The Times has published the worst news we could hear on COVID-19 today: You can catch COVID multiple times. This is no longer an anecdote, but someone whose two COVID exposures were confirmed to have genetic differences. They caught it twice.

There's some positive news mixed in there, but this is a pretty depressing milestone, even if the writing had been (anecdotally) on the wall for a while.

And that's because there are only so many end-games with COVID-19. Here are a few...

1. It's chickenpox. It really wacks the heck out of you if you catch it late, but you catch it once and you're done. (This would be scary for older people now, just like exposure to chickenpox would be, but fantastic in the grand scheme. The world wasn't horrible pre-chickpox vaccine)
2. You get a substantively effective vaccine and practically everyone with access doesn't catch the disease.
3. You do enough preventative action and enough contact tracing that you behave such that we chase the thing down into the hole. And you do this over and over until the end of time. But it's a very slow burn to the point it doesn't affect us as a whole in any nightmarish way.
4. It's a nightmarish flu. We catch it to some degree every year. Mortality is up above where it was in 2019, and this will forever be a problem for humanity.

Akiko Iwasaki [an immunologist at Yale University who was not involved with the work but reviewed the report at The New York Times’s request, said] “It’s kind of a textbook example of how immunity should work.”

That's great, but it's clearly not chickenpox-style immunity. And, painfully, as the story continues, "People who do not have symptoms may still spread the virus to others". 

This makes it sound like, without a vaccine, we're headed towards #4, maybe with some lucky reduction of the "nightmarish" qualifier. Even the best #3 (preventative action and contact tracing) to date has, in practice, not stopped transmittal and huge flare-ups outside of a few outliers. You know, like islands with carefully controlled borders. Most of us don't live there.

Now, again, #4 might not be the flu of your nightmares like I was afraid COVID might become. If, as this story quotes Iwasaski saying, "natural infection created immunity that prevented disease but not reinfection", then maybe COVID-19 gets folded in as "just another flu" rather than something that kills 300,000 Americans alone each year -- that is, the current COVID death rate seems to be about 10x that of the flu. Maybe with this immunity it drops to a fifth to a tenth of that. Though remember that it's in addition to our flu numbers, which is disheartening to contemplate.

And let me add this quick edit: The flu is nightmarish enough. Over 10% of the population contracts it badly enough to notice annually. Half a million a year are routinely hospitalized. And nearly ten percent of those people die. The flu is not child's play. It's deadly serious. We don't need two of them. We don't need one.  

Still, if we all get this extra "preventative immunity" after our first scary-as-heck bout with COVID, perhaps the future, even without a vaccine, shouldn't be nearly as hellish as the world we live in now.

That said, though the smallpox infested blankets may not have been as evil in effect as their givers hoped they'd be in theory, smallpox and other European diseases were just as frightening for the Lakota, Cherokee, and other nations as you might now be able to appreciate. I'd like to say I can't imagine, but now, unfortunately, on some small level, we all can.

EDIT: Quick, only partially related update: Wearing a mask helps the wearer too.

This makes sense, right? I remember an answer from Fauci when he was asked if masks that weren't N-95 could help you, and he basically said, sure, the holes are big enough to let things through, but if you've got two big guys running towards the same door they're going to have a hard time getting through. Any protection is better than none, and if you're reducing the load in or out, well, that's a good thing. 

So here's one article from a random source saying just that.

The amount of virus that you’re exposed to – called the viral inoculum, or dose – has a lot to do with how sick you get. If the exposure dose is very high, the immune response can become overwhelmed. Between the virus taking over huge numbers of cells and the immune system’s drastic efforts to contain the infection, a lot of damage is done to the body and a person can become very sick.

...

Research shows that both cloth and surgical masks can block the majority of particles that could contain SARS-CoV-2. While no mask is perfect, the goal is not to block all of the viruses, but simply reduce the amount that you might inhale. Almost any mask will successfully block some amount.

Laboratory experiments have shown that good cloth masks and surgical masks could block at least 80% of viral particles from entering your nose and mouth.

...
In July, the CDC estimated that around 40% of people infected with SARS-CoV-2 are asymptomatic, and a number of other studies have confirmed this number.

And I think we had hints of this "larger viral load in means more severe sickness" from the earliest news we had on the virus. Remember when the most active doctors in China were dying? It's not because they were being careless. It's because a non-perfect level of protection times patient after new patient meant you had more viral load and more danger.

It's really important to limit not just your exposure to people in general but the time that you're being exposed and how much of your respiration is ingesting that exposure.

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