How Often Do We Have to Get

Covid to Stop Getting Covid?

Natural immunity will be key to downshifting the pandemic
to endemic status. That doesn’t mean you should go out and
try to catch the virus tomorrow.

Covid is coming for all of us at some point.

Photographer: Matthew Horwood/Getty Images 
By
Justin Fox
30 de abril de 2022, 7:00 GMT-5
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Justin Fox is a Bloomberg Opinion columnist covering business. A former editorial director of Harvard
Business Review, he has written for Time, Fortune and American Banker. He is author of “The Myth of
the Rational Market.” @foxjust
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In October 2020, a few weeks before the experimental trial results for the
BioNTech-Pfizer, Moderna and Oxford/AstraZeneca Covid-19 vaccines
were released, German virologist Christian Drosten cautioned that the
shots would be of limited effectiveness in preventing the spread of the
disease.
“We are dealing here with an infection of the mucous membrane, i.e., in
the nose and the throat and then later the lungs,” he said on Episode 62 of
Das Coronavirus-Update, the podcast launched by broadcaster NDR in
March 2020 that helped make Drosten a household name in Germany.
“The mucous membranes already have their own special local immune
system. With the current vaccines, which are more likely to be injected
into the muscle, you don’t reach this local immune system so well.” As a
result, the vaccines “probably protect more against the severe course [of
the disease] than against infection.”
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Which is of course exactly how things played out. The vaccines have
been spectacularly effective at preventing severe disease and death, much
less so at preventing transmission.

Drosten has been described in the U.S. media as “Germany’s Fauci,” but
the moniker seems a little unfair. National Institute of Allergy and
Infectious Diseases Director Anthony Fauci was a top researcher in his
day, but has been running a sizable government agency (fiscal year 2021
budget, $6 billion) for the past 38 years. His appearances in the media
during the pandemic have mostly involved reciting the public-health
consensus of the moment, which was useful when the U.S. president was
a font of Covid-19 misinformation but not always especially
enlightening. Drosten, director of the Institute of Virology at
Berlin’s Charité medical school, is perhaps the world’s leading
coronavirus expert, responsible for identifying the original severe acute
respiratory syndrome virus in 2003 and devising the first diagnostic
test for the Covid-causing SARS-CoV-2 virus in January 2020. His
public commentary, delivered chiefly in podcast form after he grew
frustrated dealing with some in the German media, has tended toward
the cutting-edge and forward-looking — as indicated by what he was
saying about vaccines in October 2020.
I recount all this as context for what Drosten said last month in the 113th
and final (for now) regular Coronavirus-Update episode. He was talking
again about the mucous membrane — which in German is conveyed as
the more graphic “Schleimhaut,” literally “slime skin” — and its role in
keeping infectious diseases in check (translation and editing-for-brevity
by me):

With influenza it is simply the case that everyone gets infected x times
over the course of their lives. These infections occur in the mucous
membrane, in the throat. Our mucous membranes have a local immune
system of their own, if you want to call it that. And everyone in the
population, except for the children, of course, has so many infections
behind them that there in the mucous membrane, immunity exists. That
is why the adults in the population, and that is the vast majority of the
population, are not so infectious.

It is this mucosal immunity that keeps influenza from spreading most of

the year, with the disease’s effective reproduction number (the average
number of people who will get it from each one who has it) surpassing 1
for only a few months in winter, when indoor crowding, drier air and
other factors seem to lead to increased transmission.
Contrast that with Covid: Current vaccines generate some mucosal
immunity but it fades quickly, and while there are nasal-spray
vaccines in development that target the mucous membrane, they’re not
ready yet, and this approach has been of only mixed effectiveness against
influenza. Meanwhile, less than half the German population has been
infected with Covid, Drosten said (in the U.S., according to a Centers for
Disease Control and Prevention report this week, it’s 57.7%), so there
probably isn’t nearly enough mucosal immunity out there to prevent the
reproduction number from rising back to 2 or 3 in the fall, bringing
another huge wave of infections and concomitant stresses on hospitals
and disruption of daily life.

One thing that could preclude this, Drosten speculated, might be a lot of
young people (the “Party Generation,” he called it, in English) getting
infected a second or third time over the summer, but he expressed doubt
that this would be enough to make a difference in 2022. How many times
are people going to need to be infected to confer effective immunity
against transmission, asked NDR science reporter and podcast moderator
Korinna Hennig. Drosten’s reply:

My idea is that this is in the range of a number that you can count on one
hand. But no one can say for sure at the moment.

The role of infection-conferred immunity in slowing the spread of Covid

has been a sensitive topic. Early in the pandemic, it was emphasized by a
few scientists (and a lot of non-scientists) who wildly underestimated the
deadliness of the disease. Later, after vaccines became available, anti-
vaxxers argued that natural immunity was superior to the sort conferred
by shots. The latter claim isn’t entirely wrong — as might be expected
from Drosten’s explanations, there’s some evidence that prior infection
provides better protection against subsequent infection than current
vaccines do (although there’s counter-evidence, too). But it’s far less
dangerous to get a shot than to get Covid for the first time, and once
you’ve been infected, vaccines add significant protection against
reinfection.
Relegating SARS-CoV-2 to the status of an endemic virus like the flu or
the several coronaviruses that cause common colds, though, may require
lots and lots of us getting the disease, again and again. As Drosten put
it in an interview in January: 

Over the long run, we will not be able to vaccinate the population every
few months. That won’t do. At some point, the virus itself will have to
keep updating people’s immunity.

Given the source, it’s hard to argue with this. As a guide to policy and
behavior, though, it’s not so clear. Going to great lengths to avoid
infection makes less sense for most of us than it used to, and trying to
maintain a zero-Covid policy as a nation, as China is doing, seems to
make no sense at all. But should we be going out and trying to get
infected?
A few weeks ago, after writing about my belief that wearing masks on
buses and subways ought be encouraged even after the mandates go
away, I heard from readers who argued that this was unwise because
getting exposed to germs on the bus or subway builds immunity. But if
that’s the case, the great majority of Americans who aren’t fortunate
enough to commute by public transportation must be putting themselves
in grave danger. By that logic, don’t they need to hang out unmasked in
enclosed spaces crowded with strangers for a couple of hours every
week?

Put it that way, and the argument for not ever bothering to
take precautions falls apart. Drosten certainly doesn’t subscribe to it,
instead expressing hope in the final Coronavirus-Update that the “Asian
courtesy” of wearing a mask when ill and in certain other situations
catches on in Germany. Wondering what the right balance might be, I
asked my primary-care physician (and college classmate) Bertie
Bregman, who has been treating Covid patients in New York since the
early days of the pandemic and contracted the disease early on, too. He
had an interesting response: “In a nutshell, what I believe is that we have
to stop being so neurotic about Covid and be more neurotic about
everything else.”

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That is, with Covid now manifesting itself among the vaccinated and
those with prior infections (i.e., almost everybody) mainly as a standard-
issue upper-respiratory infection, we should probably just treat it as a
standard-issue infection, albeit with a heightened awareness that the
spread of such diseases can and should be slowed by simple measures
like staying home and wearing a mask when sick. The one “wild card,”
Bregman allowed, is Long Covid, the risk that even mild cases now
could lead to complications later. But taking reasonable care around
cold-and-flu-like symptoms is likely to be more effective in curbing
Covid, he thinks, than the current widely followed approach of taking
rapid Covid tests and going about life as normal if they come back
negative — “then half the time a week later they turn out to be positive.”

What about building immunity? Exposing children early on to germs and

allergens pays dividends later, Bregman said, but for adults “the costs of
getting sick outweigh the benefits.” So yes, most of us will probably get
Covid, repeatedly. No need to rush it, though.