December 19, 2022 – Alexander Truong, MD, has been seeing long-term COVID patients for over 2 years, but believes that number has decreased significantly by now. Instead, the post-COVID clinic at Emory Executive Park in Atlanta, which he and a colleague opened in the fall of 2020, is still seeing a steady stream of patients. Symptoms appeared to be more severe in patients with more than one infection.
“We do see a lot of patients with worsening post-COVID-19 problems after reinfection. That’s very true, and I think it’s a big sign,” said Dr. Truong said.
COVID-19 is definitely not over, says Angela Cheung, MD, PhD, senior physician-scientist at University Health Network and professor of medicine at the University of Toronto. Whenever someone is infected, they are at risk of developing long-term COVID. Prior infection doesn’t eliminate that risk, Cheung said.
“It’s not like, ‘Oh, I had it once, so it’s okay. Now I can take off the mask and do what I like. It has health effects on reinfection — higher death rates, higher hospitalizations. rates, higher risk of long-term, lingering symptoms,” she said.
People who are infected more than once are at higher risk of developing long-term COVID and other health problems than those who are infected only once, new research suggests. But Truong and other experts say analyzing the extent of those risks — especially with newer variants — is more complicated, especially when vaccinations and antiviral treatments are considered.
“It makes sense that superinfection is bad for a person’s health. But I think it’s really hard to know what the additional risk is for each subsequent infection because there are all sorts of other factors mixed in,” said Dr. Dr. Michael Peluso, MD, of San Francisco, California.
“There are vaccines — new vaccines, old vaccines. There are variants — old variants, new variants, and now there are multiple variants circulating at the same time.”
Veterans Affairs Studies
a large study Records involving 5.8 million Veterans Affairs patients, published in natural medicine In November, it was found that patients with more than one infection were at significantly higher risk of death, hospitalization, heart disease, blood clotting, long-term COVID, and many other health problems and organ damage. especially, Research These elevated risks were found to persist even 6 months after reinfection.
While the study highlights the increased risk associated with reinfection, it has limitations. The study did not directly compare primary infection and reinfection in the same patient population. It only compared a group of individuals infected once with a group of individuals infected with more than one species.
There may be other factors that make a group of people more susceptible to reinfection and at greater risk of adverse health outcomes. The study also did not compare the risk of reinfection between different variants or subvariants.
Another limitation is the VA population itself. The VA database is useful for large studies like this one because it tracks a large number of people with comprehensive medical records, but the VA’s population is mostly older white men and doesn’t reflect the demographics of the general population, experts say.
Still, the message to the public is straightforward, Cheung said. “I’m not going into the weeds. The important message and the big picture is that reinfection is bad.”
Different risks of new variants?
Experts say understanding the risk of reinfection, especially of new variants and subvariants, is complicated because more people are now vaccinated than they were earlier in the pandemic.
“There aren’t any definitive answers. … It’s hard to separate the emergence of new variants from the use of the vaccine,” Peluso said.
“Overall, the new variant of COVID does seem to be shorter in duration, but it’s hard to say if that’s characteristic of the virus, or whether most people who get it are vaccinated or have previously been infected with people who first saw the virus. Antigens have somewhat different immune baselines.”
However, there is a growing consensus that those who are vaccinated and eventually develop a breakthrough infection are at lower risk of developing long-term COVID. a british study published in a magazine Open Forum Infectious Diseases For example, in September it was found that people who had been vaccinated against COVID-19 twice at least 2 weeks before infection were 41% less likely to develop long-term COVID symptoms than those who were not vaccinated at the time of infection.
“We also know that in vaccinated patients, they are less likely to get reinfected, or when they get reinfected, they are less likely to develop a serious infection,” Truong said.
“It’s an important signal we’re sending, which is why I’m waving the flag about vaccinations as much as possible. [and boosted]”
While some data suggest that the Omicron variant has a lower long-term COVID risk compared to the Delta variant, experts point out that far more people are infected with Omicron, so even a small percentage of a large percentage of people is still a big numbers.
“a study Looking at Omicron versus Delta, it shows about half the risk, but half the risk for more people is still a lot of high absolute numbers,” Cheung said, referring to june paper published in Lancet.
She still sees a lot of patients with long-term COVID — some who just got infected last summer, some who were vaccinated and infected for the first time, and some who came after being reinfected.
While infection with the Omicron variant and subvariant may appear milder to many, doctors note that the new patients are also showing the same debilitating symptoms as those infected with long-term COVID earlier in the pandemic: fatigue, shortness of breath, rapid heartbeat , brain fog, sleep disturbances and mental health issues.
“In the days that I’m out of the COVID clinic, I’m still seeing four to eight new patients infected in 2022 with significant symptoms,” Truong said.
Prolonged COVID can kill. More than 3,500 death certificates filed between the start of the pandemic and June 2022 list long COVID as a specific cause of death, National Center for Health Statistics report.
Minimizing post-COVID risk
Peluso said that what is known from the VA study is that repeated attacks on the immune system are dangerous and that continuing to avoid infection is still very important.
“The best way to protect yourself from infection is to avoid getting COVID in the first place,” Peluso said. Truong and Cheung echoed the sentiment.
But given the transmissibility of the latest variants and subvariants and the lifting of public health measures, it is often difficult to prevent infection. However, tried-and-tested tools do work: Get timely vaccinations, wear good-quality, well-fitting masks, promote good ventilation, and test yourself with rapid antigen tests, especially during the lead-up to indoor activities during the busy holiday season.
“Over time, this may become less common. I hope that’s true,” Peluso said.
“It also has the potential to go the other way. So for that reason, I try to avoid all variants.”
