While COVID-19’s effects on the lungs and respiratory system are well known, there is growing research suggesting that the virus is also affecting the heart, with potentially lasting effects.
In a presentation at the annual meeting of the Biophysical Society, an international biophysics scientific group, Dr. Andrew Marks, chair of the department of physiology at Columbia University, and his colleagues reported on changes in the heart tissue of COVID-19 patients who had died from the disease, some of whom also had a history of heart conditions.
The team conducted autopsy analyses and found a range of abnormalities, particularly in the way heart cells regulate calcium. All muscles, including those in the heart, rely on calcium to contract. Muscle cells store calcium and open special channels inside of cells to release it when needed. In some conditions such as heart failure, the channel remains open in a desperate attempt to help the heart muscle contract more actively.
The leaking of calcium ultimately depletes the calcium stores, weakening the muscle in the end. “We found evidence, in the hearts of COVID-19 patients, abnormalities in the way calcium is handled,” says Marks. In fact, when it came to their calcium systems, the heart tissue of these 10 people who had died of COVID-19 looked very similar to that of people with heart failure.
Marks plans to further explore the heart changes that SARS-CoV-2 might cause by studying how the infection affects the hearts of mice and hamsters. He intends to measure changes in immune cells as well as any alterations in heart function in the animals both while they are infected and after they have recovered in order to document any lingering effects.
“The data we present show that there are dramatic changes in the heart,” Marks says. “The precise cause and long term consequences of those need to be studied more.” Previous studies have revealed a link between COVID-19 infections and heart-related problems. A large 2022 analysis of patients in the VA system—some of whom had recovered from COVID-19 and others who had never been diagnosed—showed those who had had COVID-19 had higher rates of a number of heart-related risks, including irregular heartbeats heart attack and stroke.
Dr. Susan Cheng, chair of women’s cardiovascular health and population science at Cedars-Sinai, is studying whether there are any associations between rates of heart attacks and surges of COVID-19 infections, in order to better understand how the virus might be affecting the heart.
There is also early evidence showing that people with hypertension may be at higher risk of heart events when they get COVID-19. What connects the viral infection to the heart isn’t known yet, but the body’s immune system is likely a major contributor.
“It’s been well documented that with SARS-CoV-2, the body responds with an inflammatory response that involves activating the immune system in a very dramatic way,” says Marks. “In the heart, it looks like the same inflammatory process is activating pathways that could be detrimental to heart function.” But more research needs to clarify that process, says Dr. Mariell Jessup, chief science and medical officer at the American Heart Association.
“If the assumption is that the infection causes inflammation, and the assumption is that the inflammation is precipitating more cardiovascular events, then how is it doing that?” It’s also possible that viruses can infect and adversely affect heart cells. “We’re still at the tip of the iceberg with respect to understanding how COVID-19 affects health,” says Cheng.
Marks is hoping to get some of those answers with the animal experiments he plans to conduct. “We hope to optimize the animal model to best reflect what we think is going on in patients,” he says. “We want to study at a very, very detailed level what happens in the heart when the virus infects an animal.”
Ultimately, that knowledge will help to better treat people who might be at higher risk of heart-related problems from COVID-19, which could in turn reduce hospitalizations and deaths from the disease. Marks has already developed a potential drug that can address the leaking calcium if that proves to be a problem with COVID-19; he is ready and eager to test it if his animal studies justify the experiments.
Until more definitive studies clarify how the COVID-19 virus is affecting the heart, Jessup says she would advise her patients to “control the things we know how to control,” such as the risk factors that might put them at higher risk of heart disease to begin with, such as obesity, high blood pressure, and high cholesterol.
And with more data emerging, if people are getting repeat COVID-19 infections, it’s also probably worth seeing their doctor to get their heart disease risk factors checked as well. “We spend a lot of time telling people they should get vaccinated,” she says. “For people who have had COVID-19, we should also be making sure they know their heart numbers and make sure they know blood pressure. “We know how to prevent heart disease, so let’s do the things we know how to do.”
Inside a cramped, windowless room at Children’s National Hospital in Washington, D.C., a special team of clinicians gathers every Wednesday to help kids struggling with long covid.
The cases are complex, varied and heartbreaking. Once-active children now struggle to walk more than 50 feet. Some are so tired they sleep for 20 hours a day. Others have had to withdraw from school because virus-induced brain fog clouds their ability to solve simple math problems. The one thing they have in common is a covid infection.
The Centers for Disease Control and Prevention estimates there were roughly 26 million cases of covid among people under 18 during the first 20 months of the pandemic. But just how many kids are dealing with long covid is hard to pin down. The condition seems to be less common in children than in adults; one international study put the risk at nearly 6 percent.
But the sheer number of initial infections in kids means that many likely face lingering symptoms — yet few areas have facilities equipped to offer adequate care. That leaves many families, especially those with lower incomes or outside of major metro areas, to figure it all out themselves.
“It’s hard for kids. Their peers often don’t understand because they look normal,” said Alexandra Yonts, an infectious disease specialist at Children’s National Hospital, which sees three new patients a week and is booked through June 2023. “The parents vocalize a lot of frustration being passed around from doctor to doctor, since there’s still a lot of community physicians that don’t believe that long covid exists in kids, or just don’t know what to do about it.”
But in quick bursts of discussion between appointments, Yonts and her colleagues — in infectious disease, physical medicine, rehabilitation and psychology — hash out what they can do about it. The team decides which blood tests might identify causes of fatigue, weigh whether to bring in a neurologist to help with headaches or rule out other conditions that might diminish concentration.
“It helps that we can all be here talking with each other,” Yonts said. “It cuts down on cross-communication.” This kind of centralized, interdisciplinary care for long covid isn’t a silver bullet — scientists are still scrambling to understand what long covid is and how best to treat it — but it’s the best option for kids dealing with debilitating symptoms that often stump other doctors.
But there are just over a dozen such clinics in the U.S. Many are staffed with clinicians juggling more routine patient care and other responsibilities at the hospital, which limits their capacity and leads to monthslong waitlists.
Families often hit many dead ends before finding their way to dedicated clinics. “It’s pretty draining,” said Monika Varma, whose then-9-year-old son Akshay got covid in December 2021. “He’d get these really difficult headaches any time he was on a screen or tried to read, have temper tantrums and was just exhausted to his core,” she said. “He didn’t have the stamina to do anything.”
For several months Varma scrambled to find the right doctors, bringing Akshay to a pediatrician, neurologist, cardiologist and pulmonologist, some of whom were unfamiliar with long covid. “We were going piecemeal until we got into [Children’s National Hospital], but leaving that clinic we had the biggest sigh of relief,” she said. “You’re there for a long time, and the doctors are all talking to each other. By the end of the day, we knew, yes, this is long covid and had specific areas to focus on.”
Recovery wasn’t smooth or easy, but the tools Akshay got from the clinic — pacing strategies to manage his depleted energy, strategies to ride out mood swings and a neurology referral to help with headaches — have helped him get traction in feeling better. “He does have days where he’ll get really tired, but that’s not the norm anymore,” said Varma. “Knock on wood, I think we’re really on the other end of it.”
“We were very, very lucky that we had the care we had and the time that I was able to devote,” she said. “We were so much luckier than most people.”….Read more
Sick Woman Lying In Bed With Tissues (Getty Images/Obradovic)
SARS-CoV-2, the virus that causes COVID, is devastating precisely because it can worm its way into so many different organs and systems in the body. That manifests as different symptoms, from fever to trouble breathing, although an infection can be asymptomatic, too — that is, no symptoms at all.
Throughout the pandemic, there have been a few telltale signs of COVID infection. The loss of sense of smell and taste were chief among them. But as the virus has mutated again and again, creating new strains like Typhon (BQ.1) and Gryphon (XBB) which can evade some of our tools to fight it, it seem that the symptoms of COVID may have changed as well.
Recent estimates published by the Centers for Disease Control and Prevention on Friday pegged Typhon and its close relative Cerberus (BQ.1.1) as making up 27 percent of cases, an 11 percent increase from last week. Meanwhile, cases of BA.5, the strain that has dominated cases for the majority of summer, dipped below 50 percent for the first time in months.
Indeed, emerging data suggests the symptoms of COVID are changing with new variants. And, they can differ regardless of whether you’ve been vaccinated or not, or previously infected. Newly released data from the ZOE Health Study, which maintains the COVID Symptom Tracker app, finds that the dominant symptoms have shifted.
The app was originally launched in March 2020. It quickly logged one million users, who typed in how COVID was making them feel, allowing researchers to pin down some of the most common COVID symptoms. It was part of the reason why it became well-known that anosmia (loss of smell and taste) is a key symptom of the original COVID strain.
More recently, ZOE crunched the data from over 4.8 million users and found that after two vaccinations, the top-ranking symptoms were sore throat, runny nose, blocked nose, persistent cough, headache, in that order. (Vaccines can protect against severe disease, which generally means hospitalization or death, but breakthrough infections are not unheard of, although far less severe than infections in the unvaccinated.)
Loss of smell has slipped to the number nine slot, while shortness of breath is down at number 30 for this group. ZOE says this indicates “the symptoms as recorded previously are changing with the evolving variants of the virus.”
Just one dose of a vaccine can shift the order of most common symptoms to headache, runny nose, sore throat, sneezing and then persistent cough. For those who haven’t received a vaccine at all, the symptoms are generally closer to the original ranking from 2020: headache, sore throat, runny nose, fever and persistent cough.
However, loss of smell has slipped to the number nine slot, while shortness of breath is down at number 30 for this group. ZOE says this indicates “the symptoms as recorded previously are changing with the evolving variants of the virus.”
Just because SARS-2 appears to be evolving does not mean that it will become more “mild” — and it’s definitely nothing like the flu or a regular cold. The virus indiscriminately attacks the inner lining of blood vessels, causing injuries to the heart and lungs, and can cause literal brain damage. Given the broad range of debilitating symptoms known as long COVID, it doesn’t really make sense to call this “mild.”
Additionally, repeat infections could have unknown consequences — experts aren’t entirely sure what happens when you get COVID two, three or more times. That’s why watching out for new symptoms are so important. COVID may manifest differently because different viral strains sometimes impact different parts of the body. The delta strain, for example, found its niche in the lower respiratory tract, while omicron BA.2 tends to prefer the upper airway.
But it’s also critical to note that the data from ZOE is self-reported and doesn’t take into account demographic information or which variant caused the infection. It’s also using averages to report the most common symptoms — everyone is different and there is no guarantee here the disease will follow a certain course.
Nonetheless, the data gives a good idea of what to expect and people should be aware of these changes in order to best protect themselves. And the tools to fight COVID haven’t really changed: testing, masking, indoor ventilation, drugs like Paxlovid and, of course, the vaccines are all powerful strategies we should be using more to prevent this winter wave from becoming extremely deadly.
The Biden Administration warned this week that an estimated 30–70,000 Americans could die from the virus this winter. But even a small wave could cause supply chain disruptions and sicken millions. One thing that could make this winter worse than previous COVID waves is the rise of a “variant soup,” meaning multiple new strains of the virus surging at once.
In previous fall and winter waves, only one type of the virus (i.e. delta or the original “wild type” strain) has really dominated. Public health experts are also warning of a “twindemic” or even “tripledemic” in which COVID surges along with flu and respiratory syncytial virus (RSV). Most people may have never heard of RSV, but it was first discovered in chimpanzees in 1956, and the virus regularly causes outbreaks in humans.
It’s usually only serious in babies and older people, but it’s still not a fun illness. Even though the fall is just beginning, both flu and RSV are returning with a vengeance after relatively few cases the previous two years. On Friday, the Washington Post reported that this flu season is early and more severe than it has been in 13 years, “with at least 880,000 cases of influenza illness, 6,900 hospitalizations and 360 flu-related deaths nationally.”
Meanwhile, pediatric hospital beds across the U.S. are filling up with RSV cases, many of them completely full for weeks. Symptoms of flu and RSV may overlap (cold-like symptoms like fever, runny nose, coughing), making it somewhat confusing for sick people to know what illness they really have. That underscores the importance of testing for COVID and visiting a doctor when ill, if you have access to medical care. It also serves as a reminder to stay home when sick and mask up when possible.
Masking prevents the spread of all three of these viruses: flu, RSV and COVID. That’s one theory as to why the last two winters have been mostly free of diseases other than COVID, which has dominated due to its novelty and severe contagiousness. But as restrictions loosen, some of these more familiar viruses are coming roaring back. Keeping track of new and old symptoms is really only part of the equation. Masks, vaccines and social distancing continue to be some of the best tools at our disposal.
Only a couple dozen doctors specialize in chronic fatigue syndrome (ME/CFS). Now their knowledge could be crucial to treating millions more patients. Kira Stoops lives in Bozeman, Montana—a beautiful mountain town where it sometimes feels like everyone regularly goes on 50-mile runs. Stoops, however, can’t walk around her own block on most days. To stand for more than a few minutes, she needs a wheeled walker.
She reacts so badly to most foods that her diet consists of just 12 ingredients. Her “brain fog” usually lifts for a mere two hours in the morning, during which she can sometimes work or, more rarely, see friends. Stoops has myalgic encephalomyelitis, or chronic fatigue syndrome (ME/CFS). “I’m considered a moderate patient on the mild side,” she told me.
ME/CFS involves a panoply of debilitating symptoms that affect many organ systems and that get worse with exertion. The Institute of Medicine estimates that it affects 836,000 to 2.5 million people in the U.S. alone, but is so misunderstood and stigmatized that about 90 percent of people who have it have never been diagnosed.
At best, most medical professionals know nothing about ME/CFS; at worst, they tell patients that their symptoms are psychosomatic, anxiety-induced, or simply signs of laziness. While ME/CFS patients, their caregivers, and the few doctors who treat them have spent years fighting for medical legitimacy, the coronavirus pandemic has now forced the issue.
Even if that proportion is 10 times lower for SARS-CoV-2, the number of Americans with ME/CFS would still have doubled in the past three years. “We’re adding an immense volume of patients to an already dysfunctional and overburdened system,” Beth Pollack, a scientist at MIT who studies complex chronic illnesses, told me.
The U.S. has so few doctors who truly understand the disease and know how to treat it that when they convened in 2018 to create a formal coalition, there were only about a dozen, and the youngest was 60. Currently, the coalition’s website lists just 21 names, of whom at least three have retired and one is dead, Linda Tannenbaum, the CEO and president of the Open Medicine Foundation, told me.
These specialists are concentrated on the coasts; none work in the Midwest. American ME/CFS patients may outnumber the population of 15 individual states, but ME/CFS specialists couldn’t fill a Major League Baseball roster.
Stoops, who is 39, was formally diagnosed with ME/CFS only four years ago, and began receiving proper care from two of those specialists—Lucinda Bateman of the Bateman Horne Center and David Kaufman from the Center for Complex Diseases. Bateman told me that even before the pandemic, she could see fewer than 10 percent of the patients who asked for a consultation. “When I got into those practices, it was like I got into Harvard,” Stoops told me.
ME/CFS specialists, already overwhelmed with demand for their services, now have to decide how to best use and spread their knowledge, at a time when more patients and doctors than ever could benefit from it. Kaufman recently discharged many of the more stable ME/CFS patients in his care—Stoops among them—so that he could start seeing COVID long-haulers who “were just making the circuit of doctors and getting nowhere,” he told me.
“I can’t clone myself, and this was the only other way to” make room for new patients. Bateman, meanwhile, is feverishly focused on educating other clinicians. The hallmark symptom of ME/CFS—post-exertional malaise, or PEM—means even light physical or mental exertion can trigger major crashes that exacerbate every other symptom. Doctors who are unfamiliar with PEM, including many now running long-COVID clinics, can unwittingly hurt their patients by encouraging them to exercise.
Bateman is racing to spread that message, and better ways of treating patients, but that means she’ll have to reduce her clinic hours. These agonizing decisions mean that many existing ME/CFS patients are losing access to the best care they had found so far—what for Stoops meant “the difference between being stuck at home, miserable and in pain, and actually going out once or twice a day, seeing other humans, and breathing fresh air,” she told me.
But painful trade-offs might be necessary to finally drag American medicine to a place where it can treat these kinds of complex, oft-neglected conditions. Kaufman is 75 and Bateman is 64. Although both of them told me they’re not retiring anytime soon, they also won’t be practicing forever. To make full use of their expertise and create more doctors like them, the medical profession must face up to decades spent dismissing illnesses such as ME/CFS—an overdue reckoning incited by long COVID.
“It’s a disaster possibly wrapped up in a blessing,” Stoops told me. “The system is cracking and needs to crack.” Many ME/CFS specialists have a deep knowledge of the disease because they’ve experienced it firsthand. Jennifer Curtin, one of the youngest doctors in the field, has two family members with the disease, and had it herself for nine years. She improved enough to make it through medical school and residency training, which showed her that ME/CFS “just isn’t taught,” she told me. Most curricula don’t include it; most textbooks don’t mention it.
Even if doctors learn about ME/CFS, America’s health-care system makes it almost impossible for them to actually help patients. The insurance model pushes physicians toward shorter visits; 15 minutes might feel luxurious. “My average visit length is an hour, which doesn’t include the time I spend going over the patient’s 500 to 1,700 pages of records beforehand,” Curtin said. “It’s not a very scalable kind of care.” (She works with Kaufman at the Center for Complex Diseases, which bills patients directly.)
This also explains why the cohort of ME/CFS clinicians is aging out, with little young blood to refresh them. “Hospital systems want physicians to see lots of patients and they want them to follow the rules,” Kaufman said. “There’s less motivation for moving into areas of medicine that are more unknown and challenging.”
ME/CFS is certainly challenging, not least because it’s just “one face of a many-sided problem,” Jaime Seltzer, the director of scientific and medical outreach at the advocacy group MEAction, told me. The condition’s root causes can also lead to several distinct but interlocking illnesses, including mast cell activation syndrome, Ehlers-Danlos syndrome, fibromyalgia, dysautonomia (usually manifesting as POTS), and several autoimmune and gastrointestinal disorders.
“I’m still amazed at how often patients come in with Complaint No. 1, and then I find five to seven of the other things,” Kaufman said. These syndromes collectively afflict many organ systems, which can baffle doctors who’ve specialized in just one. Many of them disproportionately affect women, and are subject to medicine’s long-standing tendency to minimize or psychologize women’s pain, Pollack told me:
An average woman with Ehlers-Danlos syndrome typically spends 16 years getting a diagnosis, while a man needs only four. People with long COVID might have many of these conditions and not know about any—because their doctors don’t either. Like ME/CFS, they rarely feature in medical training, and it’s hard to “teach someone about all of them when they’ve never heard of any of them,” Seltzer said.
Specialists like Bateman and Kaufman matter because they understand not just ME/CFS but also the connected puzzle pieces. They can look at a patient’s full array of symptoms and prioritize the ones that are most urgent or foundational. They know how to test for conditions that can be invisible to standard medical techniques: “None of my tests came back abnormal until I saw an ME/CFS doctor, and then all my tests came back abnormal,” said Hannah Davis of the Patient-Led Research Collaborative, who has had long COVID since March 2020.
ME/CFS specialists also know how to help, in ways that are directly applicable to cases of long COVID with overlapping symptoms. ME/CFS has no cure but can be managed, often through “simple, inexpensive interventions that can be done through primary care,” Bateman told me. Over-the-counter antihistamines can help patients with inflammatory problems such as mast cell activation syndrome. Low doses of naltrexone, commonly used for addiction disorders, can help those with intense pain.
A simple but rarely administered test can show if patients have orthostatic intolerance—a blood-flow problem that worsens other symptoms when people stand or sit upright. Most important, teaching patients about pacing—carefully sensing and managing your energy levels—can prevent debilitating crashes. “We don’t go to an ME/CFS clinic and walk out in remission,” Stoops told me. “You go to become stabilized. The ship has 1,000 holes, and doctors can patch one before the next explodes, keeping the whole thing afloat.”
That’s why the prospect of losing specialists is so galling. Stoops understands why her doctors might choose to focus on education or newly diagnosed COVID long-haulers, but ME/CFS patients are “just so lost already, and to lose what little we have is a really big deal,” she said. Kaufman has offered to refer her to generalist physicians or talk to primary-care doctors on her behalf. But it won’t be the same: “Having one appointment with him is like six to eight appointments with other practitioners,” she said.
He educates her about ME/CFS; with other doctors, it’s often the other way round. “I’m going to have to work much harder to receive a similar level of care.” At least, she will for now. The ME/CFS specialists who are shifting their focus are hoping that they can use this moment of crisis to create more resources for everyone with these diseases. In a few years, Bateman hopes, “there will be 100 times more clinicians who are prepared to manage patients, and many more people with ME/CFS who have access to care.”
For any mainstream disease, such events—a report, a guideline revision, a review article—would be mundane. For ME/CFS, they felt momentous. And yet, “the current state of things is simply intolerable,” Julie Rehmeyer, a journalist with ME/CFS, told me. Solving the gargantuan challenge posed by complex chronic diseases demands seismic shifts in research funding, medical training, and public attitudes. “Achieving shifts like that takes something big,” Rehmeyer said. “Long COVID is big.”
COVID long-haulers have proved beyond any reasonable doubt that acute viral infections can leave people chronically ill. Many health-care workers, political-decision makers, and influencers either know someone with long COVID or have it themselves. Even if they still don’t know about ME/CFS, their heightened awareness of post-viral illnesses is already making a difference. Mary Dimmock’s son developed ME/CFS in 2011, and before the pandemic, one doctor in 10 might take him seriously.
“Now it’s the flip: Only one doctor out of 10 will be a real jerk,” Dimmock told me. “I attribute that to long COVID.” But being believed is the very least that ME/CFS patients deserve. They need therapeutics that target the root causes of the disease, which will require a clear understanding of those causes, which will require coordinated, well-funded research—three things ME/CFS has historically lacked.
But here, too, “long COVID is going to be a catalyst,” Amy Proal, the president of the Polybio Research Foundation, told me. She is leading the Long Covid Research Initiative—a group of scientists, including ME/CFS researchers, that will use state-of-the-art techniques to see exactly how the new coronavirus causes long COVID, and rapidly push potential treatments through clinical trials.
While they wait for better treatments, patients also need the medical community to heed the lessons that they and their clinicians have learned. For example, the American Academy for Family Physicians website still wrongly recommends exercise therapy and links ME/CFS to childhood abuse. “That group of doctors is very important to these patients,” Dimmock said, “so what does that say to them about what this disease is all about?”
Despite all evidence to the contrary, many clinicians and researchers still don’t see ME/CFS as a legitimate illness and are quick to dismiss any connection between it and long COVID. To ensure that both groups of patients get the best possible treatments, instead of advice that might harm them, ME/CFS specialists are working to disseminate their hard-won knowledge.
Bateman and her colleagues have been creating educational resources for cliniciansand patients, continuing-medical-education courses, and an online lecture series. Jennifer Curtin has spent two years mapping all the decisions she makes when seeing a new patient, and is converting those into a tool that other clinicians can use. As part of her new start-up, called RTHM, she’s also trying to develop better ways of testing for ME/CFS and its related syndromes, of visualizing the hefty electronic health records that chronically ill patients accumulate, and of tracking the treatments they try and their effects.
“There are a lot of things that need to be fixed for this kind of care to be scalable,” Curtin told me. Had such shifts already occurred, the medical profession might have had more to offer COVID long-haulers beyond bewilderment and dismissal. But if the profession starts listening to the ME/CFS community now, it will stand the best chance of helping people being disabled by COVID, and of steeling itself against future epidemics.
Pathogens have been chronically disabling people for the longest time, and more pandemics are inevitable. The current one could and should be the last whose long-haulers are greeted with disbelief. New centers that cater to ME/CFS patients are already emerging. RTHM is currently focused on COVID long-haulers but will take on some of David Kaufman’s former patients in November, and will open its waiting list to the broader ME/CFS community in December.
(It is currently licensed to practice in just five states but expects to expand soon.) David Putrino, who leads a long-COVID rehabilitation clinic in Mount Sinai, is trying to raise funds for a new clinic that will treat both long COVID and ME/CFS. He credits ME/CFS patients with opening his eyes to the connection between long COVID and their condition.
Every ME/CFS patient I’ve talked with predicted long COVID’s arrival well before most doctors or even epidemiologists started catching up. They know more about complex chronic illnesses than many of the people now treating long COVID do. Despite having a condition that saps their energy, many have spent the past few years helping long-haulers navigate what for them was well-trodden terrain: “I did barely anything but work in 2020,” Seltzer told me.
Against the odds, they’ve survived. But the pandemic has created a catalytic opportunity for the odds to finally be tilted in their favor, “so that neither patients nor doctors of any complex chronic illness have to be heroes anymore,” Rehmeyer said.
In some ways, the COVID pandemic has felt like the world’s longest dodgeball game: Only a few players remain untouched by the virus that has already killed over 1 million people in the US alone and seriously injured or otherwise impacted millions more around the world.
Now it’s clear the coronavirus is here to stay, which suggests annual rounds of an unpredictable game no one has agreed to play.So our new reality begs the question: What does a life where COVID strikes our immune system over and over again look and feel like?Repeat infections happen all the time with the flu and other respiratory viruses, including the handful of milder coronaviruses known to cause the common cold. These reinfections don’t worry doctors or anyone else that much.
In fact, studies show you can expect to catch these other coronaviruses at least one to two times a year. But SARS-CoV-2 is unlike any other virus we’ve seen before; it can affect nearly every organ and system in the body, even months after an infection subsides, and it has a high mutation rate with the potential to produce immunity-evading variants.
Put together, its characteristics make it difficult to understand what repeat exposures mean for our bodies in the short and long term. Despite the unknowns, most of the experts we spoke to agreed on one point: Each new infection does carry some risk, and early evidence suggests the negative effects may accumulate over time.
“You may dodge [serious outcomes] the first, second, or even third time around, but you might not be as lucky the fourth time,” said Dr. Ziyad Al-Aly, chief of research and education service at the Veterans Affairs St. Louis Health Care System. “Every infection is an opportunity for you to develop a problem with the virus; you can’t possibly avoid it forever.”
What is the COVID reinfection rate?
It was one of the great unknowns early in the pandemic, but we now know that you can get COVID more than once. In fact, there doesn’t appear to be any limit on how often you can get it. A person is considered to be reinfected if they test positive again after they first had COVID and recovered (including negative tests in between).
In a study of COVID-positive people in California and New York, about 4.6% to 6.3% had previously been infected. During the Omicron wave, people ages 19 to 29 living in Iceland had a 15% reinfection rate. The rate was around 12% in those who’d had one shot of the vaccine and 11% in those with two shots, according to a research letter published in the Journal of the American Medical Association in August.
While vaccination can reduce the risk of reinfection, severe symptoms, hospitalizations, and death, its effectiveness depends on how well the shot matches the circulating variant. (Federal health officials just authorized a new booster that targets the latest BA.4 and BA.5 Omicron variants and announced that Americans should now get a COVID shot, which will be updated each year, alongside their flu vaccine every fall.)
A previous infection does offer some protection against your next one; one study found that it was associated with an 80% lower risk for subsequent infection. The protection lasted for at least six months. But if a new variant emerges that’s significantly different from the last version of the virus, then you may get infected sooner than that. This is what happened during the Omicron wave, which helps explain why some people tested positive a second or third time within a few months’ time last winter.
Is it bad to get COVID over and over again?
Any infection — whether it’s viral, bacterial, or parasitic — taxes the body to some degree, which can differ drastically from one person to the next. What happens after an exposure depends on your vaccination status, previous infections, immune system, health conditions, and many other factors.
A COVID infection, particularly the first one, can drive your body to create protective antibodies and memory cells that help it to more quickly and efficiently defend itself the next time it’s exposed to the virus. (Vaccination spurs the body to create this protective shield while avoiding dangerous or life-threatening symptoms.)
We know, too, that this protection wanes over time. But some believe that an infection (no matter how mild or severe) may, for certain people, cause damage that can weaken their ability to fight off illness the next time they contract COVID.
At least one study released in June that has yet to be peer-reviewed seems to support that theory. Researchers analyzed more than 5.6 million US veterans’ health records and found that repeat COVID infections (with a mixture of the Delta and Omicron variants) may have a cumulative effect, each positive test bringing greater risks of serious health consequences such as heart, kidney, gastrointestinal, and neurological disorders.
These risks, which were present regardless of vaccination status, persisted even six months after reinfection, at which point they entered long COVID territory. The median amount of time between a first and second infection was about two and a half months, and about two months passed between the second and third infection. (The results were adjusted for demographic and health characteristics.)
Put simply, “getting hit with a baseball bat once is better than getting hit five times,” said Al-Aly, who is the lead author of the study. This phenomenon is also common following reinfections with Dengue fever, a mosquito-borne illness that occurs in tropical regions, Al-Aly told BuzzFeed News, in which any subsequent infection increases the risks of developing severe sickness.
It’s an idea called the “multiple hit hypothesis,” according to Erin Sanders, a clinical scientist studying long COVID and Lyme disease at MIT. “For a number of environmental exposures, genetic predispositions, and stressors that you encounter, it may lead to somebody being more prone to infection or severe illness and that’s something that I very much think is going to be at play with all of this.”
Not all experts think reinfections can cause cumulative damage
Dr. Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center, recommended that people take Al-Aly’s findings with a grain of salt. Because the study only included veterans, who tend to have more underlying health problems than the general public, Doron doubts the results are generalizable to everyone else.
“We know that over any period of time, and certainly over the period between one infection and another, chronic underlying conditions can get worse. That’s the natural course,” Doron said. “I don’t want people to think that the norm is to have chronic disease as a result of the first infection and then worsening chronic disease as a result of each next one.”
Some of Doron’s skepticism is based on research that shows adults and children experience similar or less severe symptoms during their second COVID infection compared with their first, and that the risk of reinfection decreases over time.
Gerardo Chowell, an epidemiology and biostatistics professor at the Georgia State University School of Public Health, isn’t surprised that coronavirus reinfections may cause mounting damage to your body, although he said this may not be true for everyone. Even before the pandemic, Chowell said, Americans’ overall baseline health had been declining, which can make people more vulnerable to infections of all kinds.
“People with weakened immune systems will have a harder time recovering from the virus, and that’s the most significant issue here,” said Chowell, adding that he’s hopeful SARS-CoV-2 will eventually become milder. (Evolutionarily speaking, viruses don’t benefit from killing people — doing so ruins their chance of surviving and spreading in the population.)“This doesn’t mean it won’t be able to kill people, it definitely will, but perhaps not on the level that we saw during the first two years of circulation,” Chowell said.
How could repeat infections affect the body?
How and why repeat exposures might affect the body remains largely unknown. The theories that do exist mirror those for long COVID.
One explanation is that an initial infection may cause serious injury somewhere in the body that may be unnoticeable at first until a subsequent infection “pushes them over the edge,” Al-Aly said. This may be especially true for people who may not know they have a medical condition like kidney damage or a heart problem.
Another possibility is that coronavirus particles are able to remain hidden in different parts of the body like the brain, gut, eyes, and heart, silently causing damage that accumulates with each infection. There’s also the theory that COVID triggers an autoimmune response that kicks a person’s immune system into overdrive, bringing about widespread inflammation that can cause symptoms like fatigue, brain fog, muscle aches, and more.
The problem, Doron of Tufts said, is that many of these speculations have little scientific backing. “All of the things that have been on the list as potential causes haven’t reliably been found in all of the people that have been studied and so it just makes it really, really hard to know.”
Can vaccination reduce the risks from reinfections?
There is at least some indication that vaccination can lower the risk of developing post-COVID symptoms. A review of 15 studies found that people who received two doses of a COVID vaccine were about half as likely to develop long COVID symptoms that persisted for over a month; this effect was stronger in those older than 60 and lowest among 19- to 35-year-olds. The findings are promising given nearly 1 in 5 adults in the US who have had COVID are experiencing long COVID, according to the CDC.
How someone responds to COVID or vaccination depends on a myriad of factors, including their health status and general lifestyle habits, as well as the circulating variant at the time and the societal preventive measures in places like mask requirements.
For now, the best way to avoid poor outcomes following each infection is to avoid infection altogether, get vaccinated, and seek treatment like Paxlovid as early into your bout with the virus as possible, if eligible.
“Every time you get infected, you’re rolling the dice for a good or bad outcome. So as you continue to play that game, you again increase your risks,” Sanders of MIT said. “One of the biggest things that anyone can do right now is to protect yourself from getting infected again, and even if you aren’t able to fully prevent infection, there’s something to be said for reducing the amount of virus and the dose of virus that you’re exposed to.”
