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  • Richard Cree

Reinfection

14th August 2022


Total UK Deaths with COVID-19 on the death certificate – 195,962 (up to 20 May)

James Cook Hospital – Total COVID deaths – 938

All COVID cases within South Tees Hospitals Trust – 91

James Cook Critical Care

COVID cases – 0

Non-COVID cases – 48 (19 ventilated)


I remember, at the end of January, repeatedly hearing how Omicron was so infectious that there would surely be nobody left to infect come the Spring. How wrong that prediction was. Back then we were just coming to realise how different Omicron was from its predecessors. Case numbers were falling and those COVID patients that were being admitted to hospital were nowhere near as sick as before. I remember feeling optimistic that the pandemic would soon be over and I was not the only one. Boris had lifted most of our restrictions and we were officially back to what he called ‘Plan A’.


Cases continued to fall until the end of February when the requirement to self-isolate following infection was removed. The vast majority of the population were no longer testing if they became unwell and so, unsurprisingly, cases began to rise again. This rise in cases was also being driven by the proliferation of the more infectious Omicron BA.2 variant.


Thanks to the ONS household-testing programme we know that cases peaked at the end of March and began to decrease again. By the end of May, many including me, thought that we were about to enjoy a COVID-free summer. Of course, no sooner did I write my last post, than cases began to rise sharply again. The increased social mixing that took place around the Jubilee celebrations and the arrival of the even-more infectious BA.4 and BA.5 variants caused yet another ‘wave’ of infections.


Fortunately, this latest round of infections peaked at the beginning of July and cases have been declining since. Does this mean that Omicron has now finally run out of people to infect? Sadly, it looks like the answer is no. There are a growing number of people who have now caught Omicron twice. This includes a handful of my colleagues who were first infected with the BA.1 variant at the beginning of the year and are now being infected with the current BA.4 or BA.5 variants.


It’s a little disappointing to find that they have been reinfected so soon. We all knew that COVID was here to stay but I had been hoping that the interval between infections would be longer than this. We may all end up being reinfected by newer variants sooner than we had thought and it may happen over and over again.


Fortunately, none of these reinfections has caused anything other than a mild illness but those colleagues who have been infected have still been unable to work until their lateral flow tests turn negative. The number of staff who are currently off work due to COVID has only just returned to a low level but, if these reinfections continue, more people will be unable to work.


The reason people are becoming reinfected so soon is because an Omicron infection appears to do little to boost your immune system. This means that, once you have recovered, you are left with very little protection against future infection. The same is true for our current vaccines – whilst vaccination remains very effective at preventing severe disease, it also does not protect against reinfection for very long.


The good news is that the latest Omicron variants still have a tendency to colonise the upper respiratory tract rather than the lungs. This means that the lung inflammation that we saw during the first three waves remains extremely unlikely. A second Omicron infection seems to be appreciably less severe and are many people who do not know they have been reinfected. There is therefore a hope that any third or fourth infections will be milder still.


At the hospital, there is evidence that the recent rise in admissions has passed. Fewer COVID positive patients are being admitted each day and the number of COVID patients is almost back to where it was before the Jubilee celebrations. As before, relatively few of these admissions are coming to hospital as a direct consequence of their infection. We currently have no COVID positive patients in the ICU. There are still some vulnerable people in whom Omicron is far from a trivial illness and they require hospital treatment as a result, but we continue to see almost no cases of COVID pneumonitis.


It was therefore something of a surprise when we recently admitted an elderly lady who had developed respiratory failure following her Omicron infection. We are still being referred the occasional patient with possible COVID pneumonitis but, on closer inspection, nearly all of these have another illness such as a bacterial pneumonia. Those who do have genuine pneumonitis will have an underlying medical condition or be receiving treatment that supresses their immune system. Our patient had none of these and her only risk factors appeared to be that she was elderly and unvaccinated. Sadly, despite our best efforts, she did not survive.


Despite the number of COVID patients decreasing, the hospital remains surprisingly busy for the time of year. I cannot remember a previous summer when we have been so busy. There are lots of stories in the press about how stretched the health system is. The long ambulance waiting times that we are continuing to see are very concerning and news that Accident and Emergency waiting times are the worst they’ve ever been comes as no surprise to any of us.


Quite what will happen over the next few months is unclear. Many people who were infected during the second Omicron wave in March and April may become susceptible to reinfection in the autumn and we may see cases begin to rise again. We are still a while away from knowing what ‘endemic’ COVID will ultimately look like. Whilst many of these reinfections will be mild, a significant number will doubtless be serious enough to hospitalise the immunosuppressed, the frail and the elderly. The NHS is far from in a good place at the moment and the last thing it needs is for ‘winter pressures’ to arrive early.


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