduced the risk of hospitalization upon reinfection by about 90% compared with in people having their first infection.

These findings, published in the New England Journal of Medicine in December, are consistent with data released by the Centers for Disease Control and Prevention last month. In that study, a prior infection reduced the risk of hospitalization during the delta surge by more than 50 times compared with in people who hadn't had a prior infection and were not vaccinated. People who had had both a prior infection and were vaccinated had the most protection.

Not only do we all we have a functioning immune system, it appears it works the way it has always worked.

And here's the "really good news," Abu-Raddad says: This protection against severe disease persists, perhaps for years. "We've been following this same group of people for over a year and a half now, we don't see much waning. If it's there, it's too small to discern."

However, there are still populations that might remain vulnerable, even after infection. Maybe. Possibly.

But the good news doesn't necessarily hold true for everyone. This long-term protection is seen in healthy people under age 50, Abu-Raddad points out. It's likely less potent and possibly more short-lived for people who are older or who have underlying health conditions, he says. More data is needed to know how the protection varies with age.

But, wait, you might be asking, what about those early laboratory findings that found antibody levels dropping precipitously after a few months that created unnecessary fear, a vast push for universal vaccination regardless of prior infections, and a general rejection of the powers of natural immunity?

Turns out, those steep drops are completely normal, and have been well understood for years.

This pattern, with antibodies declining quickly and then plateauing, occurs with any infection, not just SARS-CoV-2, immunologist Deepta Bhattacharya told NPR back in August. "In every single immune response, there is a sharp rise in antibodies, a period of sharp decline," and then it starts to stabilize at a lower level.

I guess they they just all forgot how the immune system worked for a bit.

About six months after a SARS-CoV-2 infection, right around the time when the antibody level starts to stabilize, the immune system does something extraordinary: It generates special cells, called long-lived plasma cells, that can make potent antibodies against SAR-CoV-2, for decades, possibly even a lifetime.

There is bad news, however, as we all face a dystopian hellscape of ongoing Covid reinfections.

"Reinfections are not just possible, they're pretty much inevitable," says evolutionary biologist Jeffrey Townsend at Yale University.

Why would he say such a thing?

Well, you know how some people dismissed Covid as little more than a cold for most people?

Yeah, it's going to be a lot like a cold for most people.

To estimate how often reinfections will occur with SARS-CoV-2, Townsend and his team have been studying four other coronaviruses. They are known as "seasonal coronaviruses" and cause about 30% of colds each year.

"They all infect and reinfect on a yearly timescale," he says, "so there's no reason to expect something different from SARS-CoV-2."

Yes, it's true.

We are facing a bleak future in which you will PERIODICALLY GET SICK AND THEN RECOVER!!

As it turns out, the immune system is geared towards saving the individual at the expense of occasional reinfections. It does this by ensuring an immune response sufficient to keep you alive at the expense of the discomfort of mostly mild-to-medium infections.

In other words, the immune system is not built to stop every sickness or asymptomatic infection. And it's definitely not built to "give you a negative PCR test," Yewdell says.

Put another way, your immune system is going to respond to infections in the manner it has for... forever.

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