Emerging evidence suggests that catching the coronavirus a second time could increase long-term health risks, a worrisome development as the circulation of increasingly infectious Omicron subvariants could lead to re-infection in large numbers of Californians.
Before the pandemic, it was thought that exposure to the infection would provide protection that lasted perhaps months.
As the coronavirus has mutated, this is no longer available. And each individual infection poses a risk not only for severe disease, but also for the development of prolonged COVID-19.
“The additional risk is actually not small, not insignificant. This is really serious,” said the doctor. Ziyad Al-Ali, a clinical epidemiologist at the University of Washington. Louis and Chief of Research and Development at the St. Louis Health Care System for Veterans Affairs.
According to a preliminary study of US veterans that Al-Ali led, two or more infections “contribute to additional risks of all-cause mortality, hospitalization, and adverse health outcomes” in different organ systems, and more. outside may deteriorate. risk of diabetes, fatigue and mental health problems.
“Reinfection adds to the risk,” Al-Ali said. The study found that people who were infected a second time with the coronavirus were 2.5 times more likely to develop heart or lung disease and blood clotting problems compared to those who were infected only once. Subsequent infections are also associated with a higher risk of serious health problems and death from COVID-19.
Perhaps repeated coronavirus infections can leave someone in a better state, which most people do, Al-Ali said. “But you could be one of the unlucky ones and … you could end up with an infection and a serious health problem.”
Los Angeles County Public Health Director Barbara Ferrer recently cited Al-Ali’s pre-print study as a rationale for wearing masks in public to prevent re-infection.
“They also found that patients with repeated infections had a higher risk of gastrointestinal, kidney, mental health, musculoskeletal and neurological disorders, as well as diabetes,” said Ferrer in the study. “In addition, with each recurrence, the risk of long-term health problems increased. The risk of long-term health problems was three times higher in those who were infected.”
Older viruses like measles and chicken pox are very resistant—vaccines are highly effective, and surviving both diseases usually confers lifelong immunity.
Not so with the wildly mutated coronavirus since the pandemic began. For example, someone infected with the dominant variant in California in late 2020 was vulnerable to catching the Delta variant the following summer. And the Delta survivors were at risk of intercepting the next Omicron variant.
But the re-infection landscape has become even more elevated as California is increasingly covered by the highly contagious Omicron family of subvariants. The latest of these, the BA.5, has shown a special knack for re-infection – with the ability to even target survivors of the Omicron incident a few weeks ago.
“The concept of building immunity only works if you’re repeatedly exposed to the same predator,” Al-Ali said. But in the world of COVID-19, the BA.5 is actually a “very different beast” than previous variants.
Perhaps the acute phase of the second bout of COVID-19 is milder than the first. But a subsequent attack can be more damaging to the body than a single infection.
Think of the coronavirus outbreak like an earthquake sequence: the aftershock may be smaller than the first shock, but the cumulative effect may be more damaging. Just because your home is still standing after an earthquake doesn’t mean you shouldn’t explore ways to make it seismically safe.
“One of the reasons they don’t seem so bad for most people right now is because we’re being very aggressive with vaccines and treatments,” said Dr. Ashish Jha, the White House’s co-ordinator for the response to COVID-19, made the announcement at a health summit on the Hill. “If we take our foot off the pedal, we will see this virus come back in a more dangerous way. So we have to continue to fight this thing.”
Because this is especially true for long-lasting COVID—symptoms can persist for months or even years after initial infection—vaccination and boosters reduce risk, but studies differ on the degree of protection.
“I think having pre-existing immunity — whether it’s natural or from a vaccine — is going to reduce the risk of long-term COVID, but it’s still there. This is not zero, said the doctor. Stephen Dix, a professor of medicine at the University of San Francisco and lead researcher on the long-term effects of infection with the novel coronavirus, or LIINC.
Another report followed three vaccinated Italian healthcare workers who were hospitalized for COVID-19 and found that two or three doses of the vaccine were associated with lower long-term incidence of COVID.
A separate report said that adults who receive extra doses should also consider the longer-term risk of COVID. According to a British report, 1 in 25 adults who were vaccinated during the first wave of Omicron had persistent COVID three to four months after their first infection.
Still, some clinicians say long-term COVID-19 patients miss vaccinations or miss boosters.
“The number of patients that I see who have been vaccinated and come in with COVID for a long time is very small,” said Dr. Nisha Viswanathan, director of the UCLA Health Long COVID Program.
Long-lasting COVID also doesn’t prevent you from getting the coronavirus again. According to Viswanathan, he has had patients who have seen long-term improvement in their COVID-19 symptoms, then have another bout with COVID-19, and then have long-term COVID symptoms return.
The best way to prevent prolonged COVID is to avoid contracting COVID-19. Many officials and experts cite non-pharmaceutical interventions, such as vaccinations, as a key tool, as vaccinations can reduce but not eliminate risk.
“Wearing a mask is not a scary thing to ask people to do, especially in crowded places and high-risk areas,” Viswanathan said. Doing activities outside is also safer than unmasking at home.
Some of Viswanathan’s patients have downplayed the risk of COVID-19, saying how it is a mild illness, adding that there is no need to take precautions. However, he said, better knowledge of the lingering effects of COVID and its disabling effects will help people understand the importance of masking and vaccination and strengthening.
A UCLA study published in the Journal of Internal Medicine, co-authored by Viswanathan, found that of 1,038 patients with symptomatic COVID-19 between April 2020 and February 2021, nearly 30% had long-term exposure to COVID-19. Among hospitalized patients, the most common symptoms were fatigue and shortness of breath.
Although many are tired of the COVID-19 prevention measures two and a half years later, they remain important, said Dr. Ann Foster, Vice President and Chief Clinical Strategy Officer, University of California Health System.
The long-term COVID burden following this wave is unknown. Official case data may be too small, Foster said, given that many at-home tests are being used and that it may be difficult to predict the long-term COVID burden in the coming months.
“I know things have moved on and people are going back to how they were, and I understand that,” Dix said. “But people need to be aware that there is this added risk, it’s not going to go away, and they may change their lives accordingly.
“But it’s up to each individual.”