Introduction by Croakey: As the pandemic continues, more information is emerging about Long COVID – ongoing and persistent symptoms from COVID-19.
In the United States, journalists have written about their own experiences with Long COVID, describing its cognitive and mental health impacts, and the implications for their capacity to work.
In Israel, the Ministry of Health recently released data highlighting some of the issues for children (and read more about COVID’s implications for children and young people in this previous COVID-19 wrap).
Croakey has covered Long COVID previously (see here and here), stressing the importance of support for those who experience long-term symptoms.
In her latest COVID-19 wrap, Alison Barrett covers some recent research and updates.
Alison Barrett writes:
Recent studies have highlighted large variations in the number of people who experience Long COVID.
It seems that anywhere between five percent, as in an Australian-based study, and thirty percent, as reported in the United Kingdom (UK) and the United States (US), of people infected with SARS-CoV-2 experience Long COVID.
Data reported by the Office for National Statistics in the UK indicate that 40 percent of people with Long COVID have experienced symptoms for more than a year after their infection.
Some of the reasons for the variations in numbers include different ways in which people are enrolled to participate in studies, symptom definition and duration of follow-up. As per British researchers in the BMJ, different variants of the virus may also impact the incidence of Long COVID.
Regardless, the data is indicative of a large number of people world-wide who are likely to experience long-term symptoms from the virus, and require ongoing treatment, care and support.
While much research has been, and continues to be, undertaken about Long COVID, the underlying mechanisms are still not well understood and it is unclear why some people experience Long COVID and others do not.
(More details on this RACP event, held on 9 September, are here.)
Symptoms and characteristics
The most commonly reported symptoms of Long COVID are fatigue, breathlessness, muscle and joint pain, headaches, cough, chest pain, altered smell and taste and diarrhoea, according to a systematic review published in July 2021. Lack of concentration, or brain fog, and hair loss are other common symptoms reported in a different review.
A strong link was found between the presence of five or more symptoms in the first week of the acute phase of the infection and the development of Long COVID. This was regardless of age or gender of the patient.
People who are older, female, and have pre-existing medical conditions and severe symptoms during their acute phase tend to be at higher risk of developing Long COVID.
While these risk factors seem to be consistently reported in the literature (here and here, for examples), one article reported that those between 35 and 69 years old are at greater risk of developing Long COVID than other age groups, and another article reported that the age group most affected was 35 to 49 year-olds.
Data from the UK suggests that people who live in more deprived areas are at a greater risk of developing Long COVID.
According to Aiyegbusi and colleagues, racial differences are not well documented in Long COVID, but as Indigenous populations and Black Americans have been disproportionately impacted by acute COVID-19, it is likely they will be disproportionately impacted by Long COVID.
Other concerning long-term physical health impacts of COVID-19 have recently been documented, including a greater risk of kidney damage (when compared to people who have not been infected with the virus), loss of grey matter in the limbic system (which is connected to memory, learning and emotion), and multisystem inflammatory syndrome in children (which is inflammation in multiple organs in children who have had COVID-19).
In addition to long-term physical impacts, people who have Long COVID experience psychiatric and neurological outcomes and significant challenges to their quality of life.
In the UK, two-thirds of people with Long COVID say it impacts their daily activities and 40 percent of people who were employed before being hospitalised with COVID-19 were unable to return to work within eight weeks of leaving hospital due to continuing health problems.
Due to the wide range of symptoms and long-term impacts experienced, it is important that governments and health systems use a multidisciplinary approach to treat, care and support people with Long COVID.
Do vaccinated people get Long COVID?
In promising news, the Zoe COVID Symptom Study in the UK recently reported in The Lancet that people who received two vaccine doses were half as likely as unvaccinated people to experience symptoms for 28 days or more after being infected with SARS-CoV-2.
Although more longer-term research is required, this indicates a reduced risk of Long COVID in vaccinated individuals.
While promising, the authors of the study highlighted that the population included in the research were not very diverse, with an over-representation of females, and under-representation of people in deprived areas.
More long-term research, including diverse populations, is required to gain a better understanding of the impact of vaccines on the incidence of Long COVID.
Do COVID-19 vaccines reduce symptoms for people with Long COVID?
Interestingly, non-peer-reviewed research suggests that, for some people with Long COVID, symptoms are improved after COVID-19 vaccination.
A survey led by grassroots group, Survivor Corps, found that Long COVID symptoms improved in 40 percent of people after vaccination. The same survey found that 10-15 percent felt worse after vaccination.
A survey by advocacy group Long COVID SOS found that 56.7 percent of people with Long COVID saw an improvement to some of their symptoms after the first dose; 11.4 percent said all symptoms improved; and 19 percent said they worsened.
Researchers from Yale School of Medicine are conducting a study to collect information about the immune response in people with Long COVID before and after vaccination. This will help improve understanding of the impact of vaccination on people with Long COVID and their immune responses.
Future research and practical implications
As Australia’s COVID-19 cases continue to rise, it is important the health system is prepared to support Long COVID patients.
In the US and UK, clinics have been implemented to help patient recovery and rehabilitation. No dedicated Long COVID clinics have been implemented in Australia as yet. Croakey colleague, Linda Doherty, wrote more about this in June 2021.
Promisingly, though, the Victorian Government has increased funding to research long-term effects of COVID, and other studies about the long-term impacts of COVID-19 are being conducted at Illawarra Shoalhaven Local Health District and St Vincent’s Hospital, both in NSW.
Recognition, research and rehabilitation for Long COVID patients needs to be prioritised, as stated by Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), on 22 August 2021.
Resources and threads on Twitter
How were COVID-19 vaccines tested and approved so fast?
A new animation by Dr Siouxsie Wiles and Toby Morris nicely explains how the COVID-19 vaccines were developed.
The Swiss Cheese respiratory virus pandemic defence
If you haven’t seen it already, Associate Professor Ian Mackay has developed an infographic to explain the multiple layers required for protection against COVID-19.
He recently published version 4.2. Each iteration of the Infographic is based on current research. You can read more about the Swiss Cheese infographic here.
A thread about C.1.2 variant
Dr Maria van Kerkhove, infectious diseases epidemiologist at the WHO, posted a thread on Twitter about a new variant of COVID-19 identified in South Africa, C.1.2.
At this stage, it is classified by WHO as an alert for further monitoring.
Access the resources here.
PostScript
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
See previous editions of the COVID wrap.
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