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Ziyad Al-Aly, MD Profile picture
@zalaly
Nov 10, 2022 • 13 tweets • 9 min read • Read on X
Here is the latest from our team in @NatureMedicine

Should you protect yourself from Covid-19 reinfection

Yes!

Reinfection is not benign; it is best to avoid it

by @BCBowe @Biostayan @zalaly

A thread 🧵

nature.com/articles/s4159…
In this study of 5.8 million people

41k with reinfection

444k with 1 infection (no reinfection)

5.3 million non-infected controls

Compared to no reinfection, reinfection increased risk of death, hospitalization, and other adverse health outcomes

nature.com/articles/s4159… Image
Compared to people who did not get reinfection, those with reinfection had

2 fold increased risk of death

3 fold increased risk of hospitalization

3 fold increased risk of heart problems

3 fold increased risk of blood clotting

nature.com/articles/s4159… Image
Reinfection also increased risk of

Diabetes
Fatigue
Kidney problems
Mental health disorders
Musculoskeletal problems
Neurologic disorders
Lung problems

nature.com/articles/s4159… Image
Reinfection was associated with adverse health outcomes in

unvaccinated

those who had 1 vaccine shot

those who had 2+ vaccine shots

nature.com/articles/s4159… Image
Importantly,

Reinfection increased the risks of death, hospitalization and organ injury in the acute and post-acute phase

and

the elevated risks remained evident at 6 months after reinfection

Reinfection increases the risk of acute and #LongCovid

nature.com/articles/s4159… ImageImage
Compared to noninfected controls, cumulative risks of repeat infection increased according to the number of infections

Every reinfection contributes additional risk

3 infections worse than 2

2 infections worse than 1

1 infection worse than none

nature.com/articles/s4159… Image
For the half a billion people who had #COVID19 once, the question of whether a second infection carries additional risks is important

We show that reinfection increases risks of adverse outcomes in acute and post-acute phases of COVID-19

nature.com/articles/s4159…
What does this mean for you?

If you have Covid once, twice, three or more times,

and

even if you are vaccinated and boosted

It is absolutely worth it to protect yourself from getting covid again

nature.com/articles/s4159…
What are the broader implications?

Reinfection will add to the pandemic's high and growing toll of death, disease, and disability

Prevention of infection and reinfection with SARS-CoV-2 should continue to be the goal of public health policy

nature.com/articles/s4159…
How do we move forward?

Reinfections are not benign and will continue to happen until

We have vaccines that

a. block transmission
b. offer durable protection
c. variant proof

We also need prevention and treatment strategies for #LongCovid

nature.com/articles/s4159…
Thanks to the amazing @sourwine for developing this press release (link below).

A clear accounting of the findings.

@WUSTLnews
@WUSTLmed

medicine.wustl.edu/news/repeat-co…
Thanks to our reviewers, editors, and all those who supported us in this project.

@WUSTL
@WUSTLmed
@WUSTLnews
@VREFSTL
@sourwine
@VAResearch
@vahsrd

nature.com/articles/s4159…

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More from @zalaly

Ziyad Al-Aly, MD Profile picture
Feb 22
📣 New in @ScienceMagazine

I teamed up with @EricTopol to write this #SciencePerspective on Long Covid

Solving the puzzle of #LongCovid

A long 🧵

science.org/doi/10.1126/sc…
First, what is Long Covid?

It is a complex nonmonolithic multisystemic disease with sequelae across almost all organ systems

It can manifest across the life span (from children to older adults) and across race & ethnicity, sex, & baseline health status

science.org/doi/10.1126/sc…
Long Covid is likely a disease with many subtypes that may have different risk factors (genetic, environmental, etc.) and distinct biologic mechanisms that may respond differently to treatments.

science.org/doi/10.1126/sc…
Read 19 tweets
Ziyad Al-Aly, MD Profile picture
Dec 24, 2023
3 key messages from our recent paper in @TheLancetInfDis

1. Covid is worse than flu

Covid remains a much more serious threat to human health than the flu

thelancet.com/journals/lanin…
2. Comparing the two:

COVID is more multisystemic
Flu is more respiratory

thelancet.com/journals/lanin…
3. Both covid and flu cause more health loss in the long-term than what is evident around the time of the infection

Trivializing these illnesses as inconsequential ignores the large burden of health loss that occurs in the post-acute/chronic/long phase

thelancet.com/journals/lanin…
Read 4 tweets
Ziyad Al-Aly, MD Profile picture
Dec 16, 2023
Some people objected to use of the term “long flu”

Let me explain

A thread

thelancet.com/journals/lanin…
Lets start with the evidence about health loss

higher in post-acute flu than acute flu

higher in post-acute covid (long covid) than acute covid

In both acute and post-acute phases, burden of health loss was higher in covid than flu

thelancet.com/journals/lanin…
For me, a big revelation from the study was:

the realization that when you measure it, the burden of health loss is higher in post-acute (long) phase of illness than acute phase of illness

I knew this about covid
I did not know this about flu
Read 10 tweets
Ziyad Al-Aly, MD Profile picture
Dec 14, 2023
📣 New from my team in @TheLancetInfDis

Long-term outcomes of people hospitalized for COVID-19 vs seasonal influenza

A 🧵

thelancet.com/journals/lanin…
The study included:

81,280 individuals hospitalized for SARS-CoV-2
&
10,985 individuals hospitalized for seasonal influenza

We followed them for 1.5 years to characterize the risks of death, health care utilization & 94 health outcomes

thelancet.com/journals/lanin…
Covid had higher risk of death, healthcare utilization and sequelae in most organ systems than flu

This was evident in pre-delta, delta, and omicron; and also evident in vaccinated and unvaccinated individuals.

thelancet.com/journals/lanin…

Image
Image
Read 9 tweets
Ziyad Al-Aly, MD Profile picture
Aug 21, 2023
1/ 📣 New from my team in @NatureMedicine

In a study of 6 million people, we examined risk trajectories of 80 components of Long Covid over 2 years post-infection

📌 Risks remained elevated for many Long Covid conditions even 2 years infection

A 🧵

nature.com/articles/s4159…
2/ The study included:

138,818 individuals with SARS-CoV-2
&
5,985,227 non-infected controls

We followed them for 2 years to characterize the risk trajectories of death, hospitalization and 80 components of Long Covid

nature.com/articles/s4159…
3/ In people who were not hospitalized during the acute phase of COVID (the majority)

risk of death remained elevated up to 6 months

risk of hospitalization remained elevated up to 19 months

risks remained elevated for 31% of sequelae during the 2-year

nature.com/articles/s4159…
Image
Read 22 tweets
Ziyad Al-Aly, MD Profile picture
May 10, 2023
My piece in @TheLancetInfDis

Reflections on Long Covid prevention: progress and challenges

A thread

thelancet.com/journals/lanin…
LongCovid does not only affect patients and their life expectancy, but also societal wellbeing and economic indicators (labour participation and economic productivity).

Preventing long COVID should be a public and a global health priority.

thelancet.com/journals/lanin…
All evidence points in the same direction—SARS-CoV-2 antivirals might be important tools for prevention of Long Covid

Paxlovid reduced the risk by 26%

Molnupiravir reduced the risk by 14%

Ensitrelvir may also reduce the risk

thelancet.com/journals/lanin…
Read 12 tweets

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