"By this point in the Covid-19 pandemic, most people have had at least one brush with the virus. Those of us who have been infected again (and again) may think we know the drill.
"But symptoms can vary from one infection to the next. The virus has felt like an entirely different illness each time I’ve tested positive: The first go-round, a fever flattened me. Once, I had barely any symptoms. The worst infection left me wrung-out on my couch, so exhausted I had to strain to pay attention to a podcast.
“No two Covid infections really have behaved the same,” said Dr. Joseph Khabbaza, a pulmonary and critical care doctor at Cleveland Clinic.
"Generally speaking, the more immunity people build up from vaccination or infections, the milder symptoms of subsequent infections tend to be. But for an individual, there is no guarantee that a second infection will be less severe than the first.
"That’s partly because the virus has changed, developing into new variants. If you’re reinfected, that means the virus has evolved enough to slip past your immune defenses, said Dr. Davey Smith, an infectious disease specialist at the University of California, San Diego.
"Many Covid symptoms have stayed the same since 2020: fever, sore throat, coughing. But some have shifted. It used to be common for people to lose their sense of taste and smell when they got sick, for example, but that now seems to happen less frequently. Early in the pandemic, Dr. Khabbaza said, people would tell him that their Covid infections felt like nothing they had experienced before. Now, he said, patients often think they have a cold, and are shocked when they test positive.
"Dr. Smith said he has often seen patients who experienced the same symptoms as they had during past infections but in a different order. “Sometimes it starts off with a cough, and sometimes it ends with a cough,” he said.
"And an encounter with the virus changes you, too, Dr. Smith said: After a Covid infection you have new immune responses that shape how you would respond to another one. That may be why he often sees patients who had no symptoms at all the first time they were infected, but then feel sick the next time. People’s symptoms can also vary in intensity depending on how recently they were last vaccinated or infected.
"Other changes — like developing new medical conditions or aging — can affect how sick you get. Even small variations in your microbiome health can alter how you respond to an infection, said Dr. Ziyad Al-Aly, the chief of research and education service at the Veterans Affairs St. Louis Health Care System.
"The more times you encounter Covid, the faster you might feel sick after an exposure, said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco. Your immune system rapidly recognizes the virus and marshals its defenses. This can trigger symptoms before enough virus has built up to produce a positive result on a rapid test.
"No matter how many times someone has been infected, symptoms can persist even after that person tests negative. And any Covid infection carries the risk of leading to long Covid.
“A lot of people think that if they got Covid once, they’re immune, they’re protected for the rest of their lives,” Dr. Al-Aly said. “That’s really not true.”
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