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

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

How does reinfection 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 have not recovered. And there 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, with cases of COVID-19 already on the rise on the eve of the Thanksgiving holiday.

Now that most people in the US have been infected with COVID-19 at least once, complacency may occur; but even if another round of SARS-CoV-2 infections may start to feel like old hat, experts warn that the possibility of prolonged COVID is still a threat Americans should be wary of — even if they managed to avoid the long to 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 published in June that nearly 1 in 5 Americans who have 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 previously present. Long-term symptoms of COVID vary – from respiratory and cardiac symptoms, to neurological symptoms, to general complaints such as fatigue or muscle aches – and CDC says that 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 long-term COVID-19 hospital: people with long-term damage from a severe case of COVID-19; people with underlying illnesses exacerbated by COVID-19; and “what we consider ‘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 get better on their own within four to six months.

“But there are 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-19 for a long time and get infected with COVID-19 again?

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

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

More research is still needed on how reinfection affects those who already have long-term COVID, but self-reported cases may provide some insight. In a recent online survey conducted in the United Kingdom80% of those who described themselves as still having long-term symptoms of COVID reported that another case of COVID-19 made their symptoms worse.

Of those who were in recovery or remission from long-term COVID, reinfection recurred 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 less severe, 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 long-term COVID,” Dr. Jessica Justman, associate professor of epidemiology at Columbia University, who was not involved in the research. “The bottom line was: if you have or have had long-standing COVID, re-infection could make you feel like your long-standing 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?

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

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 reinfection are likely to be less severe than the first infection, but that “some people may experience more severe COVID-19 during reinfection” and that the range of circulating variants may mean that an individual may not have as much immunity from previous infections as is usually the case.

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

“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 mild or severe,” Ostrosky said.

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

A study published last week Using data from the Department of Veterans Affairs’ National Health Care Database, it was found that reinfection increased the risk of long-term COVID as well as other adverse health outcomes, including a two-fold increased risk of death and a three-fold increased risk of hospitalization compared to those who did not. were not re-infected.

“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 COVID phase,” senior author Ziyad Al- Aly according to the press release.

The study found that reinfection increased the risk of long-term COVID, regardless of whether participants were unvaccinated, vaccinated or boosted. In general, however, the impact of vaccination status on long-term outcomes of COVID is still unclear. Others 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 CDC says 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 cut their risk of developing long-term COVID in half.

“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 that shows us there’s a lot more to learn about the long-term consequences of multiple episodes of this infection,” Ostrosky said.

Justman pointed out that while the study provides additional reasons to pay more attention and update vaccinations, the retrospective nature of the study means some results may have been missed. Because participant data were collected retrospectively instead of 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 happens next?

"It is still important to use all the vaccines you can possibly use, ie.  flu vaccine, covid boosters.  And if you're in a crowded indoor place, 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 you can possibly get, i.e. the flu shot, the COVID boosters. And if you’re in an enclosed space full of people, think carefully about your exposure to COVID and try to see if you can wear a 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 Institutes of Health is working on a study called Researching COVID to Improve Recovery (RECOVER) to learn more about the long-term effects of COVID-19. The CDC is also conducting a number of studies with partners, including with 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 a lot of information coming out, so it’s kind of a ‘Watch this space,'” Justman said. “It’s definitely ongoing, but I think what we’ve learned so far would reinforce those same messages that everybody in public health keeps pushing repeat – which it seems the public may no longer want to hear It’s still important to get all the vaccines you can get [yourself] flu shots, COVID boosters. And if you’re in a crowded indoor space, 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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