You made it through COVID-19 once and now you’re feeling invincible. Surely, you’re not going to get it again, right? Especially after you got vaccinated?
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Sorry to be the bearer of bad news, but that’s not exactly true. Experts say you’re not in the clear just because you’ve already contracted and recovered from the virus. Breakthrough cases are possible even in previously ill people who are fully vaccinated — and, if you’ve had COVID-19 already but are not vaccinated, you may be at an even higher risk of getting sick again.
Pediatric infectious disease specialist Frank Esper, MD, answers your questions about COVID-19 reinfection, including how you can best protect yourself from getting the virus again.
Why you can get COVID-19 more than once
You can get COVID-19 more than once. In fact, doctors continue to see COVID-19 infections because vaccine immunity decreases over time, we’ve stopped being as careful as we once were and new variants are coming in stronger than previous waves of coronavirus.
“You put all four of those things together, and it’s not too surprising that we’re seeing more and more people becoming infected multiple times,” says Dr. Esper.
Here’s why those four facts matter:
- The pandemic has been happening for a while. In early January 2023, the U.S. surpassed 101 million cases of COVID-19 since the start of the pandemic. “At this point, many of those infections happened months ago or more than a year ago,” Dr. Esper says. “The immunity from those initial infections begins to wane over time.”
- Vaccine immunity diminishes with time, too. For Americans who got vaccinated as early as winter 2021, immunity may be starting to wane, as well. This is one reason why it’s critical to receive your third booster dose.
- We’ve stopped being as careful. Gone are the early days of mass vigilance around safety precautions like masking, handwashing and social distancing — all the things that initially kept the virus at bay.
- New variants are extra-contagious. COVID-19 variants are more infectious than the first wave of coronavirus. “These variants are able to overcome some of the existing immunity people developed via vaccination or a previous infection,” Dr. Esper states.
Are variants to blame for reinfections?
The U.S. Centers for Disease and Prevention (CDC) reports that the delta variant was at least twice as contagious as previous variants, and omicron was even more contagious than delta as the dominant variant in the U.S. in 2021. Now, doctors are preparing for a new dominant strain XBB.1.5.
But you may be surprised to learn that the coronavirus actually doesn’t mutate nearly as much as influenza, which changes nearly everything about its appearance from one year to the next. Rather, Dr. Esper says, it’s COVID-19’s contagiousness that makes it so, well, contagious.
“This variant’s infectiousness — including its ability to evade immune systems and prevent long-lasting immunity for those people who are infected with it — is one of the reasons why it’s been able to persist and come back,” he explains.
How soon after a COVID-19 infection can you get it again?
Research on when you can be reinfected with COVID-19 is mixed. Some studies have suggested that after you’ve been infected with COVID-19, you may be protected from reinfection for up to a year or more. Others say immunity following recovery from COVID-19 only lasts a few weeks, if even that.
The CDC says research is ongoing to better understand how soon people can be reinfected. The good news is that if you get COVID-19 again, it’s likely to be less severe than your first time around. In fact, the general rule of viral infections is that your first time is your worst time, and that’s especially true if you’ve been vaccinated.
Can you get COVID-19 twice in a month?
While not likely, it’s possible to get COVID-19 twice within a 90-day period. According to the CDC, early reinfection within the first 90 days of initial infection is possible, though most reinfections occur after 90 days.
“It is very unlikely that someone will get re-infected within the same month. However, we do see two situations where people think they are re-infected,” says Dr. Esper. “First, some people have persistent positive covid tests. This is due to the fact that covid testing is now so highly sensitive that they can detect residual particles of covid genes/proteins even after the infection itself has gone.
Second, there are a small number of individuals who have a prolonged infection with COVID-19. We see this situation most often with people who have weakened immune systems. They can have a persistent infection with the same strain of covid for months.”
New strains can also completely replace an existing COVID-19 variant. If this happens, you can get infected with the new emergent strain soon after infection with the previous variant.
If you get COVID-19 twice, are the symptoms the same?
Symptoms can be the same or different from one infection to the next and even between variants. Because of the wide array of symptoms associated with COVID-19 and its many variants, your symptoms can include a mix of any or all of the following:
- Fever or chills.
- Shortness of breath or difficulty breathing.
- Extreme fatigue or prolonged tiredness.
- Brain fog.
- Muscle or body aches.
- New loss of taste or smell.
- Sore throat.
- Congestion or runny nose.
- Nausea or vomiting.
“Not everyone gets sick the same way. In fact, you may feel differently even when you become infected with the same germ at different times during your life. This is because it’s not just the infecting organism that causes your symptoms but also your immune response,” says Dr. Esper. “Your immune system is constantly in flux, rising and recovering as it fights off numerous pathogens we experience daily. Symptoms and severity with infections may differ based on what state our immune system is in when the next infection occurs.”
Who’s at risk of COVID-19 reinfection?
By now, we know that anyone can get COVID-19 — the vaccinated and unvaccinated, those who’ve had it already and those who haven’t. In the same vein, anyone can get COVID-19 again.
“It’s important to note that we’re still learning a lot about reinfections and who’s at risk for those reinfections,” Dr. Esper states. But doctors do know that some people are at higher risk than others.
Reinfection in people who are unvaccinated
Think you don’t need to get vaccinated because you’ve already had COVID-19? Think again. One study shows that unvaccinated people are 2.34 times more likely to be reinfected with COVID-19 than those who are fully vaccinated — which drives home the importance of being vaccinated, even if you’ve already had the virus.
“Reports indicate that vaccination provides longer protection than natural infection,” says Dr. Esper. “This virus can overcome a person’s host immunity and cause a second infection. Almost all the severe cases that we’re seeing right now are people who have not been vaccinated.”
Reinfection in people who are immunocompromised
People with immune issues are at an even higher risk for COVID-19 reinfection than the general public, prompting the U.S. Food and Drug Administration (FDA) to authorize booster shots of Pfizer-BioNTech’s and Moderna’s COVID-19 vaccines starting with immunocompromised individuals.
“We always knew that people with immune problems were more likely to have less of a response to the vaccine and more likely to get a second infection after they got the vaccine,” Dr. Esper says. Booster shots are designed to help reduce that likelihood.
COVID-19 vaccines work to decrease the seriousness of illness
Breakthrough cases of COVID-19, including cases of reinfection in people who are vaccinated, aren’t a sign that the vaccine doesn’t work. Vaccines are designed to prevent an illness from reaching its worst stages should you get infected. You can think of vaccines a lot like wearing a coat of armor: Without it, you leave yourself exposed to any and all attacks at full force. With a vaccine, you’re giving your body the extra protection it needs.
“There is a very coordinated and concise effort against vaccines, and those people want to amplify breakthrough infections as a reason not to get vaccinated,” Dr. Esper notes. “But the safety and benefit of getting vaccinated is very, very strong, and they far outweigh the risks of getting vaccinated, which are very, very small.”
In short? Vaccination is still critical. If you’re not yet vaccinated, now is the time to get it done — for your safety and for the safety of those around you.