How does reinfection impact long COVID? Here’s what we know so far.

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“There are some patients we have followed for a year or a half and are not getting better. This is where we need more research on treatment options for them,” said Luis Ostrosky. UTHealth Houston and Memorial Hermann Hospital (Getty Images)

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

Now that most people in the US have been infected with COVID-19 at least once, some complacency may begin; But even as another round of SARS-CoV-2 infection is starting to feel like it’s getting old, experts warn that the possibility of prolonged COVID is a threat that Americans should be wary of, even if they’ve managed to avoid long-term COVID in the past. .

What is long COVID?

There is no single agreed-upon definition of COVID or any agreed-upon method for identifying and diagnosing it.

The Centers for Disease Control and Prevention reported in June that about 1 in 5 Americans with COVID-19 have prolonged COVID-19 symptoms, which the CDC defines as symptoms lasting more than three months after infection that was not previously present. Long-term COVID symptoms range from respiratory and cardiac symptoms to neurological symptoms to general ailments such as fatigue or muscle aches, and the CDC says prolonged COVID is more common in people, or even people, who have had a severe COVID-19 attack. Those who experience mild or asymptomatic cases may suffer from “post-COVID conditions”.

Chief of infectious diseases at UTHealth Houston and Memorial Hermann Hospital, Dr. Luis Ostrosky-Zeichner said there are three types of patients the hospital has seen in its long COVID clinic: people with permanent damage from a severe case of COVID-19; Persons with underlying diseases exacerbated by COVID-19; and “what we think of as ‘real’ long-term COVID patients, with multiple symptoms for which we can’t find an objective cause at this time.”

The good news is that most of the last category of long-term COVID patients recover on their own within four to six months, Ostrosky said.

“But there are some patients we’ve been following for a year and a half and they’re not getting better. “This is where we need more research into therapeutic options for them.”

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What if you already have a long-standing COVID and become infected with COVID-19 again?

Ostrosky said that for those who have been battling COVID for a long time, contracting another infection could be a huge blow.

“It’s pretty devastating,” Ostrosky said of some of the patients he saw with long-term COVID and reinfected with SARS-CoV-2. “They may have made a lot of progress during this four to six month recovery period, and it’s a huge setback for them. When that happens, it’s very demoralizing for them, very discouraging.”

More research is needed on how reinfection affects those who already have long-term COVID-19, but self-reported cases may offer some insight. In a recent UK online survey, 80% of those who still identified themselves as having long-standing COVID-19 symptoms reported that another case of COVID-19 had exacerbated their symptoms.

Of those in recovery or remission from prolonged COVID, approximately 60% of individuals re-infected; Of these people, 40% said their second long COVID episode was as severe as the first time, 32% said it was less severe, and 28% said it was more severe.

D., associate professor of epidemiology at Columbia University, who was not included in the survey. “This is a pretty broad spectrum of experience in terms of the severity of the second long COVID episode,” Jessica Justman told Yahoo News. The bottom line was this: If you have had or have had COVID for a long time, getting an infection again can make you feel like your long-standing COVID is worsening or returning. So that’s an additional reason to get vaccinated and take steps to minimize your exposure.”

If you haven’t had COVID for a long time, 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 services database found that reinfection increases the long-term risk of COVID and other adverse health outcomes. (Getty Images)

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

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

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

“Also, there’s a lot we don’t know about what kind of damage accumulates in repeated infections. So don’t let your guard down.”

A study published last week using data from the Department of Veterans Affairs’ national health services database found that re-infection increases the risk of long-term COVID as well as other adverse health outcomes, including a doubling the risk of death and a three-fold increase in the risk of hospitalization. compared to those who were not reinfected.

“Without uncertainty, our research has shown that second, third or fourth time infection contributes to additional health risks in the acute phase, that is, in the first 30 days and months after infection, that is, during the long COVID phase,” said the senior. writer Ziyad Al-Aly said in a press release.

The study found that re-infection increased the long-term risks of COVID-19, regardless of whether the participants were unvaccinated, vaccinated, or boosted. Overall, however, the impact of vaccination status on long-term COVID outcomes is still unclear. Another study by the same authors found that those who had 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 of developing “post”. -COVID status” more than those who are vaccinated. Other studies have shown that those who receive two doses of the COVID vaccine halve their risk of developing long-term COVID.

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

Justman noted that while the study provides additional reasons for taking extra care and staying up-to-date on vaccines, the retrospective nature of the study means some results may have been overlooked. Because data on participants was collected retrospectively rather than in real-time follow-up, the study may have missed some participants who were reinfected with SARS-CoV-2 but were asymptomatic or tested positive for a mild case and did not seek treatment. . Justman said that if such cases had been properly counted, this could have reduced the risks posed by reinfection.

“They saw [what’s known as] a dose-response relationship,” Justman said. “People with three COVID infections had a higher risk of these outcomes than people with two infections, and people with two infections had a higher risk than people with just one infection. And whenever you see this kind of dose-response relationship, it tells you that what you’re looking at may be real.”

What happens next?

"It is still important to take advantage of all the vaccines you can use, eg flu shot, COVID boosters.  If you are in a crowded indoor area, think very carefully about your exposure to COVID and see if you can wear a mask if possible." Associate professor of epidemiology at Columbia University, Dr.  Jessica Justman said.  (Getty Images)

“It’s still important to take advantage of all the vaccines you could possibly get, such as the flu shot, COVID boosters. If you’re in a crowded confined space, think very carefully about your exposure to COVID and see if it happens. Dr. Jessica Justman, associate professor of epidemiology at Columbia University, may wear a mask if possible. ” said. (Getty Images)

While information on long-term COVID and reinfection – and long-term COVID in general – is limited, a number of studies are underway that may soon offer some answers. The National Institutes of Health is working on a study called COVID Research to Improve Recovery (RECOVER) to learn more about the long-term effects of COVID-19. The CDC is also conducting a series of studies with partners, including Nova Southeastern University, for a project called “COVID-19: Understanding the Post-Viral Stage (COVID-UPP)” on patients whose symptoms have persisted 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 certainly a work in progress, but I think what we’ve learned so far will reinforce the same messages that everyone in the public health field is repeating over and over again – it sounds like the public doesn’t want to hear it anymore. It’s still important to get all the vaccines you can get. [yourself] eg flu vaccine, COVID boosters. If you’re in a crowded indoor area, think very carefully about your exposure to COVID and see if you can wear a mask if possible.”

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