Experts urge caution as Americans congregate indoors in the late fall and winter months, with COVID-19 cases already leading up to the Thanksgiving holiday.
Now that most people in the US have been infected with COVID-19 at least once, some complacency may set in; but even if a new round of SARS-CoV-2 infection is starting to feel stale, experts warn that the possibility of long-term COVID still poses a threat that Americans should be wary of — even if they’ve managed to fight long-term COVID to avoid in the past.
What is Long COVID?
There is no single agreed definition of long COVID, or any agreed method of defining and diagnosing it.
The Centers for Disease Control and Prevention reported in June that nearly 1 in 5 Americans with COVID-19 still have symptoms of long-standing COVID, which the CDC defines as symptoms persisting more than three months after infection that were not previously present. Long-term COVID symptoms vary — from respiratory and cardiac symptoms to neurological symptoms, to general conditions like fatigue or muscle aches — and the CDC says that while long-term COVID is more common in people who’ve had a severe bout of COVID-19, even people who have mild or have experienced asymptomatic cases may suffer from “post-COVID conditions”.
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 lengthy COVID clinic: those with ongoing damage from a severe case of COVID-19; people with underlying illnesses that were exacerbated by COVID-19; and “what we consider to be ‘true’ long COVID patients, who have multiple symptoms for which we cannot currently find an objective cause.”
Ostrosky said the good news is that most of the latter category of long-term COVID patients improve on their own within four to six months.
“But there are some patients that we have been following for a year or a year and a half who have not recovered. And that’s where we need more research into therapeutic options for them,” he said.
What happens if you have had COVID for a long time and become infected with COVID-19 again?
For those who have been battling COVID for a long time, Ostrosky said getting another infection can be a huge blow.
“It’s pretty devastating,” Ostrosky said of some patients he’s seen with long-term COVID who become reinfected with SARS-CoV-2. “They may have made a lot of progress with this four to six month recovery process, and then it’s a huge setback for them. Very demoralizing, very discouraging for them when this happens.”
More research is still needed on the impact of reinfection on those who have been suffering from COVID for a long time, but self-reported cases may provide some insight. In a recent online survey in the UK, 80% of those who described continuing to have long-term COVID symptoms reported that another case of COVID-19 made their symptoms worse.
Of those who recovered or were in remission from long-term COVID, reinfection recurred in approximately 60% of individuals; of those individuals, 40% said the second bout of long-term COVID was just 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 experience in terms of the severity of the second bout of long COVID,” Dr. Jessica Justman, an associate professor of epidemiology at Columbia University, who was not involved in the study, told Yahoo News. “It came down to this: if you have or have had a long COVID, getting an infection again can make you feel like your long COVID has gotten worse or is coming back. So it’s an extra reason to get vaccinated and take steps to minimize your exposure.”
If you recently had COVID, how might a second (or third or fourth) COVID-19 infection affect your chances of developing it?
The CDC says the symptoms of reinfection are likely to be less severe than the initial infection, but that “some people may experience more severe COVID-19 during reinfection,” and that the range of variants circulating may mean that a person may not have as much immunity to a previous infection, as is usually the case.
So even if you didn’t get lung COVID the first time, it’s still possible to get lung COVID if you get infected with the virus again.
“Past performance does not predict future performance. You may have had a really mild case before, but you’re not sure if the next case will be just as mild or if it will 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.”
A study published last week using data from the Department of Veterans Affairs national health care database found reinfection increased the risk of long-term COVID, as well as other adverse health outcomes, including a twofold increased risk of death and a threefold increased risk of hospitalization compared to those who were not reinfected.
“Unequivocally, our research showed that contracting an infection for the second, third or fourth time contributes to additional health risks in the acute phase, i.e. the first 30 days after infection, and in the months after, i.e. the long COVID-19 period. phase.” author Ziyad Al-Aly said in a press release.
The study found that reinfection exacerbated the risks of long-term COVID, whether participants were unvaccinated, vaccinated or boosted. Overall, however, the impact of vaccination status on long-term COVID outcomes is still murky. Another 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 weren’t vaccinated, but the CDC says people who aren’t vaccinated may be at greater risk to develop “mail”. -COVID conditions” than those who are 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 feel like ‘I’m not dying from COVID, it’s okay to get multiple infections’, this really should be an eye-opening study that shows us there’s still a lot to learn about the consequences in the long term. of multiple episodes of this infection,” Ostrosky said.
Justman pointed out that while the study provides additional reasons to be extra careful and stay up to date on vaccinations, the retrospective nature of the study means some results could have been missed. Because data on the participants was collected retrospectively rather than following them in real time, the study may have missed some participants who were re-infected with SARS-CoV-2 but were asymptomatic, or who tested positive for a mild case and had no sought treatment. If such cases had been counted correctly, Justman said, that might have reduced the risks of reinfection.
“They have seen it [what’s known as] a 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 every time you see a dose-response relationship like that, it tells you that what you’re looking at could be real.”
What happens now?
While information on long-term COVID and reinfection — and long-term COVID in general — is limited, there are a number of studies underway that could soon provide some answers. The National Institutes of Health is working on a study called Researching COVID to Enhance 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 Post-Viral Phase (COVID-UPP)” in patients who continue to have symptoms for 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 the same messages that everyone in public health keeps repeating over and over — that it feels like the public might not want to hear anymore. It’s still important to take advantage of any vaccines you may be able to use [yourself] of, ie flu vaccine, COVID boosters. And if you’re in a crowded indoor space, think carefully about your exposure to COVID and try to wear a mask if possible.