Long Covid and the vaccines: do they give us any protection?

I come bearing a shred of good news about long Covid. Or at least it’ll look good to you if, like me, you worry about the prospect of long Covid. This comes from two doctors, Sarah Ryan and Lawrence Purpura, who’ve worked extensively with it. I’ll skip the details on their experience–just follow the link if you’re interested. It’s shortcut week here at Notes. In fact, the shortcuts are so short that I’m going to quote them interchangeably. They’ll never know–and if they do I’ll take no shortcuts in apologizing.

They say the long Covid cases they’re seeing have been less severe than the ones they used to see. They attribute that first to the omicron variants attacking the upper respiratory system, where they don’t cause as many of the heavy duty symptoms–lung complications, increased heart rate, lightheadedness, and chronic fatigue–and second to the vaccines being somewhat protective against long Covid. 

No, the vaccines don’t protect us completely, but “studies show that even one dose of a COVID vaccine reduces the odds of developing long COVID by seven to 10 times.”

Break out the ice cream so we can celebrate, will you? Or at least an M&M.

Irrelevant photo: Fields after a December frost.

Who’s most at risk? An article in Cell “identified four factors that correlate with greater risk of long Covid—type 2 diabetes, prior infection with Epstein-Barr virus, level of Sars-CoV-2 RNA detected in the blood, and the presence of autoantibodies.”

A different study sees being female as an increased risk. That same study saw people’s risk decrease by 30% if they’d have two doses of vaccine.

How likely are people with Covid to get long Covid? No one has a good answer to that. There’s no one definition of long Covid, which makes it next to impossible–or maybe that’s completely impossible–to compile statistics. 

Still, they estimate that something like 1% to 5% of Covid patients will go on to get moderate to severe long Covid. At twelve weeks, around 25% of them report fatigue, 25% report insomnia, 20% report increased heart rate or dizziness, and 15% report neurocognitive deficits–things like short-term memory problems. Some of those symptoms will be very mild to some disabling.

A different study came up with 1% of people who had Covid but weren’t hospitalized coming down with long Covid, 6% of people who were hospitalized, and 32% of people who ended up in intensive care units.

Many people will have what Ryan and Purpura call “profound recovery” in three to six months; 10% will have symptoms that go on for more than a year. An even smaller percentage will still have symptoms after a year and a half. 

So the news is far from an all-clear, but in a bad-news situation, this is good news.

 

Other long Covid news 

I’ve been stacking up articles on long Covid but never seem to get back to them. But here we are in shortcut week, so let’s do a few quick summaries and then run:

  • Covid’s associated with increased liver stiffness–a possible sign of liver injury–months after infection. Note the hesitancy in there: associated with; a possible sign. Nothing definite, just something worth looking into more.
  • Covid can affect the brain profoundly even months after infection.
  • A different study, from the early stages of the pandemic (I hope that’s significant), linked Covid to impaired reasoning, speed of thinking, and verbal abilities, comparing what they saw to the effects of sleep deprivation. The severity of the symptoms matched the severity of the infection.
  • A small study found Covid can damage the DNA in cardiac tissue. Compared to the 2009 flu, “Covid has led to more severe and long-term cardiovascular disease.”
  • Covid’s associated with increased chances of long-term brain problems, including strokes, cognitive and memory problems, depression, anxiety, and migraines. And if that doesn’t make you anxious, tremors, involuntary muscle contractions, epileptic seizures, brain fog, hearing and vision abnormalities, and balance and coordination problems–basically symptoms like the ones that come with Parkinson’s. Vaccines reduce the chances of having any of this joy land in your life by about 20%. Keep in mind, though, that a group of people who’ve had Covid are more likely to face these problems than a group that hasn’t, but that doesn’t mean all of them will.
  • Covid was associated with an increased chance of stroke and heart attack. If the study’s correct, over the course of a year, for every 1,000 people who had Covid, you’d expect to find five extra strokes, three extra heart attacks, and twelve extra cases of heart failure 

Those last two studies show a pattern but don’t show cause and effect so let’s not go off the deep end with them. 

 

Is Covid no worse than the flu?

The claim that Covid’s just like the flu translates to “Don’t get hysterical.” So an article from Australia has given us a comparison of the two. 

Between the beginning of 2022 and August 28, Australia had 44 times as many Covid cases as flu cases and 42 times as many Covid deaths. 

That makes the death rate from Covid lower, right? It looks that way to this number-phobe, but it also misses the point. The absolute numbers are higher. If you find yourself in the group of people who died, you’re not going to be consoled by the percentages. 

Okay, strictly speaking, if you find yourself in that group you’ll be dead and unlikely to care anymore, but still, you see my point: Some 1,700 people were hospitalized with the flu between the start of the year and some date in September–pick a number, any number, because here at Notes we don’t really care. Compare that to a single day in July 2022 when 5,429 people were hospitalized with Covid.

 

Life expectancy

I kind of ditched our good news theme there, didn’t I? Sorry. I had some, I spent it all in one place, and now it’s gone. To hell with it, let’s do more bad news. It’s cheaper.

The Covid pandemic lowered life expectancy worldwide. Or at least in the 29 countries included in one study. That leaves out a bunch, but close enough for our purposes.

Predictably, the losses aren’t evenly distributed. Countries with the most effective responses bounced back to pre-pandemic levels relatively quickly. Countries where the response was less effective may have what the study calls “a protracted health crisis.”

It’s another piece in the argument that Covid’s not just the flu in fancy clothes. Flu in the second half of the twentieth century caused smaller, less widespread drops in life expectancy. 

 

The new variant on the block

The new variant that’s emerged in China is BF.7, which is short for something more complicated, which we don’t need to bother with. It’s more infectious than earlier variants, has a shorter incubation time, and is better at infecting people who’ve already had Covid. The symptoms aren’t that different than we’re used to: fever, cough, sore throat, runny nose, and fatigue, but some people end up with vomiting and diarrhoea.

It’s been found in several countries other than China but doesn’t seem to be spreading as quickly in them, although (as I write this, in mid-December) it’s not clear why.

What causes long Covid?

A lot of clever people are chasing the cause of long Covid, but so far the virus is outrunning them–and we’re talking about a virus, remember, that doesn’t have a degree in either science or medicine and that’s rumored to be illiterate.

Not that I’m making fun of those clever people. Long covid scares the bejeezus out of me and I’m grateful for the work they’re doing, but I’m also painfully aware that they haven’t even found all the puzzle pieces yet, never mind gotten them in the right place. 

Puzzle pieces? What happened to the chase metaphor? 

I couldn’t keep up with it and had to grab something else off the shelf where I store my cliches.

Irrelevant photos: Morning glories–or as the British call them, bindweed.

But back to our actual subject: The clever folk are at the stage where they have theories, but that’s not all bad. Theories open up possibilities and they’re a good place to start. Let’s check in with a few of them:

Pediatrician Danilo Buonsenso noticed that some of his patients–these are kids, remember, with their habit of showing up at pediatricians’ offices and licking their fingers before touching the toys–

Where were we? Some of his patients who’d had mild Covid cases were left short of breath, exhausted and sporting a variety of other symptoms. That’s not common in post-Covid kids, but what with him being a doctor and all, and one who specializes in infectious diseases (I know, I didn’t get around to mentioning that earlier)–well, the kids he’s most likely to see are the ones who are sick, which skews the sample.

As the article I stole this from explains it, “He now suspects that, in some of them, the cells and tissues that control blood flow are damaged and the blood’s tendency to clot is amplified. Minute blood clots, leftover from the viral assault or fueled by its aftermath, might be gumming up the body’s circulation, to disastrous effect from the brain to joints. ‘In some patients we have specific areas where no blood flow comes in’ or the flow is reduced, Buonsenso says. 

Another theory comes from  microbiologist Amy Proal: that the virus hangs on in the body after the acute stage of the infection is over. Studies show that “the virus is capable of persistence in a wide range of body sites,” she said. 

A third theory comes from Chansavath Phetsouphanh, who’s observed that the immune cells of long Covid patients are still on high alert as much as eight months after they first tested positive. 

A fourth theory comes from Nick Reynolds, who found amyloid clumps in the brains of people with the neurological symptoms of  long Covid. They’re similar to the clumps that cause Alzheimer’s disease and dementia. That doesn’t necessarily mean the patients will have lasting damage or that the drugs used to treat those diseases help in these different circumstances. On the other hand–well, who knows at this stage? It might.

Are any of the theories right? Are all of them showing us a small piece of a large picture? Tune in sometime later–possibly a lot later–for the next exciting episode of What’re We Going to Do to Get Out of This Mess? And keep in mind that once the clever people figure out what’s driving long Covid, they or some colleagues still need to figure out a treatment.

Don’t you just feel better after you hang around here? 

In the meantime, an assortment of studies are following up on the possibilities these theories raise. Wish them well, please. It won’t make any material difference, but it might make you feel like you contributed to the effort.

 

Numbers

How many people actually have long Covid? Answering that depends on how we define long Covid, but let’s set that aside. We’re not scientists–or most of us aren’t and anyone who is must be slumming. We can get away with being hazy when it suits us. 

In May, the U.S. Centers for Disease Control and Prevention rampaged through the medical records of some 2 million people and reported that at least 1 in 5 people who’d had Covid came away with long Covid symptoms. For some of them, that meant struggling but hanging onto their normal lives. For others, it meant struggling, only with nobut at the end of the sentence.  

In the UK, some 2 million people have long Covid according to the Office for National Statistics, which does have a definition of the thing but never mind what it is. We’re not scientists, remember? Or else we’re slumming and will have to put up with the way other people’s minds work. 

Proal (remember her?) said, “I consider Long Covid to be a massive emergency.”

 

Who’s most at risk of long Covid?

A small study from Japan found that being over 40 increased the odds. So did being over 60. Since I’m over both (it took a while, but I got there), this is not good news where I live. 

In contrast to other studies, it didn’t find sex to be a big factor, although long Covid seemed to have a harder psychological impact on women than on men. 

In contrast, a UK study found that being female, being in poor pre-pandemic mental and physical health, being obese, and having asthma all increased the odds of long Covid. 

Do the two studies contradict each other? Partially. The data they’re working from is sketchy, but the issue’s important enough to use it anyway. Take them for what they’re worth.

The UK study finds that between 7.8% and 17%of the people who reported having Covid also reported symptoms that lasted longer than longer than 12 weeks, and between 1.2% to 4.8% reported  that the symptoms were debilitating. 

Why the range? I haven’t a clue. I find numbers debilitating.

The numbers were lower when they worked from doctors’ records as opposed to self-reports, but that could be because doctors weren’t reporting long Covid before November 2020.

 

A shred of good news

The omicron variant may be less likely than delta to cause long Covid–20 to 50% lower. To put that another way, with omicron, 4.4% of cases turned into long Covid. With delta, that was 10.8%. But that’s still a shitload of people.

 

More numbers: What have vaccinations ever done for us?

Well, in the first year they were available, they prevented an estimated 19.8 million Covid deaths. That’s based on excess deaths in 185 countries and territories. 

Excess deaths? It’s the figure you use when you don’t have any other consistent or reliable way to count the pandemic’s impact. In rough terms, it compares deaths during the pandemic to deaths in some pre-pandemic year. It’s imperfect, but the other systems are even more so. If you don’t use it, you end up counting the number of people who (if they weren’t dead) could brag about having Covid listed on their death certificates. You miss a lot of people that way. You can also count the number who are known to have had Covid and who then went on to die, leaving you counting people who died because a brick fell on their head and missing some who died undiagnosed. Or you can count people who die within 28 days of a diagnosis and miss the ones who took too long to die as well as include a few who had unfortunate encounters with bricks.

The UK switched methods midway through the pandemic, probably because the government wanted it to look like fewer people had died and the new way yielded a lower number. 

Yeah, I have absolute faith in the people leading the country. They’ll do whatever works best for them and to hell with everything and everyone else.

Not only is none of the systems accurate, different countries rely on different definitions of a Covid death, raising hell with international studies. 

But let’s put death on the shelf for a minute and go back to vaccines and lives saved, which is what we’re pretending to talk about. The study estimates that 599,300 more lives would’ve been saved if the world, lower case, had met the World (upper case) Health Organization’s target of getting  two or more vaccine doses to 40% of the population of every country by the end of 2021

By now, 66% of the world’s population has received at least one dose of vaccine.

 

More numbers

In 2020 and 2021, Covid was the third leading cause of death in the United States, crossing the finish line after cancer and heart disease. So it gets a bronze medal and modest bragging rights, but not as much glory as it was hoping for.