America’s tidal wave of Omicron infections seems to have crested, but it’s still in a bad place. Even as coronavirus cases are beginning to tick down nationwide, so many Americans have tested positive for COVID since Christmas Day that they account for a quarter of all cases recorded in the United States. Thanks to the immunity America has—through shots and prior infections—most of these people came out of it largely unscathed. And they got an immunity bump too: We’ve long known that an infection with the coronavirus spurs the body to churn out more antibodies.
While public-health officials are still urging all Americans to be cautious with so much of the virus around, guidance for people who have already recovered from COVID this winter is sorely lacking. That has left Omicron survivors to deal with a confusing question: What now? I reached out to a handful of epidemiologists, and they all agreed that getting Omicron isn’t a golden ticket to normalcy. However, the immune boost from an Omicron infection can still be paired with other precautions to safely go about many activities. Keeping a few pandemic principles in mind can help make everyday decisions a little less fraught.
In an ideal world, Omicron survivors wouldn’t have to worry about getting COVID ever again. But because Omicron is still so new, it’s too early to know how well, and how long, immunity from infection will hold up against another bout with the virus, or what scientists call “reinfection.” Prior to Omicron, research suggested that immunity could begin to wane just three months after infection, though it has varied tremendously from person to person. COVID reinfections do occur: People who came down with the virus months ago, before Omicron had even been identified, don’t seem to have strong protection against this variant. (Virtually no one knows which variant they had, but if you got COVID sometime in the past month, it was very likely Omicron.)
Before letting their guard down, Americans who have had Omicron but aren’t yet fully vaccinated should get their shots. This is important not only because it protects you, but also because it builds up our collective immunity, protecting others in the process. Opinions vary, however, on the best time to get vaccinated after infection. Wafaa El-Sadr, an epidemiologist at Columbia University, told me in an email that once a person is recovered from Omicron, they must “get vaccinated and [a] booster dose as soon as eligible.” Others suggest waiting to optimize the immune response. Sten Vermund, an infectious-disease epidemiologist at Yale, told me that getting vaccinated three to six months after infection “might be very reasonable because that may be the time that the immune system could use a boost.”
Because people who were fully vaccinated before falling sick with Omicron already have a good level of protection against severe illness, they have more flexibility in what sorts of behaviors they can safely engage in. Though an Omicron infection does lead to an immunity boost, the additional layer of protection provided by an actual booster shot can only help. “The level of COVID that we have out in the community is a level we have not seen anything like in this entire pandemic, so your best level of protection is still to get a booster,” Jodie Guest, an epidemiologist at Emory University, told me. By this logic, people who had two doses of an mRNA vaccine and a booster before getting infected have the best protection of all. “You’ve presented the immune system [with] the spike protein on four different occasions, so that’s likely to generate a very substantial immune response,” Vermund said.
Even for those with this quadruple-forged shield, resuming pre-pandemic activities in a world where transmission is still rampant can seem like a bad idea. Roughly 700,000 Americans are testing positive for COVID every day, almost three times the rate during last winter’s peak. Many Americans are returning to their pre-pandemic lives. Even so, I’m the type of person who passes a crowded restaurant and can think only of the plumes of Omicron particles that might be spewed and swallowed by all those open mouths. I want to invite my vaccinated and boosted friends over, but it makes me nervous that many of them regularly go out unmasked. The epidemiologists I talked with agreed that some basic cautions are still in order. El-Sadr recommended that everyone wear a mask indoors in public settings “across the board, for now.” This is a necessary precaution because we “don’t know the level of reinfection that may occur, and with so much Omicron everywhere, it’s just the right thing,” Guest said. (And wearing a high-quality mask, such as an N95 or a KN95, is important—cloth masks don’t cut it anymore.)
But the epidemiologists largely shared more relaxed views than I had anticipated. “As a person who’s vaccinated and boosted, and does not buy into the idea that everyone has to get Omicron, I am comfortable having an indoor meal at my home with a few friends who I know are also vaccinated and boosted,” Guest said. Going out to restaurants and bars requires more forethought because there’s no guarantee that others there will be vaccinated and boosted. If you really must dine indoors, the best option is to pick a restaurant with separated seating, good ventilation, and servers who wear masks. And wear a mask when walking through the restaurant and when the server comes to see you, Guest said.
Making it through an Omicron infection doesn’t change the simple calculus around what sort of activities are safer than others. Going to a movie where you’re sitting in silence is less of a risk than a crowded indoor concert with thousands of attendees. “We still have our same principles: Outdoors is safer than indoors; ventilation is better than a not-ventilated space,” Guest told me. And the same precautions apply too: If you’re planning on attending a gathering, it’s a good idea to rapid-test yourself right before going, she said, especially if you’ll be coming into contact with someone who is immunocompromised and is more likely to get seriously sick from COVID.
The bottom line is the same as it’s always been—vaccines are really good at doing what they were designed to do, which is prevent severe illness. If you’re vaccinated and boosted, and you’ve been infected on top of that, your chances of having a serious reinfection are not high. This group, Vermund said, “can live a life free of undue fear of Omicron.”
But there isn’t a one-size-fits-all approach to post-Omicron behaviors. People take different factors into account when calculating risk, and naturally some are more comfortable with risk than others. For example, a 65-year-old who cares for an elderly parent should be more cautious than a healthy 25-year-old who lives alone. For now, while cases are still so high, we have few direct instructions—only guiding principles. A good rule of thumb for survivors is to acknowledge that going out in public increases your risk of reinfection, and take steps to minimize it. We still don’t know how likely reinfection is after Omicron. Take extra care if you’ll come into contact with people who are more vulnerable to illness than you. Know that the risk of reinfection is lower in places that permit only vaccinated people. And remember: Masking is effective and really easy to do.
Most of all, try to not be fatalistic about Omicron by assuming that it will infect everyone. Preventing infection—and reinfection—is possible and well worth the effort. A mild or asymptomatic infection could spread to a more vulnerable person who might have it much worse. And every person who gets infected, Guest said, “is a place the virus can mutate.” Again, if you haven’t knowingly gotten COVID during the Omicron wave, it’s a good idea to remain cautious until cases subside.
If the Omicron numbers continue to trend in the right direction in the coming weeks, negotiating what’s safe to do will gradually become easier—not just for the tens of millions of survivors, but for everyone. Hopefully, this will be the last time we’ll have to make these types of tough decisions. Omicron infected such a huge swath of people—many without them even knowing it—that it may have pushed us closer to the end of COVID’s crisis mode, Vermund told me. Next winter, we could “conceivably have coronavirus more at the endemic rates of other respiratory viruses,” he said, “and that is a hope that can be made a reality if we can coax all Americans to get vaccinated and boosted.”