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If you’ve never had COVID, should you relax or worry?


If you’re among those people in the United States who never had COVID-19, how should you think about your risk?

According to the Centers for Disease Control and Prevention (CDC), more than half of people in the United States are in the never-got-COVID category.

The CDC estimated that by the end of January, 43.4% in the United States had developed antibodies to SARS-CoV-2 triggered by infection, not by vaccination — suggesting nearly 60% of people have never been infected.

Now mask mandates are lifting, and daily case and death numbers are plunging. According to the New York Times tracker, new cases are down 51% for the past 2 weeks, and deaths have fallen 30% in that period.

So as those who have so far escaped the virus venture further out into reopened environments, should they worry more or less about risk than their previously infected counterparts?

Some experts weigh in with caution against feeling invincible.

No “suit of armor”

William Schaffner, MD, an infectious disease expert at Vanderbilt University School of Medicine in Nashville, Tenn., said in an interview that science has not been able to determine why some people have been able to be stay COVID-free when the virus was raging and exposure was ubiquitous.

He said it’s important to remember that though some people think they have never had COVID, they may have been asymptomatic or attributed mild symptoms to something else.

“People may have conceivably — but we can’t define them yet — different capacities to ward off viruses or bacteria,” Dr. Schaffner said.

Could it be that some people have a better immune system or genetic component or environmental reason that they are less susceptible to infectious disease? “We can’t define that in 2022 medicine, but it could be,” he said.

More is known about why people with the same COVID exposure may have different levels of illness severity.

“They’re more likely to get seriously ill if they have a list of predisposing conditions — if they’re older, if they’re frail, if they have underlying illness or are obese. All of those things clearly impair the body’s response to virus,” Dr. Schaffner said.

He warns those who have never been infected, though, not to assume they have “a suit of armor.”

All should continue to follow guidance on getting vaccinated, and those vaccinated should continue to get boosted, Dr. Schaffner said.

“Clearly, the data show that if you are vaccinated and boosted, you’re protected much more securely against severe disease,” he said.

If the never-COVIDs develop a respiratory infection, they should still get tested for COVID, Dr. Schaffner said.

He said while both vaccines and previous natural infection offer protection, the duration of that protection is not yet known.

“We have to stay tuned,” Dr. Schaffner said. “There may be a recommendation in the future to get a booster annually or something like that. We need to be open to those down the road.”

Amesh Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security in Baltimore, says it’s unclear why some people have been able to avoid COVID.

“The explanation is likely multifactorial and involves behaviors as well as possible idiosyncrasies with their immune systems that are genetically based,” he said. “It also may be the case that inapparent infections occurred and went undiagnosed.”

Dr. Adalja agrees, though, that this isn’t the time to get overconfident with risk-taking where COVID is concerned.

“People who have not knowingly been infected with COVID should be vaccinated, and after that, be assured that they are protected against serious disease from this virus,” he said.


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