Forget what you thought you knew about contracting COVID-19 more than once. SARS-CoV-2, the virus that causes COVID-19, continues to evolve, and it also has information about your risk of re-infection.
“Two years ago, we thought that if you had COVID once you would never have it again,” said Dr. Preeti Malani, an infectious disease doctor at the University of Michigan in Ann Arbor. But especially with variants that have become dominant in the U.S. this summer, this thinking no longer applies.
When it emerged last November, the omicron variant of SARS-CoV-2 showed the ability to reinfect people who had had previous versions of the virus. This summer, according to the Centers for Disease Control and Prevention, omicron BA.4 and BA.5 subvariants are sweeping the U.S., with BA.5 accounting for the majority of COVID cases. Both appear to be even more adept than other omicron subvariants at evading the body’s defenses against infection.
Even having an earlier version of omicron does not appear to protect against symptomatic infection of the subvariants BA.4 and BA.5, Malani said. Subvariants can also infect vaccinated people.
“I have friends who have had COVID three times,” said Malani, who has jointly written a series of ongoing updates on the virus for JAMA. “One of my kids had it twice.” And Malani herself recently tested positive for the first time, despite being up to date on her vaccines.
The good news is that, although they spread more easily, subvariants do not appear to cause more serious illnesses. And vaccination still protects against serious illness, especially hospitalizations and death.
But patients with heart and stroke may need to intensify their precautions.
Dr. Deepak L. Bhatt, executive director of cardiovascular intervention programs at Brigham and Women’s Hospital in Boston, said it is difficult to know exactly how a real-time pandemic is developing and that more research is needed on COVID-19 and the heart to provide definitive answers about the risks.
But conditions such as stroke, heart failure and coronary artery disease are among those that can cause serious COVID-19 disease, the CDC says. And over the past month, Bhatt has seen “a number of patients” die from serious cardiovascular, cardiopulmonary or neurological diseases from coronavirus-related problems.
“It’s not that they died specifically for COVID,” said Bhatt, who is also a professor at Harvard Medical School. “But COVID overturned them.”
Some preliminary research suggests what multiple COVID-19 attacks may mean for heart and brain health. Researchers at the University of Washington School of Medicine in St. Louis. Louis, using data from the Department of Veterans Affairs, found that reinfection increased the risk of cardiovascular and other complications in people compared to people who had an infection. The risk increased with the number of infections.
The work has not been peer-reviewed, but Bhatt called his findings “credible” and said it made sense that with a major infection of any kind, getting infected a second time would mean more chances of trouble.
The best protection against reinfection is still to be vaccinated and keep up with reinforcements.
“There are still a lot of people who aren’t vaccinated and just thought, ‘Well, I’ll get natural immunity, or I’ll just wait,'” Bhatt said. “But those strategies won’t work.”
Vaccination helps even as the coronavirus evolves, Malani said. “It still protects against serious infections. And we must not lose sight of that.”
Updated omicron-adapted vaccines are expected to be available this year. Meanwhile, taking practical steps to avoid COVID-19 can be prudent, especially for people traveling.
For Malani, a week before a big holiday that required a negative COVID test, he urged his family to be careful. “I said to everyone, ‘Listen, I think we all need to be very careful. Because if one of us has COVID, none of us will make that trip.'”
Social connections are important, he said, but meetings should be outdoors, or at least in well-ventilated areas. And people who are not well should stay home.
The CDC says anyone who tests positive should stay home for at least five days and isolate themselves from others. And while many guidelines on when to wear a mask have been relaxed, Bhatt encourages people to disguise themselves in crowded indoor environments, “even if the people around you don’t.” Research shows that it helps stop the spread of the virus.
Malani acknowledged that it can be confusing when changing advice on something such as the risk of reinfection. “This is not because scientists and public health officials are asleep behind the wheel,” he said. That’s what happens when experts learn more. Therefore, people should follow the advice of reliable sources.
“The reason we care about this is because vulnerable people can die and our health care system can be overwhelmed with sick people,” he said. “And we’ve seen that happen.”
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