Michael Hunter, MD on Medika Life

Long COVID-19: What Doctors Want You to Know

ABOUT 15 PERCENT OF AMERICAN ADULTS (WITH PRIOR INFECTION) report long COVID. The good news? Vaccination lowers the risk of suffering from long COVID. That’s the conclusion of research published in JAMA Network Open.

Most who suffer from a COVID-19 viral infection get better within a few days to weeks. A minority continues to experience the sequelae of an infection after four weeks, a phenomenon we call long-COVID-19. Any of us who has an infection is vulnerable.

Today we look at whether vaccination helps to reduce the risk of suffering from long-COVID-19.

“These so-called bleak times are necessary to go through to get to a much, much better place.” ― David Lynch.

What is long COVID?

Some individuals infected with the COVID-19 virus experience long-term effects from their infection, or long COVID.

Photo by Fusion Medical Animation on Unsplash

You may have heard the condition called long-haul COVID, post-acute COVID-19, post-acute sequelae of SARS CoV-2 infection (PASC), long-term effects of COVID, and chronic COVID.

Long COVID-19 syndrome involves a variety of new, returning, or ongoing symptoms that individuals experience more than four weeks after getting an infection. For some, post-COVID-19 syndrome lasts months or years or causes disability.

Anyone who has had an infection can experience long COVID-19. Most who suffer from the syndrome have symptoms days after first learning that they experienced an infection. Still, some who experience post-COVID conditions do not know when they became infected.

The Mayo Clinic explains that symptoms of long COVID-19 syndrome include:

  • Fatigue
  • Symptoms that get worse after a physical or mental effort
  • Fever
  • Lung symptoms, such as shortness of breath or cough

Other symptoms associated with long COVID-19 include:

  • Neurological or mental health conditions include difficulty thinking or concentrating, headache, sleep problems, dizziness upon standing, a pins-and-needles feeling, loss of taste or smell, anxiety, and depression.
  • Muscle or joint pain
  • Heart symptoms or conditions, including chest pain and a fast or pounding heartbeat
  • Digestive symptoms, including diarrhea and stomach pain
  • Blood clots and blood vessel (vascular) issues, including a blood clot that travels to the lungs from deep veins in the legs and blocks blood flow to the lungs (pulmonary embolism)
  • Other symptoms, such as a rash or changes in the menstrual cycle

There is no test to diagnose post-COVID conditions. The symptoms associated with long COVID often overlap with other health problems, sometimes making it challenging to diagnose the post-COVID syndrome.

Long COVID-19 frequency

new study analyzed data collected as part of the Lifelines COVID-19 cohort study. Researchers added a specific cohort to the established Dutch Lifelines cohort study.

Exclusion criteria included:

  • “Severe mental illness.”
  • Less than five years in remaining life expectancy at study enrollment.
  • Not being able to visit a doctor.
  • Inability to fill out questionnaires in Dutch.

Participants returned questionnaires 24 times between March 31, 2020, and August 2, 2021. The response rates ranged from 28 to 49 percent. The digital surveys included sociodemographic information and mental and physical health factors(including 23 symptoms). All had COVID-19 infections confirmed with a test or a physician’s diagnosis.

The analysis included over 76,000 participants. Symptoms reported at 90 to 150 days after COVID-19 infection (compared with pre-infection symptoms and matched controls) included chest pain, breathing difficulties, painful breathing, painful muscles, ageusia or anosmia, tingling extremities, lump in the throat, feeling hot and cold alternately, heavy arms or legs, and general tiredness.

Here are the findings:

One in eight adults (with a previous positive COVID-19 test) reported symptoms of long COVID.

Persistent symptoms in COVID-19-positive participants at 90–150 days after COVID-19 included chest pain, difficulties with breathing, pain when breathing, painful muscles, ageusia or anosmia, tingling extremities, lump in the throat, feeling hot and cold alternately, heavy arms or legs, and general tiredness.

Does vaccination lower long COVID-19 risk?

A separate study asked: How common are COVID-19 symptoms lasting longer than two months, and which adults are most likely to experience long COVID?

To examine the prevalence of long COVID and the sociodemographic factors associated with it, researchers collected data from eight waves of the COVID-19 States Project, a large-scale internet survey that collected data every six weeks between February 5, 2021, and July 6, 2022.

Respondents reported their COVID-19 test results, including the test date. Those reporting a positive test indicated when their symptoms resolved. The participants with continuing symptoms (for more than two months) filled out a checklist of common symptoms.

Study findings

The study included over 16,000 participants. Approximately 15 percent reported continuing COVID-19 symptoms for at least two months following their diagnosis. The 2,359 with long COVID symptoms reported these symptoms:

  • Fatigue — 52 percent
  • Poor memory — 46 percent
  • Smell loss — 44 percent
  • “Brain fog” — 40 percent
  • Shortness of breath — 40 percent

Women appeared more likely than men to have smell loss (46 versus 35 percent), cognitive symptoms (49 versus 36 percent), anxiety (31 versus 22 percent), and sleep disruption (32 versus 23 percent).

Symptom frequencies appeared similar by the predominant COVID variant at initial infection time, except for anosmia. Smell loss was less frequent when omicron was predominant (34 percent), compared with the alpha variant (40 percent) and the delta variant (51 percent).

Completion of vaccination before infection reduced (by more than one-quarter) long COVID-19 risk.
Michael Hunter, MD (image courtesy of the author)

Long COVID risk and vaccination — My take

Approximately 15 percent of those with a COVID-19 infection will develop long COVID. Long COVID is prevalent and more common among females and older individuals.

Vaccination before infection appears to reduce, but not eliminate long COVID risk. However, we need confirmation of this finding in prospective studies. I am glad I am up to date on my COVID vaccination.

The information I provided in this blog is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you seek medical advice, diagnoses, or treatment. I am not liable for risks or issues associated with using or acting upon the information in this blog.

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Michael Hunter, MD
I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

Michael Hunter, MD

I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

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