Elon Answers: Can you get COVID-19 again?

This is part of a series of articles featuring responses by Elon University faculty members to questions about the novel coronavirus 2019 (COVID-19) submitted by Alamance County community members.

If I get COVID-19 and then recover, will I be immune to the disease, or could I get sick again?

Those who recover from COVID-19 will most likely be immune to the disease, at least for a few months, and possibly for years or even a lifetime. It is difficult to know for certain because the novel coronavirus has been studied by scientists for only four months. Other coronaviruses, such as SARS and MERS, have the power to reinfect us after about three years of immunity protection. For COVID-19, the data so far are mixed.

Dave Gammon, professor of biology

The earliest data come from China, because that is where the pandemic began. A month-long Chinese study demonstrated that two monkeys that had recovered from COVID-19 could not be reinfected, even by placing coronavirus directly onto their throats. This study has not been peer-reviewed, meaning that other scientists still need to verify the results.

Another study from China showed that 175 recovered patients in Shanghai developed antibodies in their blood within 10 to 15 days of showing symptoms. Normally these antibodies provide protection against reinfection. We need more studies to confirm whether this is true for COVID-19. This study was also not peer-reviewed, so the results have not been verified.

Reports from South Korea show some infected people test positive for COVID-19 a second time. This might mean people were reinfected, but more likely it indicates the virus never left their bodies completely with the first infection. Scientists are unaware of anyone suffering severe symptoms a second time after recovering from COVID-19.

Dr. Anthony Fauci, the epidemiologist who currently advises the White House, believes that those who recover from COVID-19 will be immune to reinfection for several years. We hope within a month or two scientists will collect more data that allow us to have a conclusive answer to this important question.

If a vaccine is developed, will it have to be administered each year like the regular flu vaccine?

The answer will depend on whether the virus causing COVID-19 mutates over time. Each virus has a genetic sequence. If the sequence changes only slightly, then a vaccine might last for an entire lifetime, such as the vaccine for the polio virus. Because the influenza virus mutates a lot each year, the flu vaccine must be updated annually.

The virus causing COVID-19 is so new scientists cannot conclude with certainty about how quickly it will mutate, but so far the signs are positive. The earliest measurements from virologists suggest the COVID-19 virus mutates only one fourth as fast as the influenza virus. If that estimate remains true, then a COVID-19 vaccine would probably last for several years or longer. Cross your fingers, everyone.

Is it safe to visit people outside their homes? I’m thinking specifically as a teacher who wants to follow up with children from homes that lack computers or parental support, but my question could also apply to pastors, business associates, friends, etc.

As long as you stay at least six feet from other people while talking outdoors, there is little chance either of you will get infected. If they live in an apartment, you might meet outside the building, rather than standing inside a hallway. You could wear face masks to provide more protection. You should also try to avoid touching the same objects while you visit. Although there is still no conclusive evidence people get COVID-19 from touching a shared surface, viruses can exist outside the body for several hours.

We hear about the shortage of ventilators. Would CPAP machines or nebulizers work better than nothing? There may be lots of idle CPAP machines and nebulizers in people’s homes that could be donated, sterilized and adapted.

This question would be best answered by a medical professional from the community rather than an academic like me. I learned from talking to seven medical professionals, however, that they often have restrictions from their employers about what they can say publicly. So I treated my phone conversations as interviews and will now report what I learned from them:

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There is a good chance Alamance County will not run out of ventilators. Production of ventilators from national companies has increased, and there are hopeful signs the infection curve is flattening. If ventilators are needed, the following website mentions a few organizations that take donations of CPAP and BPAP machines and refurbish them into ventilators: https://aasm.org/coronavirus-covid-19-faqs-cpap-sleep-apnea-patients/.

Unfortunately, nebulizers cannot be refurbished as ventilators. They are used only to give medications, such as albuterol for asthma. Nebulizers work by mixing a liquid medication with compressed air or compressed oxygen. The mixture generates a mist, which gets inhaled into the lungs.

Are there statistics about the percentage of infected people with breathing problems that also smoke cigarettes? If smokers are more prone to the virus-induced breathing problems, maybe young people might be scared into never starting to smoke. Same question about vaping.

Scientists have known for decades that smoking cigarettes causes permanent lung damage and decreases how much oxygen can be carried within the body. The use of electronic cigarettes, also called vaping, has existed for only a few years, but we know it also causes severe problems in the lungs and respiratory tract.

The virus that causes COVID-19 usually attacks the lungs and respiratory tract of infected people. Furthermore, extremely ill COVID-19 patients often develop Acute Respiratory Distress Syndrome, which is also common in the lungs of those who heavily smoke or vape.

Because COVID-19 is a new disease, scientists do not yet have enough data to conclude whether smokers are more likely to get the disease, or whether they suffer stronger symptoms. A recent study found the opposite. Just one out of 20 COVID-19 patients admitted to two New York City hospitals during March were also current smokers. Future data will probably provide a clearer understanding of how smoking and vaping relate to COVID-19, but your lungs will appreciate it if you can avoid all three.

Why does the Johns Hopkins COVID-19 map have a bigger number for those with the disease than the state’s count? Today, it has almost 50 more cases in North Carolina than the state is reporting. Is Hopkins’ tracking accurate?

As you might expect during a rapidly unfolding pandemic, data sources often conflict, so the Hopkins team makes tough choices about which sources to favor. When I wrote this article on April 18, the Hopkins map reported 6,045 confirmed cases of COVID-19 in North Carolina: https://coronavirus.jhu.edu/map.html. The COVID-19 North Carolina dashboard reported 5,859: https://www.ncdhhs.gov/divisions/public-health/covid19/covid-19-nc-case-count.

Both sources are updated daily, so I suspect the higher number on the Hopkins map results from them using a greater variety of data sources. Nevertheless, the numbers are within three percentage points of each other, which should provide enough accuracy for most government and business leaders.

Given the low amount of testing and the fact that many COVID-19 infections express little or no symptoms, the true number of COVID-19 infections in our state is almost certainly much higher than either estimate. It will likely be months or even years before scientists can more precisely describe the true spread of COVID-19.

The COVID-19 map

The story behind the COVID-19 map is fascinating. On Jan. 21, a very normal epidemiology lab group at Johns Hopkins University held a routine meeting about a topic unrelated to COVID-19. Similar to labs all over the United States, one of the graduate students in the lab came from China.

The head of the lab, Lauren Gardner, asked her student, Ensheng Dong, whether he had been following the Chinese news about a rapidly spreading coronavirus none of them had heard of a month earlier. Dong shared his worries about his family in China and also friends living in Wuhan, where the pandemic originated. Gardner then made a fateful suggestion that would later consume her life: “Why don’t we make a dashboard?”

Dong grabbed the idea by the horns. Within hours he’d created a regional map of China, and used publicly available data to indicate the number of confirmed cases of COVID-19 using red circles on the map.

On Jan. 22, the map went online. Thanks to a viral social media post by Gardner, a flood of users from news organizations, government, and the general public devoured the webpage, which Dong updated manually every day.

The timing of Dong and Gardner was eerily perfect. Within days, their humble map began to show red dots spreading on multiple continents. They began to harvest data from more and more sources, including the European Centre for Disease Prevention and Control, the U.S. Centers for Disease Control and Prevention, the health departments of U.S. states, the Red Cross, and media-aggregating websites.

Currently, two dozen people at Johns Hopkins University work very long days keeping the dashboard updated at least daily. Data entry is automated, but the staff keeps busy responding to public demand by adding new features, such as hospitalization rates and per-capita rates of COVID-19 testing.

Dave Gammon is a professor of biology at Elon University. Reach him at dgammon@elon.edu.


To submit a question to our team of scientists, visit tinyurl.com/eloncovid19, email us at eloncovid19@gmail.com, or use social media with hashtag #eloncovid19. Answers will be published as available in the Times-News, at www.thetimesnews.com, and on Today at Elon.