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October 22, 2021

Long COVID and the science, so far…

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Gail Matthews

Increasing 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.

As SARS-CoV-2 is a respiratory disease; it predominantly attacks lung tissue, specifically the cilia.

One question, which is frequently asked, is – does COVID-19 vaccination prevent you from getting long COVID?

Here’s what the science says, so far.

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 up to 80 per cent in hospitalised patients with severe initial illness, to as low as two or three per cent – 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 per cent of patients reported at least one persistent symptom at 12 or more weeks after COVID-19 infection.

Many of these studies are highly dependent on whom they chose to study, and whether they required a definite confirmation of infection 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.

This study 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 Organisation (WHO) is currently attempting to achieve a consensus agreement from its members.

Expect to see further tweaks to this definition as it evolves.

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.

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 was being (genetically) female.

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 reported two doses.

A small proportion, less than one per cent, 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 (longer than 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 severe acute COVID infection and also most likely 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.

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.

Professor Gail Matthews is the Program Head of the Therapeutic Vaccine and Research Program at the Kirby Institute, UNSW.

First published at www.theconversation.com.

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  1. Increasing COVID-19 vaccination rates quickly is not a concern or a priority
    The Australianism “She’ll be right mate” pervades the Australian political system. Mandatory vaccination is the way to go, that is if we had the supply of vaccines.
    We are in the go-slow state all because politicians play games with the media of just who can be famous or infamous at the time of the 7 pm nightlyTV news.

  2. So, for a normally healthy person, it is 2% of 0.03% . Given that 1.3% of the population are likely to get bad covid and that 80% of those are already ill with other diseases.
    That figure is even generous given that the official US stats for co-morbidity factors in Covid deaths is 94% and that 78% of hospitalisations are of obese/overweight people.
    Like, I have been saying, given the risks, both known and unknown, of ter vaccines, vsccination should only be recommended for those in the high risk bracket.
    Lockdowns will kill more people, cause more health issues amongst the relatively healthy than they will save or solve.

  3. I feel forever grateful for the painstaking research and dedication of scientists like professor Gail Matthews. Thanks for publishing this.


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