Follow up

Previous: Can the captain of an airplane teach 5th grade? … catching Covid on a flight to Aruba

I wrote the following on 2/15/2021, added updates a week later:

I became seriously ill with Covid after dinner on January 22. Today, February 15, I’m pretty much restored. 

My oxygen levels are fine, pulse mostly back to normal. Sense of taste completely restored, and I think my sense of smell is back, though maybe not in every particular. I can’t tell.

Sidebar: with both the very mild Covid I had last March and the much more serious case I’m emerging from now, my sense of taste did not disappear altogether. Instead, it was distorted. Foods I like tasted spoiled or super-salty or faded or off in some other unpleasant way. Bacon, for instance. Bacon stopped tasting like bacon.

The good news: I have no POTS, no “post-exertional malaise,” definitely no brain fog (my worst fear). I do have minimal to moderate fatigue, depending on the day. Fatigue is my only remaining concern.

[update 2/23: Fatigue gone. Yay!]

So at the moment it looks like I’ll emerge from what was apparently a severe case of COVID pretty much unscathed. Completely unscathed, I hope. 

[update 2/23: Unscathed]

For the record, “severe” Covid, I’ve learned, means oxygen in the low 90s, not hospitalization necessarily. I had oxygen in the low 90s for three days but was never close to hospitalization. 

We need a new category for COVID infections: serious Covid. Asymptomatic, mild, moderate, serious (low-ish oxygen), severe (hospitalized), critical (ICU). That makes a lot more sense to me.  

The antibody cocktail

How much my good fortune has to do with the fact that I had an infusion of monoclonal antibodies, I don’t know. Suffice it to say that I’m a big fan of the antibody “cocktail.” My doctor told me I would feel better immediately, and I did. 

Most dramatically, after the infusion I had no more fever at all—this after I’d spent eight days in bed with a temperature of 102.

I should add that my fever was down on the morning of the infusion, but by that point I was waking up with a lowish temperature that would then rise throughout the day. After the infusion, my temperature returned to normal and stayed there.

One anomaly: it was only after the antibody infusion that my oxygen fell to the low 90s. I don’t see why monoclonal antibodies would reduce oxygen saturation given that they apparently work in patients on low-flow oxygen, and I don’t think the antibodies caused the drop. 

But since it happened in that chronological order, I’m mentioning it.

Reinfection?

The distressing aspect of my experience is that my second Covid infection was much worse than my first in March 2020. 

The only reason we set foot on an airplane in the first place was that we had read everything there was to read on the subject of second infections and, at the time we rebooked the flight, there had been, I think, just two publicized instances of a person suffering a worse case the second time around.  

One of those had occurred in a young man who became reinfected just two months after his first illness. Given that my own mild case of Covid dragged on for a full two months, I didn’t take that account seriously as a second infection. It sounded like a protracted first infection to me. 

Still, it’s possible there are more reinfections than we know. (2/25/2021: This was my experience, too: gastrointestinal symptoms the first time, loss of appetite and malaise the second.)

Whatever is or is not going on with repeat cases, we had read that while we could become reinfected, a second infection would be milder than the first.

The variants

The variants weren’t really a thing when we rebooked the flight, which brings me to the mask refusers on the plane. They were Israeli. Nationality seems important because at the time of the flight, the UK variant was responsible for up to 80% of Israeli cases. So we assume B.1.1.7 was likely responsible for my case, too.

I haven’t seen reports that B.1.1.7 causes reinfections in people who had the original sequence from Wuhan, but given that doctors are picking up reinfections with the South African variant, I wonder. 

Long story short: one theory as to why I became as sick as I did is that I was exposed to a variant that’s better at infecting cells, so more of my cells were infected this time than last. 

More infected cells = more sick.

Maybe.

Limited immunity after mild Covid?

Another theory: I may simply not have acquired much immunity after a mild case of Covid that had resolved a full eight months prior to my re-exposure. Ed’s doctor tells us that everything he’s read connects degree of illness to degree of immunity. 

That would explain Ed. Last spring, he had what I would call a moderate case of Covid. Since then he’s had chest constriction and coughing off and on. As the year went by, these episodes became fewer and farther between, and by the time we boarded our flight he hadn’t had chest constriction in two months.

He tested negative for Covid after we returned from Aruba, but the chest constriction was back.

2/23: Chest constriction gone.

He now thinks that he likely became infected with Covid this time, too, but by the time he was tested, the viral load was too low to measure.

(Oddly, my own PCR test came back negative. It was the rapid-antigen test that picked up the virus.) 

Whatever accounts for Ed’s brief recurrence of symptoms, he experienced what we thought would happen if we were exposed. Either we would fend off the virus altogether, or we would get infected again, but the infection would be mild. That happened with Ed, but didn’t happen with me.

Moderate case, better immunity? 

Complications from the shingles vaccine?

My physician has a theory that the intensity of my recent Covid case was fallout from the shingles vaccination I had just two weeks prior to being re-exposed to Covid. 

I believe it.

After my second Shingrix shot, on January 5, I was sick as a dog. I was so sick, in fact, that I missed the entire day of the Capitol Hill riots on January 7. When C. came into the bedroom and said someone had broken into Nancy Pelosi’s office and sat in her chair, I felt like I was hallucinating. 

My worst symptoms (high fever, chills, extreme fatigue) were identical to my shingles-shot symptoms. Having Covid this time was like getting a shingles shot first thing in the morning eight days in a row. 

High and protracted fever is an immune-system symptom.

My Covid symptoms per se were pretty minimal, apart from the reduced oxygen levels, obviously. I didn’t really have a cough; I had shortness of breath twice during the entire twelve days the acute phase lasted, and those episodes were subtle. I might not have noticed them if I hadn’t known I had Covid. 

Basically, my doctor thinks my immune system, hyper-charged by the shingles vaccine, came face to face with Covid and ran amok. 

She also said that the antibody infusion would calm my immune system, and it did.

So it’s possible that without the coincidence of my having been exposed to Covid on the heels of a severe reaction to a shingles vaccination, I would have had a mild second case, too. 

What’s going on with antibodies?

For months after the pandemic began, people we knew got antibody tests, hoping to learn they had developed immunity without being sick.

No one ever tested positive.

Later on, friends who knew for a fact they’d had extended exposure to Covid without becoming sick also tested negative.

Ed is in the same boat. A couple of weeks ago, he tested negative for antibodies—after having the same exposure on the plane that I did and spending a week in a hotel room with a contagious wife. That’s two exposures. He ended up with the mildest of mild symptoms—and yet he has no antibodies? 

How does that work?

There’s no question his immune system recognizes the virus. When he took the first Pfizer shot yesterday, he had all the side effects people normally experience after the second shot, which is what happens when people get the vaccine after having had the disease. For people who’ve already had Covid, the first shot is the second shot.

We both wonder whether the explanation for his symptoms has to do with B cells versus T cells.

B cells produce antibodies that kill the virus.

T cells kill your own infected cells, which kills the virus those cells are replicating.

B cells work before your cells are infected; T cells work after.

Ed thinks maybe he doesn’t have antibodies to Covid but does have T cells. That might result in exactly what he experienced: he would be infected, but the infection would be short and sweet because his T cells would rapidly kill his Covid-infected cells.

For anyone who’s wondered about antibodies versus T cells, Francois Balloux’s thread on B cells, T cells, and antibodies is terrific.

Postcript

Vaccine researcher Paul Offit:

Offit said he would be concerned if people who already had Covid-19 or who had been vaccinated were being hospitalized due to infections caused by a new variant.

“That line hasn’t been crossed,” he said. “You just want to keep people out of the hospital, and it looks like to date there’s not a variant that has escaped either disease- or vaccine-induced immunity.”

That sounds right to me.

I hope my case is an anomaly. But, if it isn’t, I come back to the fact that serious isn’t bad. I wasn’t hospitalized, I don’t have sequelae. (At least, I don’t have sequelae at this point. I don’t know whether people sometimes experience delayed effects.)

If we’re going to have reinfections that don’t kill us and don’t leave us with chronic disability, I can live with that.

I think we all can.

One thought on “Follow up

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