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Healthful Hints: COVID reinfections just keep coming

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Haven’t we been dealing with COVID long enough? We think so, but the viruses don’t seem to have the same idea. So many of us have been good medical citizens, getting our vaccinations and boosters, trying to remember to wear a mask, washing hands (good preventive idea anyway!), etc., But we still get infected. To add insult to injury, it seems several people are getting reinfected, which may compound residual injury in some. I, personally, know of six folks who have been reinfected.

One couple got sick during the winter “down south,” and then in late spring “up north.” Another had some disabling issues in mid spring, then a second go round in the last two weeks, but not as bad. The other person had a siege two months ago with no lingering problems, but got virally zapped (complicated medical term) in the last week. At our house we seem to have been fortunate as far as we know, and have had no known COVID infections.

I called our local hospital today to ask about the new booster’s availability, mentioned reinfections, and the nurse responded, “Oh, several people have had it two and three times.” Not sure where her data came from, but it sounds plausible. Trying to find some reliable computer references has been a chore. Many articles discuss reinfections, but good scientific analyses are lacking. There have been reinfections noted since the first waves of the pandemic, but many more since the BA.5 and .4 have become the dominant variants in most populations.

Those variants have mutations in the infamous spike protein on the virus’s surface, which binds to human cells to allow invasion, that are not recognized by the immunity built from prior variants or vaccinations. Hence, they are much more transmissible. The definition of a reinfection has evolved since 2021. It describes a formerly infected individual, fully vaccinated, with or without boosters, who becomes infected again with COVID-19. The CDC defines it as COVID infection of a given patient with two different strains, occurring at least 45 days apart. Alternatively, it could be two positive genetic or PCR tests with negative tests in between them.

The key to identifying both infections and reinfections accurately is testing. Testing has become a sort Wild West scenario since home tests became available. And only in certain settings are the individual genetic tests analyzed for viral mutation typing. The home antigen or protein tests don’t detect which variant it is. Different sources are still putting out numbers of cases. But, these have to be vastly underestimated since so many, like all the folks we know, with second infections did their own tests, and didn’t report them to any medical resource.

One reference said that before the BA.5 and .4 emerged, the recurrence rate was in the 3% range in the spring when BA.2 was prevalent, but by summer the rate had risen to around 6% with BA.5 and .4 the winners in the reinfection derby. Other sources had different numbers but with increases in those periods.

Another issue that has been a question is if repeat infections cause more disease and death. Overall, the immediate impression is no. Yet, a study from the St. Louis Department of Veterans Affairs health care database of patient records compared outcomes of 257,427 vets with a first infection to those 38,926 who had a second or later infection, and also 5.4 million who never had known infections. The unofficial, non-peer reviewed results showed a second infection, compared to a first one, was associated with twice the rate of dying from any cause, as well as twice the risk of heart or lung problems. The risks increase with additional COVID infections. However, this population is not representative of the general population. (As an army vet, I can vouch for that.)

We’ll avoid the confusing discussion of whether vaccinations modify the reinfection potential. At face value, they may not add prevention power, but they still stave off severe disease and death! The essence of the subject seems to simplify to: yes, you can get reinfected by different variants, not the same one, but usually it isn’t too miserable, although our friends might argue with that from their episodes. Second infections as of yet don’t seem to add to the potential for long COVID disabilities. There is no magic way to avoid reinfections, just the same old techniques of masking if you’re around bunches of people, trying to maintain some physical distance (Good luck at a football game!), and getting vaccinated to the max.

With fall upon us, and cute little petri dishes, aka children, going back to crowded classrooms, other respiratory infections coming into their seasonal glory (like influenza) and people hardly giving a tinker’s damn anymore about the viruses, chances are there will be a new resurgence of the current versions and new mutations to take center stage. Don’t let others intimidate you if you wear a mask. Avoiding an infection is a courtesy for the people you work and live with as well as yourself. To paraphrase, it if it ain’t one dang variant, it’s another.

Dr. Bures, a semi-retired dermatologist, since 1978 has worked Winona, La Crosse, Viroqua and Red Wing. He also plays clarinet in the Winona Municipal Band and a couple dixieland groups. And he does enjoy a good pun.


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