Will a previous COVID-19 infection protect you from reinfection?

Of all the pressing questions raised by the COVID-19 pandemic, one looms large: Will previous infections protect you from reinfection?

New research published in lancet, sought to understand the level and characteristics of protection against reinfection from previous COVID-19 infection, symptomatic infection, and severe or fatal disease. The aim was to systematically integrate previous studies to estimate the protective effect of past infections by variant and by time elapsed since first infection.

A systematic review and meta-analysis identified retrospective studies, prospective cohort studies, and test-negative case-control studies of the scientific literature. From these papers, researchers reviewed data and extracted estimates of reinfection risk after COVID-19 infection.

Using the keywords “COVID-19”, “SARS-CoV-2”, “innate immunity”, “previous infection”, “past infection”, “protection” and “reinfection”, studies have analyzed a myriad of databases and peer-reviewed publications. The papers included were published from the start of the pandemic to September 31, 2022.

The researchers meta-analyzed the efficacy of past infections by outcome (infectious disease, symptomatic disease, severe disease), variant, and time since infection. They performed Bayesian meta-regression to compute pooled estimates of protection.

A total of 65 studies collected from 19 countries met the inclusion criteria and were included in the analysis. Investigators found that past infections protected against symptomatic disease with the ancestral Wuhan strain, and the alpha, beta, and delta variants of concern. Protection against reinfection from these variants gradually decreased over time, but remained at 78.6% at 40 weeks.

However, the pooled efficacy of Omicron against reinfection was only 45.3%. They also had significantly lower reinfection protection against Omicron BA.1 symptomatic disease (44.0%). At 40 weeks, he was 36.1% protected against Omicron reinfection.

The average pooled efficacy was ≥78% against severe disease (hospitalization and death) from all variants studied (ancestral strains, alpha, beta, delta, and omicron).

Notably, protection against reinfection that progressed to severe disease was very robust, 90.2% at 40 weeks for all variants studied except Omicron. But even with Omicron BA.1, reinfection protection was very high, 88.9% at 40 weeks.

The researchers concluded that past infection prior to Omicron is highly effective against reinfection with COVID-19. Omicron protection against reinfection was dramatically lower and decreased more rapidly over time, whereas protection against severe disease was higher for all variants.

These findings led the study authors to argue that immunity from past COVID-19 infections should be weighed against protection from vaccination when predicting the future disease burden of COVID-19. . Indeed, the strong protection against severe disease seen in her recovered COVID-19 patients may help guide vaccination recommendations.

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