Second coronavirus case heightens long COVID risk, experts say

New evidence suggests that a second coronavirus infection may increase long-term health risks, a worrying development as the spread of increasingly contagious omicron subvariants means greater numbers of Californians are becoming reinfected.

At the beginning of the pandemic, contagion was thought to offer some permanent protection, perhaps for a few months.

However, since the corona virus is mutating, this is no longer a matter of course. And every single infection carries not only the risk of acute illness, but also the potential to develop a long COVID.

“The additive risk is really not trivial, not insignificant. It’s really remarkable,” said Dr. Ziyad Al-Aly, clinical epidemiologist at Washington University in St. Louis and director of research and development for the Veterans Affairs St. Louis Healthcare System.

According to a preprint study examining U.S. veterans, of which Al-Aly was the lead author, being infected twice or more “contributes to additional risks for all-cause mortality, hospitalization, and adverse health outcomes” in various organ systems and may additionally worsen risk for Diabetes, fatigue and mental disorders.

“Reinfection absolutely increases the risk,” Al-Aly said. The study suggested that people who contracted the coronavirus a second time were 2½ times more likely to develop heart or lung disease and blood clotting problems compared to people who had been infected only once. Subsequent infections were also associated with a higher risk of potentially serious health problems, as well as death, from COVID-19.

It’s possible for someone to be fine with repeated coronavirus infection, which happens to most people, Al-Aly said. “But you could be one of the unlucky ones and … get a really serious health problem with an infection.”

Los Angeles County Director of Public Health Barbara Ferrer recently cited Al-Aly’s preprint study as rationale for wearing masks indoors in public to avoid re-infection.

“They also saw that those with repeated infections had a higher risk of gastrointestinal, kidney, mental, musculoskeletal and neurological disorders, as well as diabetes,” Ferrer said of the study. “In addition, the risk of developing a long-term health problem continued to increase with each new infection. The risk of developing long-term health problems was three times higher among infected people than among uninfected people.”

Older viruses, like those that cause measles and chickenpox, are fairly stable — meaning vaccinations are highly effective and surviving either disease typically confers lifelong immunity.

Not so with the coronavirus, which has mutated wildly since the pandemic began. For example, someone who contracted the variant that dominated California in late 2020 was vulnerable to catching the Delta variant the following summer. And those who survived Delta took the risk of catching the later Omicron variant.

But the reinfection landscape was turned upside down even further when California was afflicted with a family of increasingly transmissible omicron subvariants. The most recent of these, BA.5, has proven particularly good at reinfection – with the ability to attack even those who survived a previous Omicron case just weeks before.

“This concept of building immunity really only works if you keep coming up against the same beast over and over again,” Al-Aly said. But in the world of COVID-19, BA.5 is actually a “very different beast” from previous variants.

It is possible that the acute phase of a second COVID-19 attack may be milder than the first. But a subsequent attack can still leave more extensive cumulative damage in the body than if there were only one infection.

Think of coronavirus infections like earthquake sequences: it’s possible that an aftershock could be less severe than the first tremor, but could do more damage cumulatively. And just because your house is still standing after an earthquake, doesn’t mean you shouldn’t be looking at ways to make it earthquake-proof.

“One reason things aren’t feeling so bad for a lot of people right now is because we’re very aggressively fighting the virus with vaccines and treatments,” said Dr. Ashish Jha, COVID-19 at the White House. 19 response coordinator, said during a health summit hosted by the Hill. “If we take our foot off the pedal, we will see this virus come back in a much more dangerous way. So we have to stay on the front line and keep fighting this thing.”

Because this is specifically long COVID — a condition in which symptoms can persist months or even years after initial infection — vaccination and booster likely reduce risk, but studies differ on the level of protection.

“I think pre-existing immunity – whether natural or through a vaccine – seems to reduce the risk of a long COVID, but it’s still there. It’s not zero,” said Dr. Steven Deeks, professor of medicine at UC San Francisco and principal investigator of the Long-term Impact of Infection With Novel Coronavirus (LIINC) study.

Another report, which observed triple-vaccinated Italian healthcare workers who were not hospitalized for COVID-19, found that two or three vaccine doses were associated with a lower prevalence of long COVID.

A separate report suggested that even adults who had received a booster dose still need to consider the risk of a long COVID. According to a UK report, during the first Omicron wave, around 1 in 25 triple-vaccinated adults self-reported having long-COVID three to four months after their initial infection.

Still, some clinicians say that long-sufferers with COVID tend to be either unvaccinated or missing their booster shot.

“The number of patients I treat who have been vaccinated and boosted and who come with long COVID is very small,” said Dr. Nisha Viswanathan, Director of the UCLA Health Long COVID Program.

Long COVID also does not prevent you from catching the coronavirus again. Viswanathan said she’s had patients who saw their long COVID symptoms improve, then fell ill with another bout of COVID-19, and then long COVID signs returned.

The best way to prevent long COVID is not to get COVID-19. Many officials and experts cite non-pharmaceutical measures like masking as key tools, as vaccinations reduce risk but don’t completely eliminate it.

“Masking is not a terrible thing to ask of people, especially in the places that are likely to be the most crowded and the places that may have the highest risk of transmission,” Viswanathan said. Doing activities outdoors is also safer than getting exposed indoors.

Some Viswanathan patients have downplayed the risk of COVID-19, commenting on how it has become a mild illness and adding that they see no point in taking precautions. But, she said, better knowledge of long-lasting COVID and its disabling effects would help people understand the importance of masking and getting vaccinated and boosted.

A UCLA study published in the Journal of General Internal Medicine, in which Viswanathan was a co-author, found that of 1,038 patients with symptomatic COVID-19 between April 2020 and February 2021, almost 30% developed long-term COVID-19. The most common symptoms were fatigue and shortness of breath in hospitalized patients.

While many are tired of COVID-19 preventive measures after nearly two and a half years, they remain important, said Dr. Anne Foster, Vice President and Chief Clinical Strategy Officer for the University of California Health System.

The burden of long COVID after this wave is unknown. With so much testing being done at home, official case numbers are likely grossly undercounted, and that could indicate the strain of long-COVID will be difficult to predict in the months ahead, Foster said.

“I know everyone has moved on and people are back to how things were and I kind of understand it,” Deeks said. “But people need to be aware that there is this extra risk that is not going away and they could adjust their lives accordingly.

“But everyone will find out for themselves.” Second coronavirus case heightens long COVID risk, experts say

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