How does reinfection affect prolonged COVID? This is what we know so far.

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“There are some patients that we have been following for a year or a year and a half who have not recovered. And that’s where we need more research into therapeutic options for them,” said Dr. Luis Ostrosky, chief of infectious diseases at UTHealth Houston and Memorial Hermann Hospital (images false).

Experts urge caution as Americans flock indoors in the late fall and winter months, with COVID-19 cases already on the rise ahead of the Thanksgiving holiday.

Now that most people in the US have been infected at least once with COVID-19, some complacency may be setting in; But even if another round of SARS-CoV-2 infection may begin to look stale, experts warn that the possibility of long-term COVID remains a threat Americans need to be wary of, even if they have managed to avoid long-term COVID. in the past .

What is long COVID?

There is no single agreed definition of long-term COVID, nor any agreed method of defining and diagnosing it.

The Centers for Disease Control and Prevention reported in June that nearly 1 in 5 Americans who had COVID-19 still have symptoms of long-term COVID, which the CDC defines as symptoms that last more than three months after infection and that they were not present before. Long-term COVID symptoms range from respiratory and cardiac symptoms to neurological symptoms and general ailments like fatigue or muscle aches, and the CDC says that while long-term COVID symptoms are more common in people who have had a severe episode of COVID-19, 19, even people who experienced mild or asymptomatic cases can suffer from “post-COVID conditions”.

Dr. Luis Ostrosky-Zeichner, chief of infectious diseases at UTHealth Houston and Memorial Hermann Hospital, said there are three types of patients he sees at the hospital’s long-running COVID clinic: people with lingering damage from a severe case of COVID-19 ; people with underlying illnesses that were exacerbated by COVID-19; and “what we consider to be ‘true’ long-term COVID patients, who have multiple symptoms for which we currently cannot find an objective cause.”

Ostrosky said the good news is that most of the latter category of long-standing COVID patients get better on their own within four to six months.

“But there are some patients that we have been following for a year or a year and a half who have not recovered. And that’s where we need more research on therapeutic options for them,” he said.

What if you already have long-term COVID and you get COVID-19 again?

For those battling COVID for a long time, Ostrosky said getting another infection can be a big blow.

“It’s pretty devastating,” Ostrosky said of some patients he’s seen with long-term COVID who become reinfected with SARS-CoV-2. “They may have come a long way with this four to six month recovery process, and then it’s a huge setback for them. Very demoralizing, very discouraging for them when this happens.”

More research is still needed on how reinfection affects those already suffering from long-term COVID, but self-reported cases may provide some information. In a recent online survey conducted in the UK, 80% of those who described themselves as still having prolonged symptoms of COVID reported that another case of COVID-19 exacerbated their symptoms.

Of those who were in recovery or remission from long-term COVID, re-infection occurred in about 60% of people; of those people, 40% said the second episode of prolonged COVID was as severe as the first, 32% said it was less severe, and 28% said it was more severe.

“It’s a pretty wide range of experience in terms of the severity of the second episode of prolonged COVID,” Dr. Jessica Justman, an associate professor of epidemiology at Columbia University, who was not involved in the survey, told Yahoo News. “The bottom line was: if you have or have had long-term COVID, getting reinfected could make you feel like your long-term COVID has worsened or come back. So it’s an added reason to get vaccinated and take steps to minimize your exposure.”

If you haven’t had COVID for a long time before, how might a second (or third or fourth) COVID-19 infection affect your chances of developing it?

A COVID-19 test with two red bands, indicating an infection.

A recent study using data from the Department of Veterans Affairs National Health Care Database found that reinfection increased the risk of prolonged COVID as well as other adverse health outcomes. (fake images)

The CDC says that the symptoms of reinfection are likely to be less severe than those of the first infection, but that “some people may experience more severe COVID-19 during reinfection,” and that the variety of circulating variants may mean that a person may not have as much immunity from a previous infection as is often the case.

So even if you didn’t have long-term COVID the first time, it’s still possible to develop long-term COVID if you get infected with the virus again.

“Past performance does not predict future performance. You may have had a really mild case before, but you’re not at all sure if the next case will be as mild or more severe,” Ostrosky said.

“There is also a lot we don’t know about what kind of damage accumulates with repeated infections. So don’t let your guard down.”

A study published last week using data from the Department of Veterans Affairs’ National Health Care Database found that reinfection increased the risk of prolonged COVID as well as other adverse health outcomes, including a two-fold increased risk of death and a three times higher risk of hospitalization compared to those who were not reinfected.

“Unambiguously, our research showed that contracting an infection a second, third, or fourth time contributes to additional health risks in the acute phase, meaning the first 30 days after infection, and in the months after infection, meaning the long phase of COVID,” the senior said. author Ziyad Al-Aly said in a press release.

The study found that reinfection aggravated the risks of prolonged COVID, regardless of whether the participants were unvaccinated, vaccinated, or boosted. Overall, however, the impact of vaccination status on long-term COVID outcomes is still murky. Another study by the same authors found that those who received the COVID vaccine were only 15% less likely to develop long-term COVID than those who were not vaccinated, but the CDC says that people who are not vaccinated may be at higher risk. to develop “post”. -COVID conditions” than those who are vaccinated. Other studies have shown that those who received two doses of the COVID vaccine halved their risk of developing long-term COVID.

“For people who feel like ‘I’m not going to die from COVID, it’s okay to get multiple infections,’ this should be an eye-opening study that shows us that there is still a lot to learn about the long-term consequences. from multiple episodes of this infection,” Ostrosky said.

Justman noted that while the study provides additional reasons to be more careful and keep up with vaccinations, the retrospective nature of the study means some results may have been missed. Because the data on the participants was collected retroactively rather than tracking them in real time, the study might have missed some participants who were reinfected with SARS-CoV-2 but were asymptomatic, or who tested positive in one case. mild and did not seek treatment. . If such cases had been counted correctly, Justman said, that could have lessened the risks posed by reinfection.

“They did see [what’s known as] a dose-response relationship,” Justman said. “People who had three COVID infections were at higher risk of these outcomes than people who had two infections, and those with two infections were at higher risk than people who only had one. And every time you see that kind of dose-response relationship, it tells you that what you’re seeing could be real.”

What happens next?

“It’s still important to take advantage of all the vaccines you can possibly get, ie flu shot, COVID boosters. And if you’re indoors with a lot of people, think very carefully about your exposure to COVID and try to see if you can wear a mask if possible,” said Dr. Jessica Justman, an associate professor of epidemiology at Columbia University. (fake images)

While information on long-term COVID and reinfection, and long-term COVID in general, is limited, several studies are underway that may soon provide some answers. The National Institutes of Health is working on a study called COVID Research to Enhance Recovery (RECOVER) to learn more about the long-term effects of COVID-19. CDC is also conducting a number of studies with partners, including Nova Southeastern University for a project called “COVID-19: Understanding the Post-Viral Phase (COVID-UPP),” in patients who continue to have symptoms for more than three months. after infection.

“A lot of information is going to come out, so it’s kind of ‘Watch this space,’” Justman said. “It’s definitely a work in progress, but I think what we’ve learned so far would reinforce those same messages that everyone in public health keeps repeating over and over again, that it seems the public may not want to hear anymore. It is still important to take advantage of all the vaccinations you can possibly get. [yourself] of, ie flu shot, COVID boosters. And if you are indoors with a lot of people, think very carefully about your exposure to COVID and try to see if you can wear a mask if possible.”

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