You’re much less likely to get long COVID if you’ve been vaccinated

Gail Matthews, UNSWIncreasing COVID-19 vaccination rates as quickly as possible is currently a major focus for Australia.

Doing so has clear benefits in reducing new infections and preventing severe disease, hospitalisation and death.

One question which is frequently asked is – does COVID vaccination prevent you from getting long COVID?

Here’s what the science says so far.

How many people get long COVID?

There has been much international debate as to the definition of long COVID, how common it is, and how long it may last.

Studies examining the frequency of long COVID range from anywhere to over 80% in hospitalised patients with severe initial illness, to as low as 2-3% in one large app-based study of largely young healthy people in the United Kingdom.

A recent review of 45 studies and almost 10,000 people suggested almost 75% of them reported at least one persistent symptom at 12 or more weeks after COVID infection.

Many of these studies are highly dependent on the choice of people studied, and whether they required a definite confirmation by positive swab testing.

The Australian ADAPT study (led by myself and other colleagues from St Vincent’s Hospital, Sydney), enrolled people who’d had confirmed positive PCR tests, as well as a mix of hospitalised people and those who didn’t go to hospital. It found around one-third of people had persistent symptoms at an average of two to three months after infection.

The most common symptoms were persistent fatigue, shortness of breath and chest tightness, although a variety of other symptoms were also reported. These findings are in keeping with most of the evolving research which documents a wide variety of long COVID symptoms.

One review published in August involving 15 studies and more than 47,000 people detailed up to 55 separate symptoms involving all body systems and organs. The five most common were fatigue, shortness of breath, palpitations, brain fog and loss of smell.

The diverse nature of long COVID symptoms makes a clear definition difficult. The World Health Organization is currently attempting to achieve a consensus agreement from its members. Expect to see further tweaks to this definition as it evolves.

Read more:
The mystery of ‘long COVID’: up to 1 in 3 people who catch the virus suffer for months. Here’s what we know so far

Yes, vaccination does reduce the risk of long COVID

Vaccination doesn’t prevent all COVID infections. “Breakthrough” infections in fully vaccinated people have been estimated to occur in a small proportion of people.

Breakthrough infections are more likely to have few or no symptoms, and are associated with lower levels of the SARS-CoV-2 virus.

Read more:
Why are we seeing more COVID cases in fully vaccinated people? An expert explains

Is this important in preventing long COVID? The answer is probably yes.

Currently our understanding of what causes or predicts long COVID is limited, not least because it’s probably a “catch all” definition for several different conditions with underlying causes.

In most studies, there were two main predictors of getting long COVID.

One was the severity of the initial illness, and the second being female sex.

The first of these is very likely to be impacted by vaccination and a recent study published in The Lancet medical journal gives weight to this argument. It looked at symptoms reported after vaccination among users of the COVID Symptom Study app in the UK.

More than 1.2 million users of the app reported at least one vaccine dose and around 900,000 had two doses. A small proportion, less than 1%, of each of these groups subsequently developed COVID infection and tracked their symptoms.

The study found vaccinated people had a much-reduced risk of being hospitalised or having multiple symptoms in the first week of infection.

Importantly, the likelihood of having a long duration of symptoms (over 28 days) was approximately halved.

This would clearly be expected to translate into a lesser number of people with long COVID at 12 weeks and beyond, although data confirming this is presently lacking.

So, vaccination has benefit in limiting both severe acute COVID infection and long COVID.

A word of caution though – long COVID appears to have a variety of triggers and many people suffering this condition didn’t have an initial severe illness. Long COVID also appears to be more common in females and this association remains unexplained.

Read more:
Do kids get long COVID? And how often? A paediatrician looks at the data

If the virus does trigger a long-lasting abnormal immune response in some people, it’s too soon to understand whether this can still occur after breakthrough infection post-vaccination.

Further research is urgently needed to understand the reasons for long COVID and direct potential treatments.

In the meantime, the likely effect of vaccination in reducing the risk of long COVID is yet another reason for us to roll up our sleeves.The Conversation

Gail Matthews, Professor and Program Head, Therapeutic Vaccine and Research Program, Kirby Institute, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Do kids get long COVID? And how often? A paediatrician looks at the data

Oded Balilty/AP/AAP

Philip Britton, University of SydneySince the rise of the more infectious Delta variant, we’ve seen reports of more cases in children than with previous strains of the virus.

Many parents are becoming more concerned about COVID in kids. One question many are asking is whether kids can get “long COVID”, too, where symptoms persist for months after the initial phase of the illness.

I’m a paediatrician and infectious diseases expert, who cares for children with COVID-19, and have been following the research in this area.

Children can get long COVID, but it seems to be less common than in adults. And they tend to recover quicker. Let’s go through the data.

What is long COVID?

There’s still no standard definition of long COVID, and the syndrome itself is quite variable.

Even though there’s no one form of it, three broad types of symptoms frequently occur:

  • cognitive effects, such as slowed thinking or “brain fog”
  • physical symptoms, including fatigue, breathlessness and pain
  • mental health symptoms, such as altered mood and anxiety.

Having symptoms that persist for more than 28-30 days following the onset of COVID is increasingly being labelled as long COVID in the medical literature.

The cumulative effect of long COVID symptoms can have a profound impact on sufferers’ ability to function in their daily life, work or schooling.

Read more:
The mystery of ‘long COVID’: up to 1 in 3 people who catch the virus suffer for months. Here’s what we know so far

Does it occur in children?

Long COVID probably does occur in children but it is likely less common than in adults.

Two Australian studies are useful here. In one study of adults and children, researchers found 20% of over 2,000 COVID cases in New South Wales had persistent symptoms at 30 days. By 90 days, this had reduced to 5%. The youngest age group (0-29 years) were more likely to recover quicker than older age groups.

In a study from Victoria that looked at children only, 8% of 151 children with mostly mild infections had some persistent symptoms for up to eight weeks. However, all had fully recovered by 3-6 months.

The most comprehensive study to date was a large study in children aged 5-17 years with mild COVID from the United Kingdom. Of 1,734 children, 4.4% reported persistent symptoms 28 days after the start of their illness.

In these children, the number of symptoms at 28 days was fewer compared to that in the first week of their illness.

The study found 1.8% of children has symptoms at day 56. Headache, fatigue and loss of smell were the main issues.

Three-quarters of the children with persistent symptoms went on to report a full recovery. However, a quarter were not followed up, so it was unclear how many among this small group may have had longer-term problems.

The same study observed children who had other viral illnesses, not COVID. It found 0.9% showed persistent symptoms at 28 days. This suggests a “background rate” of non-specific symptoms like headache and fatigue occurs in children, which is important to consider — although the rate in children following COVID was considerably greater.

Read more:
COVID: long-lasting symptoms rarer in children than in adults – new research

Some studies of COVID in children, for example, from Italy and Russia, have found persistent symptoms to be more common.

But these studies looked at variable populations, such as only those who were hospitalised or had moderate to severe illness, or collected data retrospectively.

Also, the children were infected during the first wave of COVID in Europe and the overall societal impacts may have contributed to some of the ongoing problems reported in children, like fatigue and insomnia.

This variability between studies makes it hard to compare them to work out the real rate of long COVID in children. Taken together, there seems to be a relative increase of persistent symptoms in teenagers compared with younger children.

What about Delta?

These studies were done before the effects of new variants of concern, most notably Delta, which has shown an increase in the number of COVID infections in children.

Delta might be leading to increased severity of COVID in adults. But there’s no compelling evidence yet that Delta is more severe in children.

Current admission rates in the 2021 Delta outbreak in NSW are no greater than those in children across Australia during 2020.

Read more:
Under-12s are increasingly catching COVID-19. How sick are they getting and when will we be able to vaccinate them?

Both adults and potentially children who get more severe COVID in the initial (“acute”) stage of their illness seem to be at increased risk of long COVID. But if Delta isn’t causing more severe illness in kids, it’s reasonable to expect Delta won’t increase the risk of long COVID in children either.

Scientists need to agree on a consensus definition of long COVID, and a standardised way to measure it.

Given the non-specific nature of many long COVID symptoms, research also needs to include a control group of kids who haven’t had COVID to really determine the COVID effect.

Do persistent symptoms occur following other viral infections?

Yes. Common examples include the glandular fever virus, also known as Epstein Barr virus, and Ross River fever virus.

Studies report up to 10-15% of children and adults with these infections report chronic symptoms including fatigue, pain, slowed thinking and altered mood.

What actually causes persistent symptoms following viral infections, including COVID, remains a major focus of researchers. Persisting infection itself is not likely.

Major theories include chronic inflammation, blood flow disturbances or nervous system damage.

What should I do if my child has had COVID?

Some children do have persisting cough and fatigue around the four-week mark.

Parents are understandably concerned, but should be reassured most children will fully recover. If there’s a pattern of improvement, that’s a reassuring sign.

If symptoms continue beyond four weeks, it’s sensible to stay in touch with your GP or paediatrician.

In terms of persistent symptoms following other infections, we do know what helps to promote recovery. Things to consider are:

  • ensuring good sleep
  • aiming to have your child gradually return to normal activities
  • where fatigue is an issue, use rest well, in short periods and after doing activities.

Returning to normal activities may require planning, including liaising with teachers around school return, which is especially important in the context of online learning.

Aim for incremental gains, remain optimistic about recovery, and always seek help if you’re not sure what to do.The Conversation

Philip Britton, Senior lecturer, Child and Adolescent Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why governments will have to consider the costs of long COVID when easing pandemic restrictions

Richard Meade, Auckland University of TechnologyWith governments worldwide under pressure to ease pandemic restrictions as vaccination rates rise and impatience with border restrictions grows, new threats become clearer.

One of the costliest, it is now feared, could be a tsunami of “long COVID” cases.

Long COVID is a serious ongoing illness that follows an acute episode of the disease. It is characterised by extreme fatigue, muscle weakness, post-exertional malaise and an inability to concentrate (“brain fog”), among many other symptoms.

The focus, therefore, needs to shift towards protecting quality of life as much as saving lives in the first place.

In the UK it is reported two million people have experienced long COVID. Around 385,000 having suffered symptoms for a year or more.

The nation’s so-called “Freedom Day” on July 19 went ahead despite expert warnings of soaring infections, especially among younger and unvaccinated people. A further 500,000 long COVID cases have been predicted during the current wave of infection.

These numbers far outstrip the already staggering 150,000 deaths attributed to the virus in the UK — and the associated costs will be significant.

Putting a price on long COVID

The social costs of long COVID should not be underestimated. For example, suppose an elderly person contracts COVID-19 and dies, when they might otherwise have lived in full health another five years. A health economist would say their early death has cost society five “quality-adjusted life years” (QALYs).

This is usually expressed as a monetary amount that can then be weighed against the cost of saving that person’s life when deciding on appropriate pandemic protections.

Contrast this with a young person contracting COVID-19 and not dying, but suffering long COVID for 10 years, with their estimated quality of life effectively halved while unwell.

Read more:
Long COVID: with one in three patients back in hospital after three months, where are the treatments?

They too will have lost an estimated five QALYs — the same social cost as the elderly person who died.

This means if we ease pandemic restrictions on the basis that people are no longer dying, we might be facing equally serious social costs from long COVID.

If long COVID is chronic and much more common than death from COVID (as the current data strongly suggest), the costs rise further. If sufferers of long COVID also face shortened lives, having endured years of debilitation and misery, the costs rise again.

Rough first estimates suggest the overall economic cost of long COVID could be almost half the cost of COVID-related deaths in the UK.

For younger people, however, the social costs of long COVID are estimated to far outstrip those of dying, meaning they will carry a disproportionate burden of the pandemic’s long-term costs.

Comparison with chronic fatigue syndrome

Long COVID is often likened to chronic fatigue syndrome (CFS), which is sometimes called ME (for myalgic encephalomyelitis). Both are characterised as a form of “post-viral fatigue syndrome”, with CFS leaving sufferers seriously debilitated and unable to maintain normal lives — often for years, even decades.

While we have no long-term data to gauge how chronic or serious long COVID might be, we should be mindful that it could be as long-lived as CFS.

Furthermore, long COVID is also reported to affect multiple organs in measurable ways, including damage to major organs like the heart and lungs.

Consequently, long COVID could shorten lives, if not end them. This distinguishes it from CFS which – frustratingly, for sufferers wanting to be taken seriously – lacks recognised objective markers.

Read more:
The mystery of ‘long COVID’: up to 1 in 3 people who catch the virus suffer for months. Here’s what we know so far

Protecting quality of life

On a personal note, I suffered CFS for 11 years and recovered in 2004. It emerged after a flu-like illness in 1993, which evolved into a constellation of symptoms that defied explanation or treatment.

Recovery required years off work and, with the care and support of family and friends, patient and determined rebuilding of my ability to lead a normal life.

The condition involved huge personal, social and professional costs. I was unable to maintain a normal life, relationships and work commitments. Constant ill health, with no end in sight, was enormously frustrating and miserable.

Read more:
I went from regular TV commentator on COVID to long COVID sufferer in just a few months

It never helped that medical practitioners were either incredulous or believed I was unwell but had no real solutions to offer.

Like CFS, long COVID is a serious condition that cannot be taken lightly. Even if not fatal, it can still seriously affect the sufferer’s quality of life. Hence, policymakers need to consider the social costs of long COVID when deciding when and how to ease pandemic restrictions.

Our pandemic response will need to be as much about protecting quality of life as it has been about saving lives. We need to take serious steps to keep long COVID at bay.The Conversation

Richard Meade, Research Fellow in Economics, and in Social Sciences & Public Policy, Auckland University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The mystery of ‘long COVID’: up to 1 in 3 people who catch the virus suffer for months. Here’s what we know so far


Vanessa Bryant, Walter and Eliza Hall Institute; Alex Holmes, The University of Melbourne, and Louis Irving, The University of MelbourneMost people who get COVID suffer the common symptoms of fever, cough and breathing problems, and recover in a week or two.

But some people, estimated to be roughly 10-30% of people who get COVID, suffer persistent symptoms colloquially known as “long COVID”.

Why do some people recover quickly, while others’ symptoms continue for months? This question has proved to be one of the most challenging to emerge from the COVID-19 pandemic.

While there’s no definitive answer yet, there are a few leading theories put forward by researchers around the world.

So what have we learned about long COVID, and what is the latest evidence telling us so far?

Read more:
I went from regular TV commentator on COVID to long COVID sufferer in just a few months

What is long COVID?

There’s no universally accepted definition of long COVID because it’s such a new phenomenon. A working definition is that it’s a term used to describe the situation where people experience a range of persistent symptoms following COVID-19.

The most common symptoms we (Louis and Alex) hear from sufferers in our long COVID clinic in Melbourne are fatigue, shortness of breath, chest pain, heart palpitations, headaches, brain fog, muscle aches and sleep disturbance. But it can also include very diverse symptoms like loss of smell and taste, increased worry especially in relation to one’s health, depression, and an inability to work and interact with society. In some of these people, it’s almost as if there’s a process that’s affected every part of their body.

Another feature for many in our clinic is the disconnect between the severity of their initial COVID illness and the development of significant and persisting symptoms during recovery. Most of our patients in the long COVID clinic had a milder illness initially, are often younger than those who’ve been hospitalised, and were healthy and active before getting COVID.

Regardless of the specific symptoms, many of our patients are concerned there’s persisting infection and damage occurring, along with a fear and frustration that they’re not improving.

So far we haven’t found any specific test to explain post COVID symptoms. This has confirmed our view that in most patients, long COVID symptoms are probably related to a complex interaction of physical and psychological processes that have arisen following the sudden inflammation caused by the COVID infection.

How many people have long COVID?

It’s very difficult to determine what proportion of people who get COVID end up with persistent symptoms. At this stage we don’t know the exact rate.

In our ongoing study of COVID immunity at the Walter and Eliza Hall Institute (WEHI) we found 34% of our participants were experiencing long COVID 45 weeks after diagnosis.

But our study is community-based and not designed to measure the overall prevalence of the condition in the wider population.

The data is still emerging and different sources cite different rates. It depends how the researchers recruited and followed participants, for example, as part of post-discharge follow up or community surveys.

The World Health Organization says its 10%, while a study from the UK found 30%. The proportion of people affected is likely to be different between countries.

Many doctors are still not aware of long COVID, so many cases may not be recognised and added to studies. Indeed, after some data from our WEHI study aired on the ABC’s 7.30 program, more people with ongoing symptoms came forward to join the study, and some didn’t know there was research being conducted or even that the condition existed.

We need a fully-fledged “population study” to determine the approximate rate. This would mean contacting a whole group of people who contracted COVID and seeing how many have ongoing problems at a set time, such as a year later. Doing these studies is difficult, but it would mean we can answer an important question.

Read more:
Here’s what we know so far about the long-term symptoms of COVID-19

How can it be treated?

Treating the condition is challenging given there’s no definitive clinical test to determine if someone has it, and there’s no standard treatment yet.

People with mild symptoms may not require treatment, but rather just validation and information.

Others with more severe or persistent symptoms need more. By offering clinical care backed by a coordinated team of specialists, multidisciplinary long COVID clinics ensure patients receive the best care available without the endless burden of multiple independent consultations. These clinics use a holistic approach and build knowledge of the best strategies to support recovery. They include teams of specialists such as respiratory physicians, rheumatologists, immunologists, physiotherapists, and in some cases, psychologists and psychiatrists. A graded exercise program is often useful.

For most people, the outcomes are good. After nine months, half of our patients have returned to close to normal activity and have been discharged from the clinic.

However, there’s a group of patients whose improvement is slower. They’re often young and previously high functioning. They have limited ability to work, exercise and socialise. Their return to work and other activities needs to be carefully managed, and they need to avoid doing too much too quickly.

It’s essential these patients’ persisting symptoms are acknowledged, and that they get support from their family, employer and a multidisciplinary medical team.

What causes long COVID?

We don’t know yet why some people get long COVID while others recover a few weeks after being infected.

If it was simply linked to severe COVID then that would give us clues. But it isn’t, as we’ve seen people with mild disease end up with long COVID symptoms, just as we have with people in intensive care.

However, there are some front-runner ideas that researchers across the globe have put forward.

This includes the idea that long COVID could be a consequence of people’s immune systems misfiring and working overtime in the wake of infection.

One clue that supports this theory is that some people suffering from long COVID say their symptoms markedly improve after getting a COVID vaccine. This strongly suggests the diverse symptoms of long COVID are directly linked back to our immune system. It’s possible the vaccine might help by redirecting the immune system back on track, by directly activating certain immune cells like T cells (that help stimulate antibody production and kill virus-infected cells) or frontline innate immune cells that correct this immune misfiring.

Another theory is that, in the bodies of people with long COVID, there’s a small, persistent “viral reservoir” hidden from detection by diagnostic tests, or leftover small viral fragments that the body hasn’t dealt with. These reservoirs are not infectious but may consistently activate the immune system. A vaccine might help direct the immune system to the right spots to mop up the leftover virus.

While we can’t yet say for sure a vaccine will help everyone, there’s no evidence that booting the immune response makes things worse. If anything, it’s likely to make things better.

Or long COVID might a combination of both of these, or many different elements.

The bottom line is we still need more research, as it’s still in its early stages. There’s no cure yet, but we can support and manage sufferers’ symptoms and we encourage everyone to get their COVID-19 vaccine when it’s available to you.The Conversation

Vanessa Bryant, Laboratory Head, Immunology Division, Walter and Eliza Hall Institute; Alex Holmes, Associate Professor, Psychiatry, The University of Melbourne, and Louis Irving, Associate Professor of Physiology, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.