If there is a long-term risk of COVID-19, it is worth avoiding secondary infections

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December 19, 2022 – Alexander Truong, MD, has been treating long-term COVID patients for more than 2 years, but thought the number had dropped significantly by now. Instead, a steady stream of patients is still turning up at the Emory Executive Park post-COVID clinic that he and a colleague launched in Atlanta in the fall of 2020. And in patients infected more than once, symptoms appear to be worse.

“We are definitely seeing a lot of patients having worse post-COVID problems after reinfection. That’s very true, and I think that’s a big signal,” said Truong, a pulmonologist and assistant professor at Emory University’s School of Medicine.

COVID-19 is definitely not over yet, says Angela Cheung, MD, PhD, senior scientist at the University Health Network and professor of medicine at the University of Toronto. And every time someone gets infected, they risk developing a long COVID. Previous infection doesn’t eliminate the risk, says Cheung.

“It’s not like, ‘Oh, I had one, so it’s fine. Now I can take my mask off and do whatever I please.” There are health implications for reinfection — higher mortality rate, higher hospitalization rates, higher risk of long-term, persistent symptoms,” she says.

New research suggests that those infected more than once have an increased risk of developing long-term COVID and other health problems than those infected only once. But analyzing the magnitude of those risks — particularly in newer variants — is more complicated, Truong and other experts say, especially when vaccinations and antiviral treatments are taken into account.

“It makes sense that repeated infections would not be beneficial to a person’s health. But I think it’s really hard to estimate what the added risk of each additional infection would be because there are many other things,” said Michael Peluso, MD, assistant professor of medicine and physician of infectious diseases at the University of California San Francisco.

“There are vaccines – new vaccines, old vaccines. There are variants – old variants, new variants and now several variants that are in circulation at the same time.”

Veterans Affairs Study

A big study with the records of 5.8 million Department of Veterans Affairs patients published in naturopathy in November found that patients who were infected more than once were at significantly higher risk of death, hospitalization, heart problems, blood clotting, long COVID and a host of other health problems and organ damage. Above all, the study found that these increased risks persisted even 6 months after reinfection.

While the study highlights the increased risks associated with reinfection, it has its limitations. The study did not directly compare primary infection to reinfection within the same patient pool. Only a group of people with a single infection was compared to a separate group with more than one infection.

There could be other factors that make a group more susceptible to reinfection and a higher risk of adverse health effects. The study also did not compare reinfection risks between different variants or subvariants.

Another limitation is the VA population itself. The VA database is extremely useful for large studies like this one because it follows a large number of people with comprehensive medical records, experts say, but the VA’s population is mostly made up of older white males does not reflect the demographics of the general population.

Still, the message to the public is simple, says Cheung. “I wouldn’t get caught in the weeds. The big message and the big picture is that reinfections are bad.”

Different risks with new variants?

Experts say that understanding reinfection risks, particularly among the newer variants and subvariants, is complicated because more people are being vaccinated now than earlier in the pandemic.

“There are no clear answers. … It’s very, very difficult to separate the emergence of new variants from the uptake of vaccines,” says Peluso.

“It seems like the newer variants might have had less long COVID overall, but it’s very hard to say if that’s a feature of the virus or a feature of the fact that most people who get the virus either have been vaccinated or previously infected to have a different immune baseline than someone seeing the viral antigen for the first time.

However, there is a growing consensus that those who are vaccinated and end up with breakthrough infections have a lower risk of developing long COVID. A British study published in the journal Open forum infectious diseases for example, found in September that people who had received two COVID-19 vaccinations at least 2 weeks before infection were 41% less likely to have long COVID-19 vaccines compared to people who were unvaccinated at the time of infection. to develop symptoms.

“We also know that patients who have had their vaccinations are less likely to be reinfected, or if reinfected, are less likely to have a serious infection,” Truong says.

“That’s the one big signal we have and so I’m trying to wave the flag as much as possible to get vaccinated [and boosted].”

While some data suggest that the risks of long COVID are lower with Omicron variants than with the Delta variant, experts point out that a far larger number of people have been infected with Omicron, making even a small percentage of a large number is still a large number.

A study Looking at Omicron versus Delta shows about half the risk, but half the risk with a lot more people is still a lot of high absolute numbers,” says Cheung, referring to a June newspaper Published in The lancet.

She still sees many patients with long COVID – some were infected just last summer, some were vaccinated and infected for the first time, and others come after re-infections.

And while omicron variants and subvariant infections may seem milder to many people, doctors are noting that new patients are also emerging with the same debilitating symptoms as those who had long-COVID earlier in the pandemic: fatigue, shortness of breath, tachycardia, brain fog, trouble sleeping and mental problems.

“On my post-COVID clinic days, I still see four to eight new patients who had infections in 2022 who came in with significant symptoms,” Truong says.

And long COVID can kill. More than 3,500 death certificates filed since the pandemic began through June 2022 long list COVID as the specific cause of death Reports from the National Center for Health Statistics.

Minimizing post-COVID risks

Peluso says what can be learned from the VA study is that repeated attacks on the immune system are dangerous and that further avoidance of infection remains extremely important.

“The best way for someone to protect themselves from it is not to get COVID at all,” says Peluso. It’s a sentiment echoed by Truong and Cheung.

But with the transmissibility of the latest variants and subvariants and the lifting of public health measures, it’s often difficult to prevent infection. Proven tools work, however: keeping up to date on immunizations, wearing high-quality, well-fitting masks, promoting good ventilation, and self-testing with rapid antigen tests, especially before indoor events during busy holiday periods.

“It is possible that this will become less common over time. I hope that’s true,” says Peluso.

“It is also possible that it goes the other way. So I try to avoid all variants.”

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If there is a long-term risk of COVID-19, it is worth avoiding secondary infections
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