Emerging evidence suggests that a second coronavirus infection could increase long-term health risks, a worrying development as circulation of infectious omicron sub-variants leads to re-infection of larger numbers of Californians.
Earlier in the pandemic, infection with an infection was assumed to provide some degree of lasting protection, perhaps for a few months.
With the coronavirus mutating, this is no longer a foregone conclusion. Each individual infection carries a risk not only of developing acute illness but also the possibility of developing COVID for a long time.
“The added risks are really not trivial and they are not insignificant. They are really significant,” said Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis and head of research and development at the Veterans Affairs Healthcare System, Dr. Ziyad Al-Ali.
According to the preprint study examining American veterans, of which Al-Ali is the lead author, infection two or more times “contributes to additional risks of all-cause mortality, hospitalization and adverse health outcomes” in various organ systems, and can also be exacerbated. Risk of diabetes, fatigue and mental health disorders.
“Re-infection certainly adds risks,” Al-Aly said. The study indicated that compared to those infected only once, individuals who contracted the virus for the second time were two and a half times more likely to develop heart or lung disease and blood clotting problems. Subsequent infections have also been associated with an increased risk of serious health problems, as well as death from COVID-19.
Al-Ali said that it is likely that repeated infection with the Corona virus will leave a person unwell, which is what happens to most people. “But you might be one of the unlucky people and… have a really serious health problem because of the infection.”
Los Angeles County Public Health Director Barbara Ferrer recently cited Al-Ali’s preprint study as a rationale for wearing masks in indoor public spaces to avoid reinfection.
“They also saw that those with frequent infections had a higher risk of developing digestive, kidney, mental health, musculoskeletal and neurological disorders, as well as diabetes,” Ferrer said of the study. “Furthermore, the risk of developing a long-term health problem increased more with each reinfection. The risk of developing long-term health conditions was three times higher for those infected than for those who did not.”
Ancient viruses, such as those that cause measles and smallpox, are quite stable – which means that vaccines are very effective and that surviving either disease usually confers lifelong immunity.
This was not the case with the coronavirus, which has mutated dramatically since the pandemic began. Someone who was infected with the variant that took over California in late 2020, for example, was at risk of developing a delta type the following summer. And those who survived the delta run the risk of catching the later Omicron variant.
But the re-infection scene has been turned even further, as California is filled with a family of sub-variants increasingly transmitted from Omicron. The latest of them, BA.5, has shown particular efficiency in re-infection – with the ability to target even those who survived a previous Omicron case just weeks ago.
“This concept of building immunity, it only works if you encounter the same monster over and over again,” Al-Aly said. But in the world of COVID-19, BA.5 is actually a “completely different beast” than the previous variants.
The acute phase of the second episode of COVID-19 is likely to be milder than the first. But a subsequent attack can leave more extensive cumulative damage to the body than if there was only one injury.
Think of coronavirus infections like an earthquake sequence: The aftershock is likely to be less severe than the first earthquake, but cumulatively can add more damage. And just because your house is still standing after one earthquake doesn’t mean you shouldn’t explore ways to make it earthquake safer.
“Part of the reason a lot of people feel it’s not so bad right now is that we’re so aggressive in responding to the virus with vaccines and treatments,” Dr. Ashish Jha, White House COVID-19 Response Coordinator, during the Health Care Summit hosted by Hill. “If we take our foot off the pedal, we will see this virus come back in a much more serious way. So we have to stay ahead and keep fighting this thing.”
Because it relates specifically to prolonged COVID – a condition in which symptoms can persist for months or even years after the initial infection – vaccination and boosters probably reduce risk, but studies differ regarding the degree of protection.
“I think having some pre-existing immunity – whether it’s natural or from a vaccine – seems to reduce the risk of getting COVID for a long time, but it’s still there,” said Dr. Stephen Dicks, UCSF professor of medicine and lead researcher on the long-term effect. Long-term infection with the emerging coronavirus, or LIINC, it’s not zero.”
Another report, monitoring triple-vaccinated Italian health care workers who were not hospitalized due to COVID-19, found that two or three doses of the vaccine were associated with a lower prolonged COVID prevalence.
A separate report noted that even adults who received a booster dose still had to consider the risk of contracting the Covid virus for a long time. A British report said that during the initial Omicron wave, about 1 in 25 triple-vaccinated adults reported having had COVID for a prolonged period three to four months after the first infection.
However, some doctors say long-term coronavirus sufferers tend to be either not immune or missing out on their boosters.
“The number of patients I see who have been vaccinated and who come with COVID for a long time is very low,” said Dr. Nisha Viswanathan, director of the UCLA Health Long COVID Program.
Also, a prolonged COVID does not prevent you from contracting the coronavirus again. Viswanathan said she has had patients who saw an improvement in their prolonged COVID symptoms, then had another bout of COVID-19, and then noticed a return of their prolonged COVID symptoms.
The best way to prevent COVID for a long time is not to catch COVID-19. Many officials and experts cite non-pharmacological interventions such as masking as key tools, because vaccinations reduce risks but do not eliminate them completely.
“It’s not terrible to ask people to wear a mask, especially in probably the most crowded places, places that may be more susceptible to transmission,” Viswanathan said. Taking activities outside is also safer than unmasking indoors.
Some Viswanathan patients downplayed the risk of contracting COVID-19, commenting on how it had become a mild illness, adding that they did not see the benefit of taking precautions. But, she said, better knowledge of Covid’s long illness and its disabling effects will help people understand the importance of masking, vaccination and boosters.
A UCLA study published in the Journal of General Internal Medicine, of which Viswanathan was a co-author, found that among 1,038 patients with COVID-19 symptoms between April 2020 and February 2021, nearly 30% developed prolonged COVID-19. The most common symptoms were fatigue and shortness of breath among hospitalized patients.
Anne Foster, vice president and director of clinical strategy for the University of California Health System, said while many are tired of COVID-19 preventive measures after nearly two and a half years, they remain important.
The prolonged COVID burden after this wave is unknown. Foster said the official case numbers are probably understated, given that many at-home tests are being used, and that may indicate that the long COVID burden in later months will be difficult to predict.
“I know everyone has come forward and people are going back to how things were, and I kind of understand that,” Dix said. “But people need to realize that there is an additional risk that will not go away and they may adjust their lives accordingly.
“But everyone will find out on their own.”
This story originally appeared in the Los Angeles Times.