Insights from an N3C RECOVER EHR-based cohort study characterizing SARS-CoV-2 reinfections and Long COVID
Hadley, E; Yoo, YJ; Patel, S; et al., Communications Medicine
Published
July 2024
Journal
Communications Medicine
Abstract
Background: Although the COVID-19 pandemic has persisted for over 3 years, reinfections with SARS-CoV-2 are not well understood. We aim to characterize reinfection, understand development of Long COVID after reinfection, and compare severity of reinfection with initial infection. Methods: We use an electronic health record study cohort of over 3 million patients from the National COVID Cohort Collaborative as part of the NIH Researching COVID to Enhance Recovery Initiative. We calculate summary statistics, effect sizes, and Kaplan-Meier curves to better understand COVID-19 reinfections. Results: Here we validate previous findings of reinfection incidence (6.9%), the occurrence of most reinfections during the Omicron epoch, and evidence of multiple reinfections. We present findings that the proportion of Long COVID diagnoses is higher following initial infection than reinfection for infections in the same epoch. We report lower albumin levels leading up to reinfection and a statistically significant association of severity between initial infection and reinfection (chi-squared value: 25,697, p-value: <0.0001) with a medium effect size (Cramer's V: 0.20, DoF = 3). Individuals who experienced severe initial and first reinfection were older in age and at a higher mortality risk than those who had mild initial infection and reinfection. Conclusions: In a large patient cohort, we find that the severity of reinfection appears to be associated with the severity of initial infection and that Long COVID diagnoses appear to occur more often following initial infection than reinfection in the same epoch. Future research may build on these findings to better understand COVID-19 reinfections.
Authors
Emily Hadley, Yun Jae Yoo, Saaya Patel, Andrea Zhou, Bryan Laraway, Rachel Wong, Alexander Preiss, Rob Chew, Hannah Davis, M Daniel Brannock, Christopher G Chute, Emily R Pfaff, Johanna Loomba, Melissa Haendel, Elaine Hill, ; N3C and RECOVER consortiaRichard Moffitt
Keywords
Not available
Short Summary
This RECOVER study looks at how often people get COVID-19 more than once and if they develop Long COVID afterward. The study also looks at whether a repeat COVID-19 infection, or reinfection, is worse than the first one. RECOVER researchers identified a reinfection when a person had a positive COVID-19 test at least 60 days after their first infection. They studied the health records of over 3 million patients in different ways to understand COVID-19 reinfections. By studying a large number of patients, the researchers were able to learn key details about COVID-19 reinfections. They found that about 6.9% of people got COVID-19 more than once. Most reinfections happened when the Omicron variant was spreading. Researchers found that Long COVID was more common in people who had COVID-19 for the first time compared to those who were reinfected. This finding suggests that protecting yourself from getting COVID-19 is the best way to prevent Long COVID. People who had a moderate or severe case of COVID-19 the first time were also more likely to get very sick again when they were reinfected. These people were often older and at higher risk of death.