St. Louis, MO—Pharmacists promoting initial COVID-19 vaccines and boosters often get a response somewhat like, “Oh, I had COVID. It was like a bad cold. I’m not worried about getting it again.”
New research suggested those who recovered from past bouts with SARS-CoV-2 should be more concerned.
A study from the Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System reveals the troubling health consequences of reinfection. The findings, published in Nature Medicine, were that repeat SARS-CoV-2 infections contributed significant additional risk of adverse health conditions in multiple organ systems.
Among those additional risks are greater risk of hospitalization; disorders affecting the lungs, heart, brain, and the body’s blood, musculoskeletal, and gastrointestinal systems; and death. Diabetes, kidney disease, and mental health issues are also affected by reinfection.
“During the past few months, there’s been an air of invincibility among people who have had COVID-19 or their vaccinations and boosters, and especially among people who have had an infection and also received vaccines; some people started referring to these individuals as having a sort of super immunity to the virus,” stated senior author Ziyad Al-Aly, MD, clinical epidemiologist. “Without ambiguity, our research showed that getting an infection a second, third or fourth time contributes to additional health risks in the acute phase, meaning the first 30 days after infection, and in the months beyond, meaning the long COVID phase.”
What are the consequences? “This means that even if you’ve had two COVID-19 infections, it’s better to avoid a third,” Dr. Al-Aly stated. “And if you’ve had three infections, it’s best to avoid the fourth.”
The report noted that the first infection with SARS-CoV-2 is linked with an increased risk of acute symptoms, postacute death, and sequelae in various organ systems. The authors noted that it had been unclear what effect future infections had.
To answer that question, the study team used the U.S. Department of Veterans Affairs’ national healthcare database to build a cohort of 443,588 individuals with one SARS-CoV-2 infection; 40,947 with reinfection—defined as two or more infections; and a noninfected control group of 5.3 million.
Compared with no reinfection, the results indicated that reinfection contributed the additional risks of:
• Death (hazard ratio (HR) = 2.17; 95% CI, 1.93-2.45)
• Hospitalization (HR = 3.32; 95% CI, 3.13-3.51)
• Sequelae, including pulmonary, cardiovascular, hematological, diabetes, gastrointestinal, kidney, mental health, musculoskeletal, and neurological disorders.
“The risks were evident regardless of vaccination status,” the researchers advised. “The risks were most pronounced in the acute phase but persisted in the post-acute phase at 6 months. Compared to noninfected controls, cumulative risks and burdens of repeat infection increased according to the number of infections.”
They noted that the research was limited by including a cohort of mostly white males.
Still, the authors added, “Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention.”
How to do that? Dr. Al-Aly recommended, “People should do their best to prevent repeat infections by masking, for example, getting all of their eligible boosters, staying home when sick. Also, get a flu shot to prevent illness. We really need to do our best to reduce the chance we will have a twin-demic of both COVID-19 and the flu this winter season.”
Overall, the researchers found that people with COVID-19 reinfections were twice as likely to die and three times more likely to be hospitalized than those with no reinfection. They also were 3.5 times more likely to develop lung problems, three times more likely to suffer heart conditions, and 1.6 times more likely to experience brain conditions than patients who had been infected with the virus only once.
“Our findings have broad public health implications as they tell us that strategies to prevent or reduce the risk of reinfection should be implemented,” Dr. Al-Aly said. “Going into the winter season, people should be aware of the risks and practice vigilance to reduce their risk of infection or reinfection with SARS-CoV-2.”
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