Dec. 19, 2022 — Alexander Truong, MD, has been seeing lengthy COVID sufferers for greater than 2 years however thought the numbers would have considerably dwindled by now. As an alternative, a gradual circulation of sufferers nonetheless exhibits up on the Emory Govt Park post-COVID clinic he and a colleague launched in fall 2020 in Atlanta. And amongst sufferers contaminated greater than as soon as, the signs seem worse.
“We’re positively seeing quite a lot of sufferers who, after they get reinfected, have worsening post-COVID points. That’s very true and I believe that’s a giant sign,” says Truong, a pulmonologist and an assistant professor at Emory College’s Faculty of Drugs.
COVID-19 is unquestionably not over, says Angela Cheung, MD, PhD, a senior doctor scientist with the College Well being Community and a professor of drugs on the College of Toronto. And every time somebody will get contaminated, they danger growing lengthy COVID. A previous an infection doesn’t erase the chance, Cheung says.
“It’s not like, ‘Oh, I’ve had one, so it’s OK. Now I can take off my masks, do what I like.’ It has well being penalties for reinfections – larger mortality fee, larger hospitalization charges, larger danger of long run, lingering signs,” she says.
New analysis means that these contaminated greater than as soon as have an elevated danger of growing lengthy COVID and different well being issues in comparison with these contaminated simply as soon as. However parsing out the extent of those dangers – significantly with newer variants – is extra difficult, Truong and different consultants say, significantly when factoring in vaccinations and antiviral remedies.
“It is sensible that repeat infections wouldn’t be useful to an individual’s well being. However I believe it is actually exhausting to know what the extra danger of every subsequent an infection could be as a result of there are all kinds of different issues within the combine,” says Michael Peluso, MD, an assistant professor of drugs and an infectious illnesses physician on the College of California San Francisco.
“There are vaccines — new vaccines, outdated vaccines. There are variants — outdated variants, new variants, and now a number of variants circulating on the similar time.”
Veterans Affairs Examine
A large study involving the information of 5.8 million Division of Veterans Affairs sufferers that was revealed in Nature Drugs in November discovered that sufferers contaminated greater than as soon as had considerably larger dangers of demise, hospitalization, coronary heart issues, blood clotting, lengthy COVID, and a bunch of different well being points and organ injury. Notably, the study discovered that these elevated dangers remained even 6 months after reinfection.
Whereas the research highlights the elevated dangers related to reinfections, it has its limitations. The research didn’t straight examine a primary an infection to reinfection throughout the similar pool of sufferers. It solely in contrast one group of people who had a single an infection to a separate group who had multiple an infection.
There may very well be different elements that made one group extra vulnerable to reinfection and at better danger of adversarial well being outcomes. The research additionally didn’t examine reinfection dangers between totally different variants or subvariants.
One other limitation is the VA inhabitants itself. The VA database is extraordinarily helpful for big research like this one as a result of it follows numerous folks with complete medical information, consultants say, however the VA’s inhabitants of principally older white males doesn’t mirror the demographics of the overall inhabitants.
Nonetheless, the message for the general public is simple, says Cheung. “I wouldn’t get into the weeds. The massive message and large image is that reinfections are dangerous.”
Completely different Dangers With New Variants?
Specialists say understanding reinfection dangers, significantly with the newer variants and subvariants, is difficult as a result of extra folks are actually vaccinated in comparison with earlier within the pandemic.
“There aren’t any definitive solutions. … It’s very, very troublesome to disentangle the emergence of latest variants from the uptake of vaccines,” says Peluso.
“It does appear to be total there could also be much less lengthy COVID with the newer variants, however it’s very exhausting to say whether or not that could be a attribute of the virus or a attribute of the truth that most people who find themselves getting the virus have both been vaccinated or beforehand contaminated to have some totally different immune baseline from anyone who’s seeing the viral antigen for the primary time.”
Nonetheless, consensus is rising that those that are vaccinated and find yourself with breakthrough infections are at decrease danger of growing lengthy COVID. One U.K. study revealed within the journal Open Discussion board Infectious Illnesses in September, for instance, discovered that individuals who had two COVID-19 vaccinations at the very least 2 weeks previous to an infection had a 41% lower within the odds of growing lengthy COVID signs, in comparison with individuals who weren’t vaccinated on the time of an infection.
“We additionally know that in sufferers who’ve had their vaccinations, they’re much less more likely to have a reinfection, or after they do have reinfection, they’re much less more likely to have extreme an infection,” says Truong.
“That’s the one large sign that we now have and that’s why I am attempting to wave the flag as a lot as I can about getting vaccinated [and boosted].”
Whereas some knowledge suggests the dangers of lengthy COVID are decrease with Omicron variants in contrast with the Delta variant, consultants level out {that a} far better variety of folks have been contaminated with Omicron, so even a small share of a big quantity remains to be a big quantity.
“One study taking a look at Omicron versus Delta exhibits about half the chance, however half the chance in much more folks remains to be quite a lot of excessive absolute numbers,” Cheung says, referring to a June paper revealed in The Lancet.
She nonetheless sees quite a lot of sufferers with lengthy COVID – some contaminated as just lately as this previous summer time, some vaccinated and contaminated for the primary time, and others coming in following reinfections.
And whereas Omicron variant and subvariant infections might seem milder for many individuals, medical doctors be aware new sufferers are additionally displaying up with the identical debilitating signs as those that received lengthy COVID earlier within the pandemic: fatigue, shortness of breath, racing coronary heart, mind fog, sleep disturbances, and psychological well being points.
“On my post-COVID clinic days, I’m nonetheless seeing 4 to eight new sufferers who had infections in 2022 are available with vital signs,” says Truong.
And lengthy COVID can kill. Greater than 3,500 demise certificates filed from the beginning of the pandemic by June 2022 record lengthy COVID as a selected reason for demise, the National Center for Health Statistics reports.
Minimizing Put up-COVID Dangers
Peluso says what could be realized from the VA research is that repeated assaults on the immune system are harmful and that persevering with to keep away from an infection stays extraordinarily vital.
“The easiest way for somebody to guard themselves towards that’s to keep away from getting COVID within the first place,” says Peluso. It’s a sentiment echoed by Truong and Cheung.
However given the transmissibility of the latest variants and subvariants and the removing of public well being measures, it’s typically troublesome to stop an infection. Tried and true instruments do, nonetheless, work: being updated on vaccinations, carrying high-quality, well-fitted masks, advocating for good air flow, and conducting self-testing with fast antigen checks, significantly forward of indoor occasions throughout busy vacation intervals.
“It’s attainable that this will turn out to be much less frequent over time. I hope that’s true,” Peluso says.
“It’s additionally attainable that it’d go the opposite means. And so for that motive, I’m attempting to keep away from the entire variants.”
