Unraveling the Interplay of Omicron, Reinfections, and Long Covid

Authors:  Liz Szabo AUGUST 26, 2022 KHN

The latest covid-19 surge, caused by a shifting mix of quickly evolving omicron subvariants, appears to be waning, with cases and hospitalizations beginning to fall.

Like past covid waves, this one will leave a lingering imprint in the form of long covid, an ill-defined catchall term for a set of symptoms that can include debilitating fatigue, difficulty breathing, chest pain, and brain fog.

Although omicron infections are proving milder overall than those caused by last summer’s delta variant, omicron has also proved capable of triggering long-term symptoms and organ damage. But whether omicron causes long covid symptoms as often — and as severe — as previous variants is a matter of heated study.

Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, is among the researchers who say the far greater number of omicron infections compared with earlier variants signals the need to prepare for a significant boost in people with long covid. The U.S. has recorded nearly 38 million covid infections so far this year, as omicron has blanketed the nation. That’s about 40% of all infections reported since the start of the pandemic, according to the Johns Hopkins University Coronavirus Research Center.

Long covid “is a parallel pandemic that most people aren’t even thinking about,” said Akiko Iwasaki, a professor of immunobiology at Yale University. “I suspect there will be millions of people who acquire long covid after omicron infection.”

Scientists have just begun to compare variants head to head, with varying results. While one recent study in The Lancet suggests that omicron is less likely to cause long covid, another found the same rate of neurological problems after omicron and delta infections.

Estimates of the proportion of patients affected by long covid also vary, from 4% to 5% in triple-vaccinated adults to as many as 50% among the unvaccinated, based on differences in the populations studied. One reason for that broad range is that long covid has been defined in widely varying ways in different studies, ranging from self-reported fogginess for a few months after infection to a dangerously impaired inability to regulate pulse and blood pressure that may last years.

Even at the low end of those estimates, the sheer number of omicron infections this year would swell long-covid caseloads. “That’s exactly what we did find in the UK,” said Claire Steves, a professor of aging and health at King’s College in London and author of the Lancet study, which found patients have been 24% to 50% less likely to develop long covid during the omicron wave than during the delta wave. “Even though the risk of long covid is lower, because so many people have caught omicron, the absolute numbers with long covid went up,” Steves said.

recent study analyzing a patient database from the Veterans Health Administration found that reinfections dramatically increased the risk of serious health issues, even in people with mild symptoms. The study of more than 5.4 million VA patients, including more than 560,000 women, found that people reinfected with covid were twice as likely to die or have a heart attack as people infected only once. And they were far more likely to experience health problems of all kinds as of six months later, including trouble with their lungs, kidneys, and digestive system.

“We’re not saying a second infection is going to feel worse; we’re saying it adds to your risk,” said Dr. Ziyad Al-Aly, chief of research and education service at the Veterans Affairs St. Louis Health Care System.

Researchers say the study, published online but not yet peer-reviewed, should be interpreted with caution. Some noted that VA patients have unique characteristics, and tend to be older men with high rates of chronic conditions that increase the risks for long covid. They warned that the study’s findings cannot be extrapolated to the general population, which is younger and healthier overall.

“We need to validate these findings with other studies,” said Dr. Harlan Krumholz, director of the Yale New Haven Hospital Center for Outcomes Research and Evaluation. Still, he added, the VA study has some “disturbing implications.”

With an estimated 82% of Americans having been infected at least once with the coronavirus as of mid-July, most new cases now are reinfections, said Justin Lessler, a professor of epidemiology at the University of North Carolina Gillings School of Global Public Health.

Of course, people’s risk of reinfection depends not just on their immune system, but also on the precautions they’re taking, such as masking, getting booster shots, and avoiding crowds.

New Jersey salon owner Tee Hundley, 43, has had covid three times, twice before vaccines were widely available and again this summer, after she was fully vaccinated. She is still suffering the consequences.

After her second infection, she returned to work as a cosmetologist at her Jersey City salon but struggled with illness and shortness of breath for the next eight months, often feeling like she was “breathing through a straw.”

She was exhausted, and sometimes slow to find her words. While waxing a client’s eyebrows, “I would literally forget which eyebrow I was waxing,” Hundley said. “My brain was so slow.”

When she got a breakthrough infection in July, her symptoms were short-lived and milder: cough, runny nose, and fatigue. But the tightness in her chest remains.

“I feel like that’s something that will always be left over,” said Hundley, who warns friends with covid not to overexert. “You may not feel terrible, but inside of your body there is a war going on.”

Although each omicron subvariant has different mutations, they’re similar enough that people infected with one, such as BA.2, have relatively good protection against newer versions of omicron, such as BA.5. People sickened by earlier variants are far more vulnerable to BA.5.

Several studies have found that vaccination reduces the risk of long covid. But the measure of that protection varies by study, from as little as a 15% reduction in risk to a more than 50% decrease. A study published in July found the risk of long covid dropped with each dose people received.

For now, the only surefire way to prevent long covid is to avoid getting sick. That’s no easy task as the virus mutates and Americans have largely stopped masking in public places. Current vaccines are great at preventing severe illness but do not prevent the virus from jumping from one person to the next. Scientists are working on next-generation vaccines — “variant-proof” shots that would work on any version of the virus, as well as nasal sprays that might actually prevent spread. If they succeed, that could dramatically curb new cases of long covid.

“We need vaccines that reduce transmission,” Al-Aly said. “We need them yesterday.”

Omicron’s Mutations Impaired Vaccine Effectiveness, CDC Says

Authors: Madison Muller  August 25, 2022 Bloomberg

Almost 40% of people hospitalized in the US with the Covid subvariant that circulated this spring were vaccinated and boosted, highlighting how new strains have mutated to more readily escape the immunity offered by current shots.

The findings from scientists at the US Centers for Disease Control and Prevention underscore the importance of having Covid shots that are better at targeting omicron subvariants. 

From the end of March through May, when the omicron BA.2 and BA.2.12.1 subvariants were dominant in the US, weekly hospitalization rates increased for all adults — with those over 65 hit the hardest. Even so, the total number of hospitalizations remained much lower than when the delta variant was rampant last fall. 

The overall number of hospitalizations is an important point, said Abraar Karan, an infectious disease doctor at Stanford University.

“When you look at who’s hospitalized, it’s much more likely that they will have been vaccinated because so many people are vaccinated now,” Karan said. “The real comparison is how many hospitalizations do we have now versus in the past when people were not vaccinated or not up-to-date with boosters.”

CDC scientists found that vaccines and boosters did a better job of keeping people with delta infections out of the hospital than those with later variants. Effectiveness decreased slightly with the BA.1 variant, then changed significantly with BA.2 — with a much greater share of hospitalized adults who had been vaccinated with at least one booster. 

Read more: Retiring Fauci expected Covid to be ‘behind us’

Immunity from vaccines starts to wane within six months, so staying up-to-date with shots is key to being fully protected. Fewer than half of Americans have gotten a booster shot.

Adults with at least two booster shots fared better than other people when BA.2 was dominant. The majority of those admitted to the hospital also had at least one underlying condition. Unvaccinated adults were more than three times as likely to be hospitalized, but breakthrough infections still represented a significant number of the severe Covid cases, the data show.

US regulators have pushed Moderna Inc., Pfizer Inc. and BioNTech SE to expedite development of omicron-specific boosters for a September rollout. The drugmakers this week submitted early data to the US Food and Drug Administration seeking emergency clearance for updated shots that target the BA.4 and BA.5 virus strains. Scientists and vaccinemakers are already beginning to look toward next-generation shots that may provide longer-lasting protection against more variants. 

The new report’s findings also indicate that along with vaccination, other pharmaceutical and non-pharmaceutical measures should be used by those at highest risk of getting Covid. That includes easy access to therapeutics such as Pfizer’s antiviral drug Paxlovid and Gilead Sciences’ remdesivir, as well as AstraZeneca’s Evusheld for immunocompromised people. Scientists also note that wearing a mask can help guard the wearer from getting sick.  

Though the number of Covid deaths is the lowest it has been since last July, the US continues to see hundreds of deaths each day from Covid, CDC data show.

Why Are So Many People Getting COVID a Second and Third Time?

Doctors say if you got infected with the Omicron BA.1 or BA.2 variants, your antibodies might not fully protect you against the newer BA.4 and BA.5 subvariants now spreading through Southern California

Authors: Joel Grover and Josh Davis  June 16, 2022 NBC News

A sign encouraging mask use hangs on a fence before the local school council and the Chicago Teachers Union held a press conference Tuesday, Sept. 28, 2021 outside Jensen Elementary School in Chicago’s North Lawndale neighborhood. (Brian Cassella/Chicago Tribune/Tribune News Service via Getty Images)

Just days after Congresswoman Maxine Waters attended the Summit of the Americas in downtown LA last week, she tested positive for COVID-19. It was the second time in less than two months Waters has tested positive.

Until recently, many people who got COVID-19 thought they had months or years of protection from getting it again. But researchers tell the NBC4 I-Team that’s not the case.

“I’m not surprised to see people testing positive a second and third time,” says Dr. Saahir Khan, an infectious disease expert at USC’s Keck School of Medicine.

“The virus is mutating very quickly,” Dr. Khan told NBC4.

Doctors like Khan say if you got infected with the Omicron BA.1 or BA.2 variants, your antibodies might not fully protect you against the newer BA.4 and BA.5 subvariants now spreading through Southern California.

“As the virus mutates more and more, the antibodies to the prior variants give less and less protection over time,” Dr. Khan says.

But public health experts say second and third infections are often very “manageable.”

“The thing about these reinfections, is they get increasingly milder. Much less likely to even cause you to call your doctor,” says Dr. Amesh Adalja of Johns Hopkins Bloomberg School of Public Health.

So how soon can you get COVID for a second or third time, after a previous infection?

U.S. Health and Human Services Secretary Xavier Becerra tested positive this past Monday, less than a month after his first positive test.

“I wouldn’t say there’s a hard and fast timeline when you can get reinfected. It’s just that your protection wanes over time, over the course of a few months,” says Dr. Khan at USC.

Public health experts say the vaccines that are now available might not prevent reinfection by newer variants, but a new class of vaccines that could be out by this fall could provide wider protection.

“COVID is spread through the air, particularly in indoor spaces where people share the same air. And so what you can do to prevent reinfection is wear a mask indoors, particularly in a high risk situation where a lot of people congregate, like airports and grocery stores, Dr. Khan told the I-Team.

Two new Omicron COVID subvariants BA.4 and BA.5 being analyzed by WHO

Only a few dozen cases of BA.4 and BA.5 have been reported to the global GISAID database, according to WHO

Authors: Jennifer Rigby Reuters April 11, 2022

The World Health Organization said on Monday it is tracking a few dozen cases of two new sub-variants of the highly transmissible Omicron strain of the coronavirus to assess whether they are more infectious or dangerous.

It has added BA.4 and BA.5, sister variants of the original BA.1 Omicron variant, to its list for monitoring. It is already tracking BA.1 and BA.2 — now globally dominant — as well as BA.1.1 and BA.3.

The WHO said it had begun tracking them because of their “additional mutations that need to be further studied to understand their impact on immune escape potential.”

Viruses mutate all the time but only some mutations affect their ability to spread or evade prior immunity from vaccination or infection, or the severity of disease they cause.

For instance, BA.2 now represents nearly 94% of all sequenced cases and is more transmissible than its siblings, but the evidence so far suggests it is no more likely to cause severe disease.

Only a few dozen cases of BA.4 and BA.5 have been reported to the global GISAID database, according to WHO.

The UK’s Health Security Agency said last week BA.4 had been found in South Africa, Denmark, Botswana, Scotland and England from Jan. 10 to March 30.

All the BA.5 cases were in South Africa as of last week, but on Monday Botswana’s health ministry said it had identified four cases of BA.4 and BA.5, all among people aged 30 to 50 who were fully vaccinated and experiencing mild symptoms.

COVID cases rise again in half the states

Change in reported COVID-19 cases per 100k people in the last two weeks

March 23 to April 5, 2022

Half of the states are seeing COVID case numbers rise again while nationwide totals continue to fall.

The big picture: The Omicron subvariant known as BA.2 is the dominant strain circulating around the U.S., accounting for almost three out of every four cases.

By the numbers: Overall, cases dropped 5% across the U.S. to an average of about 28,700 cases from an average of more than 30,000 cases two weeks ago.

  • Three states — Alaska, Vermont and Rhode Island — had more than 20 new cases per 100,000 people.
  • Nine states — Utah, Montana, South Dakota, Kansas, Louisiana, Iowa, Arkansas, Indiana and Tennessee — had three or fewer new cases per 100,000 people.

Between the lines: Deaths fell to an average of 600 a day, down 34% from just over 900 a day two weeks ago.

What we’re watching: While U.S. officials have said they aren’t expecting a significant rise in hospitalizations or deaths, there have been signs of hospitalizations rising among older individuals in the U.K., the Guardian reported.

  • Since those numbers lag behind new cases, we won’t have a clear view of that impact in the U.S. for a few weeks.
  • The highly contagious subvariant surged through parts of Europe but probably will spare many Americans, thanks in part to this winter’s Omicron surge.

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This New COVID Variant Is the Most Unpredictable One Yet

Authors: David Axe Published Apr. 03, 2022 10:47PM ET 

After spreading across Asia and Europe, the BA.2 subvariant of the novel coronavirus is now dominant in the United States, according to the U.S. Centers for Disease Control and Prevention.

Right now, U.S. COVID cases are at a six-month low. But what happens next in the U.S. and nearby countries is hard to predict. Looking to Europe for hints isn’t enormously helpful because, on that continent, BA.2 has behaved… unpredictably. Indeed, unpredictability might be exactly what Americans—and everyone else—should expect as the pandemic enters its 28th month.

A patchwork of public health rules, varying vaccination rates, and differing amounts of natural immunity from past infections mean that no two countries are the same. But even those differences don’t fully explain BA.2’s uneven impact.

“The bottom line is that it is not predictable what BA.2 will do,” John Swartzberg, a professor emeritus of infectious diseases and vaccinology at the University of California-Berkeley’s School of Public Health, told The Daily Beast.

Amid this confusion, at least one thing remains true, however. As volatile as BA.2 is when it comes to countries and populations, you can still protect yourself by getting vaccinated.

Usually, there’s a pattern with new COVID lineages. An uptick in positive tests from clinics, hospitals, and wastewater samples correlates with a proportional increase in symptomatic infections.

But when it comes to BA.2, “something different seems to be occurring,” Peter Hotez, an expert in vaccine development at Baylor College, told The Daily Beast. “BA.2 is going up everywhere in terms of percentage of virus isolated” in tests, Hotez explained, “yet this translates into many different scenarios in terms of rise in cases.”“I can’t say with any certainty that this can be chalked up to their vaccine policies or vaccine politics alone.”

BA.2 is a highly mutated cousin of the previously dominant BA.1 subvariant of Omicron, the latest major variant—“lineage” is the scientific term–of the SARS-CoV-2 virus. Changes to the spike protein, which helps the virus to grab onto and infect our cells, make BA.1 and BA.2 extremely transmissible.

BA.1, which first appeared last fall and quickly drove record infections across much of the world, was the most contagious respiratory virus many virologists had ever seen—until BA.2 showed up a few weeks after its older cousin. BA.2 could be as much as 80 percent more transmissible than BA.1, Swartzberg said.

That’s why BA.2 eventually has outcompeted BA.1 and become the dominant sublineage in a steadily growing number of countries. It happened first in China, which for more than two years managed to avoid major COVID outbreaks through a combination of travel restrictions, business closures, careful contact-tracing and strict quarantine rules.

BA.2 blew right through China’s so-called “zero-COVID” strategy, causing cases to spike in Hong Kong then neighboring Shenzen then Shanghai. Authorities locked down each city in turn but still failed to stop the sublineage’s march across the country.

Europe was next. Health officials in the Americas watched nervously as BA.2 became dominant in one European country after another. After all, Europe tends to catch a particular coronavirus lineage or sublineage a month or six weeks before the U.S. and its neighbors do.

But BA.2 hasn’t sent clear signals. The first confusing datapoint actually wasn’t in Europe—it was in Africa. Weirdly, BA.2 was a virtual no-show in South Africa. That country logged a big surge in BA.1 cases in December, and then… nothing. A steady decline in cases even as BA.2 was ravaging other big, rich countries.

Some European countries likewise have escaped significant harm from BA.2. Others are reeling.

The United Kingdom and France caught BA.1 big-time in December and January. Both countries reported record numbers of cases that, owing to the vaccines, fortunately didn’t lead to record hospitalizations and deaths. Austria, by contrast, muddled through BA.1 before taking a huge hit from BA.2.

The U.K. reported a weekly average of 183,000 new daily cases in early January. Three weeks later, France counted a staggering weekly average of 354,000 daily new cases. The U.K.’s worst day for BA.1 deaths was Feb. 2, when authorities reported 535 COVID fatalities. On France’s worst day of BA.1, Feb. 8, 691 people died of COVID.

Comparing the two countries is natural. Not only are they neighbors, they also have roughly the same number of people–around 67 million. Both have managed to fully vaccinate around three-quarters of their populations. Both have wound down all major domestic COVID restrictions.

It makes sense that BA.2 would affect France and the U.K. similarly. And there, at least, the sublineage made some sense. The BA.2 wave that rolled across the U.K. and France starting in February has been relatively minor compared to the BA.1 wave—in both countries.

France’s daily new BA.2 cases seem to be leveling off at a weekly average of 126,000 infections. The U.K.’s weekly average of daily new cases peaked at 125,000 on March 21. Deaths tend to lag cases by a few weeks, so it’s not clear how fatal BA.2 will be in either country, but so far the worst daily death toll is much lower than it was for BA.1.

Now consider Austria. With just 8.9 million people, it’s smaller than the U.K. and France. But it’s equally well-vaccinated—and even came close to having a nationwide vaccine mandate before canceling the planned mandate back in early March, days before it was due to take effect. Austria, like most countries in Europe, has ended domestic restrictions on businesses and travel.

But unlike the U.K. and France, Austria caught BA.2 worsethan BA.1. Daily new case rates from BA.1 swelled to a weekly average of 34,000 and stayed there for a month and a half. Then BA.2 arrived in early March and, without much respite from BA.1, added another 10,000 daily new cases on top of the existing weekly average.“I don’t see a consistent thread between countries.”

Aside from a tiny dip in mid-March, the daily death rate has been going up and up on a weekly basis since January in Austria. BA.2 is claiming 40 lives a day, day after day on average.

It’s difficult to determine which policies make the difference—assuming differences in public health strategy matter at all against a virus as contagious as BA.2. Yes, Austria almost had a vaccine mandate, but it didn’t actually take force. And it’s very hard to say what the proposed mandate’s impact was, or would have been.

“Even if no additional people got vaccinated after a mandate was introduced, this doesn’t mean it didn’t ‘work,’ as the purpose of the mandate may have been to simply ensure that the only people you encounter when out at a restaurant or concert are vaccinated,” Maxwell Smith, a bioethicist at Western University in Ontario, told The Daily Beast.

“In that case, the vaccination mandate ‘working’ would mean reducing levels of transmission of the virus in the settings to which it applied,” Smith added. “Or, in the case of preserving critical infrastructure, it would mean something like fewer cases of severe illness or hospitalizations among those to whom the mandate applied.”

There are lots of ways Austria’s vaccine mandate might have improved outcomes for millions of Austrians at risk of catching COVID. But that didn’t stop Austria as a whole from suffering worse from BA.2 than other nearby countries.

“There are many factors that may have led to the case numbers we’re seeing both in Austria and its neighboring countries, so I can’t say with any certainty that this can be chalked up to their vaccine policies or vaccine politics alone,” Smith said.

Experts are at a loss to explain what other factors might be at work. If nearby countries have vaccinated roughly the same percentage of their populations and have also reopened their borders, businesses and schools—thus allowing for a certain level of natural immunity from past infection—then they should be equally prepared for a new viral lineage.

Clearly, they’re not. “I don’t see a consistent thread between countries,” Swartzberg said.

There are serious implications for the rest of the world as it braces for BA.2. Even strong vaccine uptake and lingering natural immunity might not spare you a big bump in infections. By the same token, BA.2 might just bypass a country for reasons no one fully understands, like it did with South Africa.

But the experiences of whole countries aren’t the experiences of individuals. Yes, BA.2 might have unpredictable effects on populations. But the science is clear on how people can reduce their personal risk. Favor well-ventilated indoor spaces. Wear an N95 mask when local case rates are high.

Most importantly, get vaccinated and boosted.