Experts urge caution as Americans gather indoors in late fall and winter, with COVID-19 cases already on the rise ahead of the Thanksgiving holiday.
Now that most people in the United States have been infected with COVID-19 at least once, some complacency may set in; but even though another round of SARS-CoV-2 infections may be starting to feel overwhelmed, experts warn that the possibility of a long COVID is still a threat Americans should be wary of — even if they have managed to avoid a long COVID in the past.
What is the long COVID?
There is no single agreed definition of long COVID, nor an agreed method for defining and diagnosing it.
The Centers for Disease Control and Prevention reported in June that nearly one in five Americans who had COVID-19 still had symptoms of long COVID, which the CDC defines as symptoms lasting more than three months after infection that weren’t present earlier. Long COVID symptoms vary — from respiratory and cardiac symptoms, to neurological symptoms, to general conditions such as fatigue or muscle aches — and the CDC says that although long COVID is more common in people who have suffered a severe COVID-19 crisis, even people who have experienced mild or 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 at the hospital’s long-running COVID clinic: people with persistent damage from a severe case of COVID-19; people with underlying conditions that have been exacerbated by COVID-19; and “what we consider to be ‘true’ long-term COVID patients, who have multiple symptoms for which we cannot currently find an objective cause.”
Ostrosky said the good news is that most patients in the last category of long-term COVID patients improve on their own within four to six months.
“But there are patients that we have been following for a year or a year and a half who have not recovered. And this is where we need more research into treatment options for them,” he said.
What if you already have a long COVID and you 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 huge blow.
“It’s pretty devastating,” Ostrosky said of some patients he’s seen with long COVID who are 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 that happens.
More research is still needed on the impact of reinfection on those already suffering from long COVID, but self-reported cases may provide insight. In a recent online survey conducted in the UK, 80% of those who described themselves as still having long-lasting COVID symptoms reported that another case of COVID-19 had exacerbated their symptoms.
Among those who were in recovery or remission from long COVID, reinfection recurred in about 60% of individuals; of those, 40% said the second episode of long 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 experiences in terms of the severity of the second episode of long COVID,” Dr. Jessica Justman, an associate professor of epidemiology at Columbia University, who didn’t have participated in the survey. “The bottom line was: if you have or had long COVID, getting an infection again could make you feel like your long COVID has gotten worse or has come back. So that’s one more reason to get vaccinated and take steps to minimize your exposures.
If you haven’t had COVID long before, 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 less severe than the first infection, but that “some people may experience more severe COVID-19 during reinfection,” and that the assortment of circulating variants may mean that a individual may not have as much immunity to a previous infection as is usually the case.
So even if you didn’t get long COVID the first time around, it’s still possible to get long COVID if you get reinfected with the virus.
“Past performance does not predict future performance. You may have had a very mild case before, but you have no certainty whether the next case will be as mild or if it will be more severe,” Ostrosky said.
“There’s also so much we don’t know about the kind of damage that accrues from 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 that reinfection increased the risk of long-term COVID, as well as other adverse health effects, including a risk of death multiplied by two and a risk of hospitalization multiplied by three. compared to those who were not reinfected.
“Unambiguously, our research has shown that acquiring an infection a 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 following months, i.e. the long COVID phase,” senior author Ziyad Al-Aly said in a press release.
The study found that reinfection worsened the risks of long COVID, whether participants were unvaccinated, vaccinated, or boosted. In general, 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 COVID than those who weren’t vaccinated, but the CDC says people who aren’t vaccinated may be at greater risk of developing “post-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 COVID.
“For people who think ‘I’m not going to die from COVID, it’s normal to have multiple infections’, this really should be an eye-opening study that shows us there’s still a lot to learn about the long-term consequences. term of several episodes of this infection,” Ostrosky said.
Justman pointed out that while the study provides additional reason to take extra precautions and keep up to date with vaccinations, the retrospective nature of the study means some results could have been missed. Because participant data was collected retroactively instead of tracking 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 these cases had been properly counted, Justman said, it could have reduced the risks posed by reinfection.
” They saw [what’s known as] a dose-response relationship,” Justman said. “People who had three COVID infections had a higher risk of these outcomes than people who had two infections, and those who had two infections had a higher risk than people who had only one. And every time you see that kind of dose-response relationship, it tells you that what you’re looking at might be real.
What happens next?
Although information about Long COVID and reinfection — and Long COVID in general — is limited, a number of studies are underway that may soon offer 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 titled “COVID-19: Understanding the Post-Viral Phase (COVID-UPP),” on patients who continue to present 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 those same messages that everyone in public health keeps repeating – which makes the public feel like they don’t maybe want to hear it more. It is always important to take advantage of all the vaccines you can benefit from [yourself] of, i.e. flu vaccine, COVID reminders. And if you’re in a crowded indoor place, think very carefully about your exposure to COVID and try to see if you can wear a mask if possible. »
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