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Getting COVID-19 today is much less scary and more common than it was three years ago. By now, many people have had it not just once, but two, three, or even more times. Most of the time, repeat infections aren’t as severe as they were the first time, leading to a sense of complacency about getting COVID-19 over and over.

But reinfections aren’t harmless. As cases continue to rise and more variants arrive on the scene, infectious-disease experts are warning that repeat infections could have cumulative, lasting effects.

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“There is some early evidence starting to show that if you had COVID-19, there can be all sorts of problems after getting infected” and reinfected, says Dr. Robert Murphy, professor of medicine and executive director of the Havey Institute for Global Health at Northwestern’s Feinberg School of Medicine. “We are just at the beginning of learning about them.”

A higher risk of Long COVID

Dr. Ziyad Al-Aly, assistant professor of medicine at Washington University School of Medicine in St. Louis and director of the clinical epidemiology center at the VA St. Louis Health Care System, studies Long COVID: a condition marked by health effects that linger after infection. “Reinfection remains consequential,” he says.

In a paper published in Nature Medicine in 2022, he found that people who had gotten COVID-19 at least twice experienced higher rates of short- and long-term health effects, including heart, lung, and brain issues, compared to those who were only infected once.

But why? Dr. Davey Smith, a virologist and head of infectious diseases at University of California San Diego, says that certain characteristics—such as older age—may make people more vulnerable to complications after repeat bouts. “The older you get, the worse you do with viruses in general, but specifically with SARS-CoV-2,” he says. “Every time you get COVID-19 again and again, you increase the likelihood of having a worse infection just based on age.”

Underlying health conditions that people may not necessarily be aware of—like prediabetes or increased inflammation—could also put them at higher risk after each infection. “For somebody who is already on the edge of developing diabetes and then gets COVID-19, that could damage the pancreas and the endocrine system enough to change things,” Smith says. Similarly, having high rates of inflammation before COVID-19 could raise the risk of heart events such as stroke or a heart attack after an infection.

Regardless of a person’s health status, each COVID-19 infection can raise the risk of developing blood clots, which can travel to the brain or lungs. That’s why Smith believes anyone who is eligible for antiviral drugs such as Paxlovid should take them, since controlling the virus as quickly as possible can reduce any potential long-term or lingering effects an infection can have on the body.

COVID-19 may alter the immune response

At this point, many people view COVID-19 as relatively benign. But even if you’ve already recovered from a mild case, there’s no guarantee that next time will go as smoothly. “Just because you did okay with it last year doesn’t mean you’ll do okay with it this year,” Smith says.

“There is a mischaracterization in the public understanding that you can get an acute infection with fever, cough, malaise, and fatigue, get over it after a few days or a week or so, then bounce back, and it’s gone,” says Al-Aly. “The data are showing that [some] people still display increased risk of problems even two years after an infection.”

That’s what he found in his study. People who had multiple infections were three times more likely to be hospitalized for their infection up to six months later than those who only got COVID-19 once, and were also more likely to have problems with clotting, gastrointestinal disorders, kidney, and mental-health symptoms. The risks appeared to increase the more infections people experienced.

Understanding why SARS-CoV-2 has a uniquely lasting effect on the body remains a challenge. Historically, when the immune system meets a new pathogen like a virus, it generates novel defenses and remembers the intruder, so it has a head start if the virus returns. That’s certainly the case with SARS-CoV-2—which is why vaccines work, and why getting reinfected generally leads to milder symptoms.

But there is also growing evidence that in some people, getting COVID-19 the first time may compromise the immune response in a way that makes the body less likely to respond effectively the next time it sees the virus. That could leave certain organs and body systems, such as the brain, weaker for months after infection—and subsequent ones. “It’s the balance of these two opposing forces—the immune system learning from the past and knowing how to deal with a virus and do a better job the second and third time around, and the idea that a first encounter with a virus might alter the immune system in some way that it becomes less efficient—that could explain why some people get Long COVID,” says Al-Aly.

Data also continue to show that even vaccinated people can get Long COVID—although the risk may be lower—since the protection provided by vaccines wanes over time, just as it does from infections. Vaccines are therefore a strong but not absolute barrier to the virus.

Preventing reinfections

“Each time you get hit, it does impact your body, so let’s try not to get it too many times,” says Smith. That’s easier said than done, since after three years, people are tired of taking precautions such as wearing masks and avoiding crowded public spaces. “We’ve lost the public-health battle; there is no appetite for public masking or stringent public health measures,” says Al-Aly.

That means other strategies need to become available, including universal vaccines that can protect against multiple variants and nasal spray vaccines that stand guard at the nose, which is where SARS-CoV-2 generally enters. Researchers are currently testing these next generation shots, so while “the good news is that these technologies do exist, they need to be accelerated and brought to market as soon as possible to protect the public,” says Al-Aly.

In the meantime, Smith says it’s important for people to understand that they still need to do everything they can to avoid getting COVID-19. That means staying up to date with vaccinations and taking some basic precautions, such as wearing high-quality masks indoors when cases are high, especially in crowded places and on public transportation.

“I wish we lived in a world where getting repeat infections doesn’t matter,” says Al-Aly, “but the reality is that‘s not the case.”

Is It Dangerous to Keep Getting COVID-19? Common as they are, reinfections may have lasting impacts.

Too many seniors are prescribed too many drugs. About four of every 10 older adults take five or more medications, triple the rate from two decades ago. Almost 11 million Americans, or two of every 10 seniors, are on 10 or more drugs.

As a career geriatrician, I’ve seen it firsthand: One of the best ways to improve your personal health is to work with your doctors to edit down your prescription list.

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Polypharmacy—when one patient takes multiple drugs—is responsible for a vast but underpublicized American tragedy. Medication overload will contribute to the premature deaths of 150,000 seniors over the next decade, one study found, while causing the hospitalization of 750 seniors per day.

It’s a sad but true reality of the medical business: Doctors often prescribe new drugs without knowing how they will interact with a patient’s existing medicine regime.

How this happens is no mystery. Our siloed medical system means seniors often see many different doctors who don’t talk to each other. It’s not uncommon for people to be riding a conveyor belt of specialists who prescribe different medicines for heart conditions, bone issues, diabetes, depression, insomnia, and cancer. It’s as if a senior is a collection of ailments instead of a living, breathing whole person.

Consider the example of an 85-year-old grandmother with mild memory problems. She lives alone with very few health issues. She may have elevated blood pressure at her checkup, so her doctor starts a drug called amlodipine, which can prevent heart attack and stroke, but has a side effect of causing swelling in the ankles.

That medicine brings down her blood pressure, but the ankle edema worries her doctor. He sends her to the cardiologist, who says her heart looks good, but she needs a water pill like furosemide to treat that swelling in her ankles.

The water pill makes her incontinent; she has to go to the bathroom all the time. So she sees a urologist who prescribes a medication to stop her bladder from contracting. That medication, oxybutynin, has a side effect of leaving her confused, and she starts acting a little delusional and accuses her son of stealing her money. This worries everybody. She goes to the hospital and is prescribed an antipsychotic.

In less than six months, she’s gone from no medications to four different drugs. She’s a mess. She never gets back home.

That all may sound a little hysterical, but drug cascading like this is happening every day in medicine across the nation.

Nobody in health care gets out of bed in the morning trying to harm this grandmother. But too often, that’s how our siloed medical system works: each doctor is paid to prescribe treatment through the lens of their medical specialty and only their medical specialty.

Our health care system fails to integrate all the different prescribers in a way that adds up to a safe plan for the patient. The one doctor who is expected to sort this all out is the overworked primary care physician. In a 20-minute office visit, the primary care doctor is expected to make sense of a medication list of 10 or 15 different drugs that were prescribed by four or five specialists. It’s like trying to solve a Rubik’s cube, while juggling and playing beat the clock on a merry-go-round.

So what should seniors and their loved ones do?

The No. 1 piece of advice is to schedule a doctor’s appointment to specifically consider the risk and benefits of every medication being taken, and how they may interact with one another.

It’s crucial to let your physician know in advance that this is the purpose of the visit. That way, the doctor can prepare and research. Don’t just slide in such an important topic when you’re on a routine follow-up or in for a different concern. The key point is that the doctor should know this appointment is about polypharmacy, identifying potential drug cascades, and de-prescribing.

Seniors may want their adult children to accompany them to help with both advocacy and understanding of this important matter.

One other key point: Do not attempt to pare down your drug list on your own. No one should decide to just taper off without consulting a medical professional. Eliminating drugs is a complex decision that can be just as risky as adding them.

Still, there’s little doubt de-prescribing is a worthy goal. The American Society of Health System Pharmacists recommends: “Do not prescribe medications for patients currently on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications.” The American Geriatrics Society similarly advises: “Do not prescribe a medication without conducting a drug regimen review.”

People on fewer medications can function better, think better, and feel better. Cutting down your drug list may require some patient advocacy and an extra appointment, but it’s worth it.

Are You Taking Too Many Medications? How to Trim Your Prescription List Polypharmacy—when one patient takes multiple drugs—can contribute to health issues, Dr. Nick Schneeman writes.

You get the dreaded text: the friend you just met for lunch tested positive for COVID-19. Now you’re left to wonder if you, too, will get sick in the coming days.

But when should you expect symptoms to start if you do get sick? The answer has changed from the earliest days of COVID-19, experts say.

“In the beginning of the pandemic, we were really looking at seven to 10 days as the window of time where people had to quarantine or isolate after an exposure,” says Andrew Pekosz, a virologist at Johns Hopkins University. “That has shortened significantly now.”

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How long does it take to develop COVID-19 symptoms?

An incubation period is the length of time it takes someone to develop symptoms after exposure to a pathogen. The incubation period for SARS-CoV-2, the virus that causes COVID-19, has shortened considerably since the virus first began circulating, recent data suggest. Incubation periods averaged about five days when the Alpha variant was dominant, about 4.5 days when Beta and Delta were dominant, and about 3.4 days once Omicron took over, according to a 2022 research review.

Newer research from various countries, including Japan, France, and Singapore, also suggests Omicron strains have incubation periods of about three days, or even a little less.

The virus’ incubation period is likely shrinking for a few reasons, says Shane Crotty, chief scientific officer at the La Jolla Institute for Immunology. The virus has evolved over time, becoming faster and more adept at infecting humans, Crotty says. Nearly everyone has also now had at least one brush with COVID-19, whether through vaccination or illness. Each encounter leaves behind instructions for the immune system, helping it recognize the virus faster the next time it appears.

“You having symptoms is all about your immune system being activated,” Crotty explains. “The whole pre-symptomatic period is bad news because your immune system has not managed to pull the fire alarm yet.” A shorter incubation period means that your body is “recognizing the virus faster and pulling those sprinkler systems faster.”

When should I test for COVID-19 after an exposure, and when am I in the clear?

Federal health authorities, including the U.S. Centers for Disease Control and Prevention, recommend testing no sooner than five days after a COVID-19 exposure, unless you develop symptoms earlier. But since current variants seem to have incubation periods of around three days, Pekosz says it’s appropriate to test as soon as day three, again unless symptoms start earlier.

Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, says he starts to feel more confident he’s dodged an infection if he’s still feeling healthy three days after a potential exposure. But, “remember, incubation periods are statistical probabilities,” he says. “There’s always going to be outliers.” You could develop a sore throat or runny nose only a couple days after exposure to the virus, or you might not feel sick until day five—or, if you’re lucky, you may not get infected at all.

The timing of symptom onset depends on lots of factors, including the amount of virus to which someone was exposed, Hotez says. Their level of pre-existing immunity may also affect the likelihood or timing of getting sick, Crotty adds.

Given all this variation, Pekosz recommends monitoring your health for up to a week after an exposure and wearing a mask around other people during that time. Remember, too, that false negatives are possible on at-home tests. If you get a negative result, the U.S. Food and Drug Administration recommends taking at least one more test 48 hours later to confirm it.

What is the incubation period of JN.1?

It’s too soon to know exactly, but Hotez says JN.1 is likely to have an incubation period similar to that of other Omicron strains. One 2023 study found that while incubation periods have gotten shorter over time, the various Omicron subvariants’ have all been similar to one another.

In general, Crotty says, there’s a limit to how low incubation periods can go. The SARS-CoV-2 virus works by invading human cells and using them to make numerous copies of itself. SARS-CoV-2 has a long genome that takes a while to copy, so Crotty doubts its incubation period will get much shorter than it already has. Viruses like measles and varicella (which causes chickenpox) on average take longer than a week to incubate, so, by comparison, a three-day incubation period is already pretty fast.

I Was Exposed to COVID-19. How Long Will It Take for Symptoms to Start? Here’s how long it typically takes for symptoms to start.

Hundreds of thousands of cans of Nutramigen Hypoallergenic Infant Formula Powder, a specialty powdered baby formula used by infants with allergies to cow’s milk, have been recalled in the U.S. due to a potential bacterial contamination. 

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“No illnesses have been reported to date in connection with this recall, and it is likely most of the product that was distributed in the U.S. has already been consumed,” the FDA said in a statement on Dec. 31st. 

The recall, the second from manufacturer Reckitt/Mead Johnson Nutrition in less than a year, comes two years after a major formula shortage sent parents scrambling to keep infants fed and raised questions about oversight in the formula industry. 

Why was Nutramigen recalled?

On Dec. 29, Reckitt/Mead Johnson Nutrition announced a voluntary recall of  675,030 cans of Nutramigen powdered formula, after the Israeli Ministry of Health notified the FDA that batches of the formula exported from the U.S., had initially tested positive for Cronobacter species, bacteria that can be found in dry goods, during routine sampling. The bacteria can cause an infection known as cronobacter sakazakii, which can cause seizures and inflammation of the brain and spinal cord, among other things.

“Cronobacter can have fatal consequences for a newborn as their immune systems are very immature,” says Ann Kellams, a University of Virginia faculty pediatrician. 

Kellams says that though it’s too early to tell if this will lead to another shortage, it seems unlikely. “There are some other companies that also make these hydrolyzed formulas,” she says, “We wouldn’t anticipate that this would spread to the other companies and makers of those products, because it’s specific to a specific brand and factory.”

The FDA claims there is no reason to worry. “The FDA does not expect that this recall will have a major impact on the U.S. supply and availability of powdered infant formulas, and the agency has been in communication with other manufacturers to request their assistance in ensuring a robust supply of hypoallergenic product,” the administration said in a statement. 

What has caused previous disruptions in baby formula supply? 

Kellams says that the complex process of creating formula—which involves collecting cows milk and processing it to resemble human’s milk— can lead to missteps. “There’s a lot of processing and handling steps, and each one of those steps has an opportunity to have contamination or a problem,” says Kellams, who adds that staffing shortages means that mistakes might not always get caught. “I think combined with the pandemic—which significantly contributed to staffing shortages and workforce issues like oversight issues— you can just imagine how that might invite errors along the process.”

For parents, the good news is that the Nutramigen recall is not nearly as big as the 2022 shortage— one of the largest baby formula shortages the U.S. had seen in decades. The shortage was mostly caused by supply chain strains created during the pandemic and was exacerbated by panic buying by parents and the shutdown of a major factory in Michigan due to concerns of Cronobacter contamination. (The manufacturer has since said that the FDA and CDC “did not find any definitive link between the company’s products and illnesses in children.”) 

In the aftermath of the 2022 shortage, the FDA says that it has taken numerous steps to enhance the safety of formulas— through the development of a Cronobacter prevention strategy, enhanced inspections, and regulatory actions and has called for those involved in the manufacturing and distribution of powdered infant formula to share safety information. 

What’s Causing the Latest Baby Formula Recall Hundreds of thousands of cans of Nutramigen Hypoallergenic Infant Formula Powder have been recalled.

Pure, natural spring water, just as nature intended. Well, not exactly.

Bottled water has long been marketed as a safer alternative to what comes out of the tap—if it doesn’t come straight from a mountain spring, it’s at least purified and chemical free. But a new study by scientists at Columbia University and Rutgers University demonstrates that bottled water may be far worse when it comes to microscopic plastic pollutants capable of passing into the bloodstream.

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For years scientists have raised the alarm over the global spread of microplastics, which form when plastics break down into increasingly smaller fragments. The particles, which range in size from five millimeters (1/4 of an inch) down to 1 micrometer (1 millionth of a meter, or 1/25,000th of an inch) have been found at the top of Mount Everest and at the bottom of the deepest ocean trenches, with unknown impacts on human and ecosystem health. Previous studies have found that a liter of bottled water can contain tens of thousands of identifiable (at least through a microscope) plastic particles. But those studies stopped at the 1 micrometer threshold, largely because of technological limitations.

This week’s study, published Jan. 8 in the journal Proceedings of the National Academy of Sciences, uses a newly developed laser technology to find even smaller fragments, upping the number of plastic particles in bottled water by a factor of 10, and in some cases, more than a 100. Using this new technology, which was invented by Columbia biophysicist and study coauthor Wei Min, the authors detected an average 240,000 plastic fragments per liter of bottled water.

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Approximately 90% of the particles were considered nanoplastics, which, as the name implies, are smaller than 1 micrometer. Unlike microplastics, nanoplastics are capable of passing through the intestine and lungs into the bloodstream. From there they can lodge in the heart muscle and other organs, pass the blood-brain barrier into the brain, and even into the bodies of unborn infants by crossing the placenta.  

Not surprisingly, one of the most common nanoplastic types in the three popular brands of bottled water tested (the scientists did not name the brands) was polyethylene terephthalate, or PET, which is the plastic most commonly used in the bottled drinks industry. Most likely the minute particles abrade into the water when the bottle is squeezed, or when the top is repeatedly screwed on or off. Another common plastic type found in the bottled water samples was nylon. Study co-author Beizhan Yan, a geochemistry research professor at Columbia’s Lamont-Doherty Earth Observatory (LDEO), suggests that such particles may in fact come from filters designed to purify the water.

Read More: There’s Almost No Research on the Health Impact of Plastic Chemicals in the Global South

So far, there is little research that shows what, exactly, nanoplastics do once they enter the bloodstream. But there is copious evidence that chemicals used in plastic production are deleterious for human health and mammalian reproduction. Even if the nanoplastics themselves are not harmful, they can serve as carriers for dangerous chemicals used in plastic production, such as bisphenols, phthalates, dioxins, organic contaminants, and heavy metals that are harmful in high doses, increasing the risk of cancer and impacting key organs such as the kidneys, the liver, the heart, reproduction and the nervous system. They can also accumulate through the food chain.

“There is a huge world of nanoplastics to be studied,” says Min. Even if nanoplastics make up 90% of the number of plastic particles found in bottled water, they make up far less in mass, he says. In this case that fact provides little comfort: “It’s not size that matters. It’s the numbers, because the smaller things are, the more easily they can get inside us.”

Microplastics in Bottled Water At Least 10 Times Worse Than Once Thought New research reveals that a liter of bottled water contains an average 240,000 microscopic plastic particles. The health impact is unclear.

The antiviral drug regimen Paxlovid can be lifesaving for people vulnerable to COVID-19’s worst effects, helping them avoid hospitalization or worse if they catch the virus.

But what about adults who are young and healthy? Is there any reason they should take Paxlovid if they catch COVID-19?

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Right now, there’s “no proven benefit” to doing so, and even some potential downsides, says Dr. Roy Gulick, chief of infectious diseases at Cornell University’s Weill Medical College. Here’s what to know.

Do low-risk people benefit at all from taking Paxlovid?

Paxlovid—a five-day course of two different pills—is approved by the U.S. Food and Drug Administration for adults at high risk of developing severe COVID-19, such as those who are elderly, immunocompromised, or have underlying health conditions. (It is also available under emergency-use authorization for adolescents with health conditions that make them susceptible to serious disease.) Paxlovid “absolutely works” for these patients, Gulick says, slashing their chances of being hospitalized or dying and potentially shortening the length of their infections.

But studies suggest that people without risk factors for severe COVID-19 are unlikely to benefit from taking Paxlovid. The serious COVID-19 complications it is designed to prevent—namely hospitalization and death—are already rare among people who are young and healthy, and research from manufacturer Pfizer suggests Paxlovid does little to eliminate routine symptoms among lower-risk people. Based on these findings, Pfizer stopped studying Paxlovid among “standard risk” patients in 2022.

For people who are unlikely to get very sick in the first place, “I don’t know that it adds a whole lot,” says Dr. Cameron Wolfe, an infectious-disease specialist at the Duke University School of Medicine.

Even in a 2023 study of Canadian adults who all had some risk factors for serious disease, such as age or health problems, the researchers found that Paxlovid’s benefits were strongest among “extremely vulnerable” individuals, and petered out among people who weren’t quite as susceptible to complications.

That said, deciding who is at high risk is not always simple, Wolfe says. Though he is hesitant to prescribe Paxlovid to someone without any risk factors for severe disease, he’s more willing to do so for people in the gray area—such as a person in their 50s with some health concerns, or someone who is young and healthy but nonetheless had a bad prior case of COVID-19. If you think you may benefit from Paxlovid, it’s best to speak with a physician about your specific case, he says.

Does Paxlovid prevent Long COVID?

Some research suggests that high-risk people who take Paxlovid shortly after catching COVID-19 are less likely to later develop Long COVID symptoms. But the same doesn’t seem to be true within the general population, according to a study published in January 2024.

In the new study, researchers compared a group of about 350 vaccinated people who had COVID-19 and took Paxlovid with a group of about 1,250 vaccinated people who didn’t take the antiviral when they were sick. About the same percentage of people in both groups went on to experience Long COVID symptoms: 16% of those who’d taken Paxlovid, and 14% of those who hadn’t.

Are there downsides to taking Paxlovid just to be safe?

About 20% of people who take Paxlovid later experience “rebound” positive tests, according to one recent study—although it’s possible to have a rebound after an untreated case of COVID-19, too.

Paxlovid also comes with side effects including gastrointestinal upset and a bad aftertaste. In addition, it interacts with some other medications, meaning patients may have to stop taking other drugs while they’re on it. “For people who need it, these [drawbacks] can be managed and the balance favors taking it,” Gulick says. “But for people who don’t need it, there are enough negative qualities of the drug that it should be a very carefully considered decision.”

Finally, the federal government stopped offering Paxlovid for free to everyone in the U.S. on Dec. 15, 2023, meaning some people now have to pay for Paxlovid. It remains free for people who are uninsured or on Medicaid or Medicare, and the government has also partnered with digital-health company eMed on a free test-to-treat program available to all adults.

Are other treatments available for people who are young and healthy?

There are other COVID-19 antivirals on the market, including the intravenous drug remdesivir and the pill molnupiravir. But, as with Paxlovid, they’re intended for people at increased risk of getting very sick, and Gulick says there’s no proof that they help people at lower risk. Molnupiravir is also less effective than Paxlovid, Gulick says, while remdesivir is a more invasive option since it must be delivered intravenously in a medical facility.

“There may be other drugs in the future that we might turn to,” Gulick says. But for now, people without specific risk factors for severe disease are best off staying home, resting as much as possible, and using over-the-counter medications to manage symptoms.

I’m Young and Healthy. Should I Take Paxlovid? Do lower-risk people stand to benefit at all from the COVID-19 treatment?