Can I go back to “normal” after having a breakthrough COVID infection?

If you’re fully immunized 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. Add to that the extra immunity conferred by a breakthrough infection and you’re about as protected against the coronavirus as you can get. Infectious disease specialists have called the combination of vaccination and immunity conferred by infection “hybrid immunity”, and say it is the highest form of immunity against SARS- CoV-2.

There are unknowns, such as how the protection achieved after omicron infection compares to that of delta. But doctors generally agree that, for a time, vaccinated people who have 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 bypass some of our immunity, according to Amesh Adalja, an infectious disease expert and principal investigator at the Johns Hopkins University Center for Health Security. Reinfections will eventually occur – even in people with hybrid immunity – but these future infections will likely be mild, thanks to all the immunity they have built up.

“For these types of people, they really shouldn’t worry about going back to their normal activities, at least for several months,” Adalja said. “And even after that time, if they’re likely to get a reinfection, that reinfection will be very mild.”

How protected are you after a breakthrough infection?

Vaccines provide us with an excellent immune response specifically targeted at the coronavirus spike protein – the part of the virus that attaches to our cells. Evidence shows that the vaccine-induced immune response continues to do a great job of keeping people out of hospital. Scientists are still learning about omicron infections, given that the variant – although now in decline – is still new.

“We tend to think that if you’ve been infected you have a good 90 days to get some level of protection – and that’s probably the case. [with omicron]but we have to be absolutely sure,” said Carlos del RioProfessor of Medicine, Global Health and Epidemiology at Emory University.

A pre-publication study from Hong Kong found that breakthrough omicron infections elicit a wide range of antibodies and T cell response that works well against other variants – alpha, beta, gamma, delta. The antibodies your immune system produces during an infection are all over your body, including the nasal cavity, which is our first line of defense when we inhale virus particles.

Centers for Disease Control and Prevention guidelines say recently recovered people are well protected for three months. Some data suggests the protection is even longer lasting — seven to eight months, sometimes longer, Adalja said.

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Experts are still collecting data on omicron, including the duration of immunity after a breakthrough infection.

Keep in mind that immunity is not a one-size-fits-all thing. Most people with hybrid immunity will have strong resistance against serious illnesses — including those with health conditions that put them at risk for COVID, such as obesity or diabetes, Adalja says. Immunocompromised people – including those who have had stem cell or organ transplants – will need to be protected, as some may not mount a strong immune response after vaccination or infection.

For others without underlying issues, antibody levels will decline over time and reinfections will occur (just as they do with other respiratory viruses). “Don’t assume that just because you’ve been infected once, you won’t have it again,” del Rio said. Yet cell-mediated immunity will continue to protect most people from serious illness, hospitalization and death.

So can I go back to normal?

We are not in a place where life will be like before the pandemic. Everyone will still have to look at their own risk tolerance. The vast majority of people with hybrid immunity will experience incredible protection against COVID, especially if severe consequences, for several months. Because of this, people with hybrid immunity may feel a little safer doing indoor activities in the immediate future, said Monica Gandhi, an infectious disease specialist at the University of California, San Francisco.

Severely immunocompromised people will still need to be careful, as they have been advised to behave in previous respiratory virus seasons, Adalja said. If this is you, continue to take protective precautions.

Everyone in the general population also has a responsibility to care for immunocompromised people, even after they have recovered from a breakthrough infection. This means taking steps to keep them safe, such as 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 you show signs of illness.

Those relying on rapid tests to visit at-risk family members can likely have peace of mind for the first few weeks after recovery, del Rio added. “But if you have access to testing, test yourself,” he said.

Since we will not be able to eliminate the coronavirus, we will all remain susceptible to contracting it throughout our lives, according to Adalja. The goal now, he said, is to keep such disease mild. This is done mainly by vaccination and booster. Hybrid immunity can also contribute (but, obviously, don’t try to infect yourself 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 at the time of publication, but advice may change as scientists discover more about the virus. Please consult the Centers for Disease Control and Prevention for the most recent recommendations.


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