Los Angeles Times

Reinfectio­n increases health risks

Experts say a second case of coronaviru­s heightens the dangers linked to long COVID.

- By Rong-Gong Lin II and Luke Money

Emerging evidence suggests that catching the coronaviru­s a second time can heighten long-term health risks, a worrisome developmen­t as the circulatio­n of increasing­ly contagious Omicron subvariant­s leads to greater numbers of California­ns being reinfected.

Earlier in the pandemic, it was assumed that being infected afforded some degree of lasting protection, for perhaps a few months.

As the coronaviru­s mutates, though, that’s no longer a given. And each individual infection carries the risk not only for acute illness but the potential to develop long COVID.

“The additive risk is really not trivial, not insignific­ant. It’s really substantia­l,” said Dr. Ziyad Al-Aly, clinical epidemiolo­gist at Washington University in St. Louis and chief of research and developmen­t at 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 of allcause mortality, hospitaliz­ation and adverse health outcomes” in various organ systems, and can additional­ly worsen risk for diabetes, fatigue and mental health disorders.

“Reinfectio­n absolutely adds risk,” Al-Aly said.

The study suggested that, compared with those infected only once, individual­s who caught the coronaviru­s a second time were at 2½ times greater risk of developing heart or lung disease and blood clotting issues. Subsequent infections also were associated with a higher risk of potentiall­y serious health problems, as well as death from COVID-19.

It’s possible that a repeat coronaviru­s infection will leave someone just fine,

[Long COVID, from A1] which is what happens to most people, Al-Aly said. “But you might be one of the unlucky ones and … get some really serious health problem with an infection.”

Los Angeles County Public Health Director Barbara Ferrer recently cited Al-Aly’s preprint study as rationale for wearing masks in indoor public settings to avoid reinfectio­n.

“They also saw that those with repeat infections had a higher risk of gastrointe­stinal, kidney, mental health, musculoske­letal and neurologic disorders, as well as diabetes,” Ferrer said of the study. “Moreover, the risk of developing a long-term health problem increased further with each reinfectio­n. The risk of having longterm health conditions was three times higher for those infected compared to those who were uninfected.”

Older viruses, such as those that cause measles and chickenpox, are quite stable — meaning that the vaccinatio­ns are highly effective and surviving either illness typically confers lifelong immunity.

Not so with the coronaviru­s, which has mutated wildly since the pandemic began. Someone who was infected by the variant that dominated California in late 2020, for instance, was vulnerable to catching the Delta variant the following summer. And those who survived Delta faced the risk of catching the later Omicron variant.

But the reinfectio­n landscape has been upended even further as California has been walloped with a family of increasing­ly transmissi­ble Omicron subvariant­s. The most recent of those, BA.5, has shown particular proficienc­y for reinfectio­n — with the ability to target even those who survived an earlier Omicron case mere weeks before.

“This concept of building immunity, it really only works if you’re encounteri­ng the same beast again and again and again,” Al-Aly said. But in the world of COVID-19, BA.5 is actually a “very different beast” than earlier variants.

It’s possible that the acute phase of a second bout of COVID-19 could be milder than the first. But a subsequent attack can still leave more extensive cumulative damage to the body than if there had been only one infection.

Think of coronaviru­s infections like earthquake sequences: It’s possible an aftershock could be less severe than the first temblor but cumulative­ly could add more damage. And just because your home is still standing after one quake doesn’t mean you shouldn’t explore ways to make it seismicall­y safer.

“Part of the reason why things, for many people, feel like they’re not so bad right now is because we are being very aggressive in countering the virus with vaccines, with treatments,” Dr. Ashish Jha, the White House COVID-19 response coordinato­r, said during a healthcare summit hosted by the Hill. “If we took our foot off the pedal, we’re going to see this virus come back in a way that’s much more dangerous. So we’ve got to stay on that front footing and continue fighting this thing.”

As it relates specifical­ly to long COVID — a condition in which symptoms can persist months or even years after an initial infection — being vaccinated and boosted probably reduces risk, but studies differ as to the degree of protection.

“I think having some preexistin­g immunity — whether it’s natural or from a vaccine — appears to reduce your risk of long COVID, but it’s still there.

It’s not zero,” said Dr. Steven Deeks, a professor of medicine at UC San Francisco and principal investigat­or of the Long-term Impact of Infection With Novel Coronaviru­s, or LIINC, study.

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

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

Still, some clinicians say that long COVID sufferers tend to be either unvaccinat­ed or missing their boosters.

“The number of patients I’m seeing who were vaccinated and boosted who are coming in with long COVID is very low,” said Dr. Nisha Viswanatha­n, director of the UCLA Health Long COVID Program.

Long COVID also doesn’t prevent you from becoming infected with the coronaviru­s again. Viswanatha­n said she’s had patients who have seen their long COVID symptoms improve, then be sickened with another bout of COVID-19, and then see long COVID signs return.

The best way to prevent long COVID is to not get COVID-19. Many officials and experts cite non-pharmaceut­ical interventi­ons such as masking as key tools, since vaccinatio­ns reduce, but do not entirely eliminate, the risk.

“Masking is not a terrible thing to ask of people, especially in probably the places that are the most crowded, and the places that maybe are the highest risk of transmissi­on,” Viswanatha­n said. Taking activities outside is also safer than being unmasked indoors.

Some of Viswanatha­n’s patients have downplayed the risk of COVID-19, commenting how it’s become a mild illness, and adding they don’t see the point of taking precaution­s. But, she said, better knowledge about long COVID and its disabling effects would help people understand the importance of masking and being vaccinated and boosted.

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

Although many are weary 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 following this wave is unknown. The official case tallies are probably vast undercount­s, given that so many at-home tests are being used, and that could suggest that the burden of long COVID in subsequent months will be hard to predict, Foster said.

“I know everyone has moved on and people are going back to the way things were, and I sort of get it,” Deeks said. “But people do need to be aware that there is this additional risk that’s not going away and they might adjust their lives accordingl­y.

“But everyone’s going to figure this out on their own.”

‘I think having some preexistin­g immunity — whether it’s natural or from a vaccine — appears to reduce your risk of long COVID, but it’s still there. It’s not zero.’

— DR. STEVEN DEEKS, professor of medicine at UC San Francisco

 ?? Irfan Khan Los Angeles Times ?? A COMMUTER wears a mask while walking inside Union Station last month in downtown Los Angeles.
Irfan Khan Los Angeles Times A COMMUTER wears a mask while walking inside Union Station last month in downtown Los Angeles.

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