By Delia Berlin
After almost four years of dodging the bullet, I finally left the ever-shrinking minority of “novids”—those who still have not gotten COVID. The Centers for Disease Control has estimated that as of July 2023, more than 77% of the U.S. population had experienced at least one COVID infection. Until now I had been lucky enough to avoid it, even when my husband got it last December. But then I was only two months away from my last booster. This time, things were different.
Last month, I was visiting family in NYC when David called me to report that, after feeling congested, he had taken a COVID home test that came out positive. Unfortunately, I had been with him up to that early morning. Now, I had already spent some time with my 12-year-old granddaughter, who immediately gave me a test. We both masked while we waited for the result. I was negative and felt well, but still wanted to be cautious. Since it was an unusually warm day, my granddaughter and I spent the rest of our visit outside, until she had to go to a theater rehearsal. Later, I dined outdoors with my daughter, while my son-in-law had work commitments.
While I was happy to make the most of my visit under the circumstances, I knew that returning home to David would almost certainly give me COVID. The updated vaccines were just beginning to appear in our area and most appointments were still being canceled due to slow-arriving supplies. My last bivalent booster was already six months old and unlikely to protect me against new variants. But staying in NYC while David’s infection evolved in unknown ways was not an acceptable option, so I returned the next day.
By the time I got home, David had started taking the antiviral Paxlovid and was already asymptomatic. Paxlovid works amazingly well when taken as soon as symptoms begin. It greatly prevents severe illness, hospitalizations, and deaths, and reduces the chances of getting long COVID. David was fully recovered by the time I felt sick and tested positive. I was trailing him by three days. Fortunately, I had also started taking Paxlovid immediately and responded equally well, getting all better soon.
But just two days after I tested negative, I once again felt congested and tested faintly positive. This “rebound” seems to be quite common with Paxlovid, although the literature still calls it rare. But rebound cases tend to be mild and self-limiting, not calling for additional medical interventions. Still, they are inconvenient because they prolong the need for social isolation and masking precautions. In our household, with our staggered onsets and my rebound, this disruption covered more than two weeks.
Another type of disruption that a COVID infection imposes is a delay in vaccinations. We had planned to be immunized for flu, COVID, and RSV by the time the holiday season arrived. As I write this, about a month after our COVID infections, we have just managed to get our flu shots. The timing of our updated COVID vaccines is further delayed since it is recommended to wait approximately two months from an infection. We will get those as soon as we hit that mark.
Day after day, new scientific information emerges about the long-term risk of COVID infections. Contrary to popular belief, immunity via infection is neither durable nor safe. Even mild or asymptomatic infections can produce serious long-term consequences, and each subsequent infection is not necessarily milder. Counterintuitively, instead of reinforcing immunity, getting multiple infections increases the chances of getting yet additional infections. The lesson to be drawn from this evidence is not complicated: it is best to try to stay healthy.
Fortunately, there are many ways of reducing one’s chances of getting COVID and other airborne infections. A layered approach that utilizes all of them may hold the most promise, but any one of the mitigations reduces risk at least partly. Everyone should weigh the benefits of each strategy against their own objections. The list is short and sweet: vaccinations, ventilation, and masking.
While current vaccines are not very durable and the virus continues to mutate, they do convey excellent protection against severe illness and death. New and more effective nasal vaccines are coming, which is exciting. Meanwhile, ventilation strategies include avoiding crowded indoor spaces, using air filters or cleaners, selecting outdoor venues whenever possible, and simply opening more windows and doors in acceptable weather. Masking is nobody’s favorite, but a well-fitted, high-quality mask can be very effective against airborne pathogens. I still mask in most indoor spaces, including the gym. I never fail to mask in public restrooms and elevators, even if I am the only person in them. They are poorly ventilated places containing the breath of many previous occupants. Before getting COVID from my less-disciplined husband, I went four full years without even getting a cold—I liked that! I think it was a first for me and I attribute it to masking.
It would have been great if the updated vaccines had been rolled out before the start of the school year. Unfortunately, they are just now starting to flow. I am beyond disappointed in the low level of protection that we have been providing for our youth. Most schoolchildren are getting multiple infections, many of which could have been avoided simply by improving ventilation. In addition to reducing pathogens, good ventilation reduces pollutants, which are particularly harmful to children. I try to remain optimistic and hope that this will continue to improve gradually.
Meanwhile, David and I are gradually getting closer to getting our updated COVID vaccines. In the past, we have received a mix of Moderna and Pfizer shots. This time we will be looking for Novavax. This is a traditional protein vaccine, as opposed to a messenger RNA vaccine. It targets features of the virus that appear to be more stable than the spike protein, perhaps providing broader protection against variants. Also, it may be a little more durable and with fewer side effects. To be clear, head-to-head effectiveness comparison of all COVID vaccines is not complete, and any updated vaccine is better than none. In our area, Novavax is still more difficult to find, but since our recent infections have bought us some time, our search for it will continue.