Last May a subvariant of the ever-evolving Omicron stunned Chris Goodnow, an internationally renowned immunologist.
The extremely fit Australian scientist, who hiked, biked and surfed at Sydney’s Manly Beach, had been bolstered by four doses of vaccine. Having spent nearly four decades studying how white blood cells in the immune system protect us from infection, he felt pretty safe about removing his mask.
"Maybe it would be better to catch the 'rona and get it over with, now that I'm fully vaccinated?" he remembers speculating.
“After all, isn't it just a cold in fully immunized people? And once I've had it, won't I have acquired immunity that will mean I won't get sick at all if I get it again?"
But Omicron made a mockery of these popular assumptions.
On May 26, Goodnow came down with a scratchy throat. Twelve days later his immune system had not cleared the virus. Then he got hit by congestive heart failure. He developed a chest cough and was breathless. His ankles swelled up.
Goodnow was lucky. His acute myocarditis (inflammation of the heart muscle) was on the mild end of the spectrum but severe enough to reduce his mobility and working life.
“That is the thing that really stunned me and I’m sure has stunned most immunologists,” he said in the radio interview.
Like many scientists Goodnow assumed that any infection after vaccination would be mild; that reinfections would largely be asymptomatic; that COVID would behave like a cold after vaccination; and that variant-specific vaccines would deliver us from the pandemic.
But Goodnow now considers these assumptions wrong and has set about debunking myths that “many of us, myself included, have entertained more than we should have,” he writes. He now joins a growing cadre of scientific experts sounding new alarms about COVID, the “so many others” he says, who “are working hard to stop endless waves of reinfection.”
Not a cold or flu
The first myth that Goodnow wants debunked is probably the most common, that COVID is just a cold.
But colds don’t behave the way COVID does in the body.
Colds, for example, don’t leave 2.3 per cent of athletes with inflamed hearts after infection, as tests found at 10 U.S. universities.
Nor do colds worsen outcomes with each subsequent infection, as Goodnow and others worry may be the case with COVID. He points with concern to a study, yet to be peer reviewed, from the U.S. Department of Veteran Affairs, led by Ziyad Al-Aly at the Washington University School of Medicine.
Al-Aly and two other researchers looked at the health records of 250,000 veterans who had been infected once with COVID; 36,000 who had been infected twice, and 2,000 who had been infected three times.
Using a “hazard ratio” — a measure of how often bad things happen to one group compared to another — the researchers found that the risk of heart, brain, kidney and blood complications all increased with each subsequent infection.
As Goodnow has noted about the findings, “The risk of cardiovascular disease, for example, increased after one infection, but doubled in people who had two infections, and tripled in those who had been infected thrice.”
Similar risks were found for heart disease, blood clotting problems, brain decline and diabetes. Nor did vaccines seem to help in preventing these problems, which most frequently occur up to six months after infection.
“Every time you dip your bucket in that COVID well, you’ve got the same chance of a whole lot of bad things happening,” explained Goodnow, who considers the veterans study “really important real-world data.”
His takeaway: “COVID-19 is not just a cold, and having it before doesn't ‘get it over with.’”
The implications are plain to see in Goodnow’s own home. On Sept. 14 researchers noted that “so far in 2022, more than 12,000 Australians have died with COVID, six times the number of deaths in the previous two years.” Adding that a deadly summer surge “happened despite greatly increased immunity from third- and fourth-dose vaccination, natural infection and lifesaving therapies introduced in April this year.”
Not a one and done virus
The second myth that Goodnow wants demolished is that COVID is a “one and done virus.”
Many viruses, such as polio or measles, both childhood diseases, confer long-time immunity after a vaccine shot or natural infection. But members of the coronavirus family don’t behave the same. An infection or vaccine provides only temporary or passing immune protection. This waning or transient immunity explains the need for repeated boosters.
Take for example the four different cold viruses — all members of the coronavirus family — that assail humans every year, explains Goodnow. Recent U.S. research shows that two of these viruses have been behaving like Omicron for the last three decades. “They come along every year or two years and escape the antibodies we made before.”
Coronaviruses have also learned to evade the immune system of other species.
In fact the very first coronavirus discovered was found in chickens in the 1930s. In chickens, the infectious bronchitis virus, or IBV, doesn’t just cause respiratory disease but damages the gut, kidney and even the reproductive system. For the chicken industry, IBV remains the second biggest viral problem after influenza, because the coronavirus is so adept at mutation and immune evasion.
Giving chickens one vaccine shot against IBV might provide immunity for about 16 weeks against the infection and then “the antibodies drop off,” notes Goodnow. “This is a modus operandi unique to coronaviruses” including COVID, he says. “It is a trick this class of viruses developed a long time ago.”
So COVID is not a “one and done” virus and an infection or vaccine provide limited durable immunity against another infection.
Vaccines don’t stop transmission
Goodnow also has dissected another powerful myth: that vaccines stop transmission.
Many people have long assumed that being fully immunized means they can’t get infected. “That's another bit of hubris I carried — up until very recently,” says Goodnow.
What really changed that assumption was the appearance of Omicron, the most immune evasive variant to date. Prior to the Omicron wave, getting reinfected with other COVID variants was a rare event. Now reinfections account for more than 10 per cent of all cases.
At a population level, vaccines have done a good job of keeping people out of the hospital and graveyard, and recent research finds that vaccines are associated with lowering the risk of long COVID. As important as it is to be vaccinated, however, getting the shot can’t stop infections or some of the complications caused by those infections.
Goodnow cites data from the U.K. Health Security Agency showing that protection from infection in citizens who have received two shots plus a booster fell from 95 per cent against Delta to just 45 per cent against Omicron.
“Because prior infection and vaccination don't stop the virus spreading, Omicron has already spawned an even more heavily mutated offspring, BA.5, which is three times better at evading our body's defences,” noted Goodnow in an article.
“You should assume you have less protection now, and while it's essential to get your booster, don't make the mistake of ditching masks or social distancing just yet.”
Since Goodnow wrote about Omicron in July, more evidence bolstering his warnings has come to light. In a yet to be peer reviewed study, Danish scientists have reported “the incidence of Omicron-Omicron reinfections is occurring over a shorter time interval than seen after a primary infection with a non-Omicron variant of concern.
“Our analysis suggests that a single infection from SARS-CoV-2 may not generate the protective immunity required to defend against reinfections from emerging Omicron lineages.”
And South African researchers have reported a “rapid waning of vaccine effectiveness against the current sublineages of the Omicron variant with respect to protection against hospitalization.”
Variant-specific vaccines are no silver bullet
The last myth Goodnow tackles is the belief that variant-specific vaccines are the big answer to getting back to normal.
Boosters do increase antibodies and confer added protection against hospitalization and death, but they are in a race with viral evolution.
Moderna’s new bivalent vaccine (it contains the old Wuhan strain plus the first of the Omicron variants) increases neutralizing antibodies to twice the level of the original booster. And that’s good news, says Goodnow.
But when faced with the immune evasive properties of BA.5, those neutralizing antibodies take a substantial hit.
Given the intense level of viral evolution, vaccines find themselves in what Goodnow calls a “two steps forward three steps back dilemma.” And, like some other experts, he doesn’t think that state of affairs will end “until we devise a way to outwit the virus by developing a durable, variant-proof, transmission-blocking vaccine.”
Can it be done? “Nobody knows,” says Goodnow, even as many scientists have put their hopes on the development of a successful nasal spray vaccine.
But the Australian immunologist who once believed he “had a pretty good handle on COVID” now believes this: “We can’t just have this virus become something we get two or three times a year. It is not just acceptable” given “the social, personal and economic costs.”
For now, Goodnow has his own plan to avoid the dangers posed by cumulative reinfections: “I'm dropping my COVID hubris and donning a mask.”