Unraveling the interplay of omicron, reinfections and long COVID
The latest outbreak of COVID-19, caused by a shifting mix of rapidly evolving omicron subvariants, seems to weakencases and hospitalizations starting to decline.
Like previous waves of COVID, this one will leave a lingering imprint in the form of a long COVID, an ill-defined catch-all term for a set of symptoms that can include debilitating fatigue, difficulty breathing, chest pain and brain fog.
Although omicron infections are be softer overall than those caused by last summer’s delta variant, omicron was also found to be able to trigger long-term symptoms and organ damage. But whether omicron causes long-lasting COVID symptoms as often — and as badly — as previous variants is a matter of passionate study.
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Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, is among researchers who say the much higher number of infections with omicron compared to earlier variants signals the need to prepare for a significant increase in the number of people with long-term COVID. The United States has recorded nearly 38 million COVID infections so far this year, as omicron has the nation covered. This represents about 40% of all infections reported since the start of the pandemic, according to the Center for Coronavirus Research at Johns Hopkins University.
Long COVID “is a parallel pandemic that most people don’t even think about,” said Akiko Iwasaki, a professor of immunobiology at Yale University. “I suspect there will be millions of people who acquire long COVID after an omicron infection.”
Scientists have just started comparing the variants head-to-head, with varying results. Whereas a recent study in The Lancet suggests omicron is less likely to cause long COVID, another found the same rate of neurological problems after omicron and delta infections.
Estimates of the proportion of patients affected by long COVID also vary, from 4% to 5% in triple-vaccinated adults at up to 50% among unvaccinated, based on differences in the populations studied. One of the reasons for this wide range is that long COVID has been defined very variably in different studies, ranging from self-reported fogginess for a few months after infection to a dangerously impaired inability to regulate pulse and blood pressure that can last for years.
Even at the low end of these estimates, the sheer number of omicron infections this year would increase the number of long-term COVID cases. “That’s exactly what we found in the UK,” said Claire Steves, professor of aging and health at King’s College London and author of the Lancet study, which found that patients were 24% to 50% less likely to develop long COVID during omicron wave than during delta wave. “Even though the risk of long COVID is lower because so many people caught the omicron, the absolute numbers with long COVID have increased,” Steves said.
A recent study analysis of a Veterans Health Administration patient database found that reinfections significantly increased the risk of serious health problems, even in people with mild symptoms. The study of more than 5.4 million VA patients, including more than 560,000 women, found those re-infected with COVID were twice as likely to die or have a heart attack as those infected just once. time. And they were much more likely to experience health problems of all kinds from six months later, including problems with their lungs, kidneys and digestive system.
“We’re not saying a second infection will get worse; we say it increases your risk,” said Dr. Ziyad Al-Aly, chief of research and education at the St. Louis Veterans Health Care System.
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The researchers say the study, published online but not yet peer-reviewed, should be interpreted with caution. Some have noted that VA patients have unique characteristics and tend to be older men with high rates of chronic conditions that increase long-term COVID risks. They cautioned that the study results cannot be extrapolated to the general population, which is younger and healthier overall.
“We need to validate these results with other studies,” said Dr. Harlan Krumholz, director of the Yale New Haven Hospital Center for Outcomes Research and Evaluation. Still, he added, the VA study has “worrying implications.”
With an estimate 82% of Americans having been infected with the coronavirus at least once in mid-July, most new cases are now reinfections, said Justin Lessler, professor of epidemiology at the University of Carolina’s Gillings School of Global Public Health. North.
Of course, people’s risk of reinfection doesn’t just depend on their immune system, but also on the precautions they take, such as masking up, getting vaccinated, and avoiding crowds.
New Jersey salon owner Tee Hundley, 43, has had COVID three times, twice before vaccines became widely available and again this summer, after being fully vaccinated. She still suffers the consequences.
After her second infection, she returned to work as a cosmetologist in her Jersey City salon, but battled illness and shortness of breath for the next eight months, often feeling like she was “breathing through a straw.”
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She was exhausted, and sometimes slow to find her words. When plucking a client’s eyebrows, “I would literally forget which eyebrow I was plucking,” Hundley said. “My brain was so slow.”
When she contracted a breakthrough infection in July, her symptoms were short-lived and milder: cough, runny nose and fatigue. But the tightness in his chest remains.
“I feel like it’s something that will always be there,” said Hundley, who warns friends with COVID not to overwork themselves. “You may not feel terrible, but inside your body there is a war going on.”
Although each subvariant of omicron has different mutations, they are similar enough that people infected with one, like BA.2, have relatively good protection against newer versions of omicron, like BA.5. People sickened by earlier variants are much more vulnerable to BA.5.
Several studies have found that vaccination reduces the risk from the long COVID. But the extent of this protection varies across studies, from as little as a 15% off in danger at more than 50% decrease. A study published in July found that the risk of long COVID decreased with each dose people received.
For now, the only surefire way to prevent long COVID is to avoid getting sick. This is no easy task as the virus is muting and Americans have largely stopped masking up in public places. Current vaccines are excellent at preventing serious illnesses, but do not prevent the virus from spreading from person to person. Scientists are working on next-generation vaccines – “variant-proof” injections that would work on any version of the virus, as well as nasal sprays that could actually prevent the spread. If they are successful, it could significantly curb new long COVID cases.
“We need vaccines that reduce transmission,” Al-Aly said. “We need it yesterday.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.