Reinfection Time, Part 2
I am adding a disclaimer at the top here instead of deleting this post, so that links will find it. I was wrong. As predicted by my good friend and occasional colleague Jessica, I was misreading the study results. Reinfection isn’t necessarily worse then your first case. Rather than give you my analysis again, I will quote an actual epidemiologist:
“What about the Veteran’s Affairs (VA) reinfection study?
A few weeks ago, a now infamous VA pre-print was released comparing the risk of poor outcomes (e.g. death, health problems) among those with reinfections to those with primary infections. The viral pre-print sent shockwaves through media, as the study was widely misinterpreted to say the health risks from reinfections are worse than risks from primary infections. This is not what the study showed.
The authors did not compare reinfections to the same person’s primary infection. Instead they compared people with reinfections to a separate cohort of people with primary infections (see figure below). Because of this, the only thing we can conclude is that being infected again is worse than not being infected again, which is expected.” Source
Reinfection Time, Part 2
Last week I talked about why everyone seems to be getting their second - or third - COVID infection. Today I’m going to talk about why that’s really, really bad. I’ll give you the short version right here, in case you’re busy today and can’t read to the end: according to a new paper, your second infection is much more likely to be dangerous than your first. It has a doubled risk of death, lung problems, and heart problems. It has triple the risk of hospitalization. Your third infection carries even more risk than your second.
In the words of the authors, “compared to people with first infection, reinfection contributes additional risks of all-cause mortality, hospitalization, and adverse health outcomes in the pulmonary and several extrapulmonary organ systems (cardiovascular disorders, coagulation and hematologic disorders, diabetes, fatigue, gastrointestinal disorders, kidney disorders, mental health disorders, musculoskeletal disorders, and neurologic disorders); the risks were evident in those who were unvaccinated, had 1 shot, or 2 or more shots prior to the second infection; the risks were most pronounced in the acute phase, but persisted in the post-acute phase of reinfection, and most were still evident at 6 months after reinfection.”
That’s a whole lot of bad. It’s saying that the initial acute infection is worse when it’s a reinfection. It’s also saying that that the lingering system impact of COVID - also known as long COVID - is more likely after a reinfection. So, every time you get COVID you’re more likely to get very sick or die during your acute phase and those odds keep getting worse. And every time you get COVID you’re more likely to get long COVID - with those odds also going up with every additional infection,
The paper is a pre-print, which means it hasn’t completed peer review and been published formally. We could still discover a major flaw. But the authors are COVID researchers who have consistently published high quality work, and people I respect trust the research. You can find Eric Topol’s take on it here.
I think the paper is solid. I also think there is a mechanism of action here that makes sense. COVID damages multiple body systems, and it’s logical that those weakened systems would be more vulnerable in the face of the next infection. Immunopathology is the phenomenon where the body’s own immune system causes harm in response to an infection. We know that’s a factor in the harm done by COVID. It could also be a factor in the severity of the damage done by reinfection. I also found a paper on MERS, our previous novel coronavirus, indicating that some rabbits had more severe illnesses when they were reinfected with the virus.
Or there could be something completely new and weird going on. Viruses evolve all kinds of strange tricks. The dengue virus, for example, gets worse with every reinfection because of an unique interaction with the immune system. Zika does something similar. Chickenpox hides in your body as varicella zoster, and then comes back later in life as shingles. We don’t actually know if people can be reinfected by Ebola, because it’s so effective at hiding in the body that we don’t know if a case is a reinfection or a resurgence without gene sequencing.
So, last week I talked about the phenomenon of the rise in COVID reinfection. This week I told you that reinfection is worse than the first infection. Who knows what joy I will bring you next week?
Note: while researching viral reinfections, I found this 2007 article on the OG SARS outbreak of 2003, warning us all that another novel coronavirus was likely to emerge from an animal vector and the world wasn’t ready. Anyone who tells you that we didn’t see COVID coming is either ignorant, stupid, or lying.