How does re-infection affect long-term COVID?  Here’s what we know so far.

How does re-infection affect long-term COVID? Here’s what we know so far.

How does re-infection affect long-term COVID? Here’s what we know so far.

How does re-infection affect long-term COVID?  Here’s what we know so far.

“There are some patients that we follow for a year or a year and a half who haven’t recovered. And that’s where we need more research on therapeutic options for them,” said Dr. Luis Ostrosky, chief of infectious diseases at UTHealth Houston and Memorial Hermann Hospital. (Getty Images)

Experts urge caution as Americans gather indoors in late fall and winter due to COVID-19 cases already on the rise on the eve of Thanksgiving.

Now that most people in the US have been infected with COVID-19 at least once, perhaps a little complacency sets in; but even if a new round of SARS-CoV-2 infections starts to feel old, experts warn that the possibility of prolonged COVID is still a threat 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 long-term COVID, nor any agreed-upon method for defining and diagnosing it.

Centers for Disease Control and Prevention reported in June that nearly 1 in 5 Americans who had COVID-19 still have symptoms of prolonged COVID, which the CDC defines as symptoms that last more than three months after infection and were not present earlier. Long-term symptoms of COVID vary – from respiratory and cardiac symptoms, to neurological symptoms, to general ailments such as fatigue or muscle aches – and says the CDC that while long-term COVID is more common in people who have suffered a severe bout of COVID-19, even people who have had mild or asymptomatic cases can suffer from a “post-COVID condition.”

dr. Luis Ostrosky-Zeichner, chief of infectious diseases at UTHealth Houston and Memorial Hermann Hospital, said there are three types of patients he sees in the hospital’s long-term COVID-19 clinic: people with long-term damage from a severe case of COVID-19; persons with underlying diseases aggravated 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-term COVID patients recover on their own within four to six months.

“But there are some patients we follow 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 happens if you have had COVID for a long time and get infected with COVID-19 again?

For those who have been battling COVID for a long time, Ostrosky said the new infection can be a big blow.

“It’s pretty devastating,” Ostrosky said of some patients he’s seen with long-term COVID who have become reinfected with SARS-CoV-2. “Maybe they’ve made a lot of progress with this four-to-six-month recovery process, and then it’s a big step back for them. Very demoralizing, very disheartening for them when this happens.”

More research is needed on how re-infection affects those with long-standing COVID, but self-reported cases may provide some insight. In a recent online survey conducted in the United Kingdom80% of those who said they still had long-term symptoms of COVID reported that a second case of COVID-19 made their symptoms worse.

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

“It’s a pretty wide range of experiences in terms of the severity of a second bout of prolonged COVID,” Dr. Jessica Justman, an associate professor of epidemiology at Columbia University, who was not involved in the research, told Yahoo News. “The bottom line was: if you have or have had long-term COVID, getting infected again could make you feel like your long-term COVID has gotten worse or has come back. So that’s all the more reason to get vaccinated and take steps to reduce your exposure.”

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

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

A recent study using data from the Department of Veterans Affairs’ National Health Care Database found that re-infection increases the risk of long-term COVID as well as other adverse health outcomes. (Getty Images)

CDC says that the symptoms of re-infection are likely to be less severe than the first infection, but that “some people may experience more severe COVID-19 during re-infection”, and that the selection of circulating variants may mean that the individual may not have sufficient immunity from a previous infection, which is usually case.

So even if you didn’t get over long COVID the first time, it’s still possible to develop long COVID if you re-infect yourself with the virus.

“Past performance does not predict future performance. You may have had a really mild case before, but you have no certainty if the next case is going to be just as mild or if it’s going to be more severe,” Ostrosky said.

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

AND study published last week using data from the Department of Veterans Affairs National Health Care Database found that re-infection increased the risk of long-term COVID as well as other adverse health outcomes, including twice the risk of death and three times the risk of hospitalization compared to those who were not reinfected.

“Unequivocally, our research showed that getting infected 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 that, meaning the long phase of COVID,” senior author Ziyad Al-Aly it is stated in the press release.

The study found that re-infection increased the risk of long-term COVID regardless of whether participants were unvaccinated, vaccinated or vaccinated. Overall, however, the impact of vaccination status on long-term outcomes of COVID remains unclear. More 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 says the CDC that people who have not been vaccinated may be at greater risk of developing a “post-COVID condition” than those who have been 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 think ‘I’m not going to die from COVID, it’s okay to get multiple infections,’ this should really be an eye-opening study to show that there’s still a lot to learn about the long-term consequences of multiple episodes of this infection.” , Ostrosky said.

Justman noted that while the study provides additional reasons for extra care and vaccination follow-up, the retrospective nature of the study means some outcomes may have been missed. Because participant data were collected retrospectively rather than being followed in real time, the study may have missed some participants who were reinfected with SARS-CoV-2 but were asymptomatic, or who tested positive for a mild case and did not seek treatment. If such cases were properly counted, Justman said, it could reduce the risks posed by reinfection.

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

What’s next?

"It's still important to take advantage of any vaccines that can help, eg flu shot, COVID boosters.  And if you're indoors with a lot of people, think carefully about your exposure to COVID and try to see if you can wear a mask if at all possible," dr.  Jessica Justman, associate professor of epidemiology at Columbia University, said.  (Getty Images)

“It’s still important to get any vaccines that can help, like the flu shot, the COVID-19 boosters. And if you’re indoors with a lot of people, think carefully about your exposure to COVID and try to see if you can carry mask if at all possible,” said Dr. Jessica Justman, associate professor of epidemiology at Columbia University. (Getty Images)

Although information about long-term COVID and reinfection — and long-term COVID in general — is limited, there are a number of studies underway that may soon offer some answers. The National Institute of Health is working on a study of the so-called COVID Research to Promote 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 Postviral Phase (COVID-UPP),” on patients who continue to have symptoms more than three months after infection.

“There’s going to be a lot of information coming out, so it’s kind of a ‘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 is repeating over and over — that the public may not seem to want to hear anymore. It is still important to take advantage of all the vaccines that can help you [yourself] of, i.e. flu vaccine, COVID booster. And if you’re indoors with a lot of people, think carefully about your exposure to COVID and try to see if you can wear a mask if at all possible.”

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