Can Infections that Breakthrough Lead to a Long COVID?

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When health experts discuss COVID-19 vaccines’ exceptional success, they frequently mention their capacity to prevent severe sickness and death.

According to research from the US Centers for Disease Control and Prevention (CDC), fully vaccinated persons can still have “breakthrough” infections from the virus that causes COVID-19, but they are more than 10 times less likely to be hospitalized or die from their disease than unvaccinated people.

When health experts discuss COVID-19 vaccines’ exceptional success, they frequently mention their capacity to prevent severe sickness and death. According to research from the US Centers for Disease Control and Prevention (CDC), fully vaccinated persons can still have “breakthrough” infections from the virus that causes COVID-19, but they are more than 10 times less likely to be hospitalized or die from their disease than unvaccinated people.

COVID-19’s worst effects, according to April Zaleski, aren’t restricted to severe sickness and death, even in fully vaccinated persons. After getting vaccinated in January, Zaleski, a 32-year-old from Idaho, contracted COVID-19 in July 2021.

She felt better after a few weeks and assumed the worst was passed. Her weariness returned with a vengeance, coupled with brain fog, shortness of breath, vertigo, and a rapidly rising heart rate. She began to suspect she had Long COVID, a term for patients who experience symptoms years after contracting the virus.

COVID-19’s worst effects, according to April Zaleski, aren’t restricted to severe sickness and death, even in fully vaccinated persons. After getting vaccinated in January, Zaleski, a 32-year-old from Idaho, contracted COVID-19 in July 2021. She felt better after a few weeks and assumed the worst was passed. Her weariness returned with a vengeance, coupled with brain fog, shortness of breath, vertigo, and a rapidly rising heart rate. She began to suspect she had Long COVID, a term for patients who experience symptoms years after contracting the virus.

Experts predicted that between 10% and 30% of those who contracted COVID-19 had persistent symptoms of some form and intensity in the pre-vaccine phase of the pandemic. Though it’s not exactly known why this happens, Yale University immunobiologist Akiko Iwasaki says the two leading theories are that the virus can activate an autoimmune reaction, in which the body attacks itself, or that viral remnants can linger in the body and produce long-term symptoms.

Vaccines have altered the game to some extent. According to the CDC, vaccinated people are considerably less likely to become infected than unvaccinated people. From April through mid-July 2021, the CDC tracked COVID-19 cases in 13 U.S. states and/or major cities, finding that only 8% of cases occurred among fully vaccinated adults. In terms of Long COVID, this is good news: if you don’t get infected, you won’t acquire Long COVID.

But what about those who are unfortunate enough to acquire a breakthrough infection? That question is only now being investigated.

In a research published in July in the New England Journal of Medicine, 39 fully vaccinated Israeli health care workers who experienced breakthrough infections were examined. Six weeks later, over 20% of them still had symptoms. Despite the study’s small sample size, it showed that Long COVID is conceivable following a breakthrough infection.

Another study, published in September in the Lancet Infectious Diseases, examined self-reported symptom data from adults in the United Kingdom who tested positive for COVID-19 after being fully or partially vaccinated, as well as data from an unvaccinated control group who tested positive for the virus. They discovered that a fully vaccinated person who had a breakthrough infection was half as likely as an unprotected person to develop COVID-19 symptoms at least a month after diagnosis. That’s positive, however, the investigation also revealed that some patients who have been vaccinated are acquiring Long COVID.

Dr. Megan Ranney, who co-directs the Long COVID research effort at Brown University School of Public Health, estimates that 5 percent to 10% of completely vaccinated people who get infected may experience lasting symptoms. However, she adds that this is based on a small amount of preliminary data, making it difficult to determine for sure. Since the CDC ceased documenting mild breakthrough cases this spring, it’s unclear how many vaccinated people in the United States have been infected—making it difficult to estimate how many have acquired Long COVID.

According to Ranney, the chance of acquiring Long COVID is likely low enough that vaccinated persons shouldn’t be concerned. “Long COVID should not be a big driver of your decisions about what to do on a daily basis if you are completely vaccinated,” she adds, adding that everyone should take steps to decrease their possible exposure to the virus for a variety of reasons.

The risk, however, is not zero. Lauren Nichols, vice president of the Long COVID support group Body Politic—a national organization with over 11,000 members—estimates that her organization receives roughly five fully vaccinated prospective members each week.

One of them is Anna Kern, a 33-year-old from the Detroit region. She contracted COVID-19 in April 2021, despite having been vaccinated months before, and she now suffers from exhaustion, difficulties walking or standing, and a beating heart. “There were relatively few people [who had received extended COVID from a breakthrough infection] when I developed COVID,” she explains. “By sheer numbers and the passage of time, there are more of us now.”

Body Politic, for example, is battling for attention. Nichols, 33, who contracted Long COVID after contracting the virus in March 2020 and is still sick, says: “COVID isn’t only about the fatality rate.” “It’s also about the…disability and chronic sickness that result from it,” says the author.

That component of the pandemic, according to Nichols, is often overlooked by public health officials, who treat COVID-19 as a binary: either you have a severe case that can be fatal, or you get a light case and are alright. Nichols believes that just because Long COVID doesn’t fit nicely into either box doesn’t mean it should be ignored.

“Understandably, we are focused on deaths, severe sickness, and hospitalization. Long COVID, on the other hand, is a crippling condition, as Iwasaki admits. “It has been mostly overlooked, and I am baffled as to why.” She believes that greater tracking of breakthrough infections, as well as follow-up questionnaires that track patients’ symptoms over time (such as those employed in a recent Lancet study), could aid in a better understanding of Long COVID and the threat it poses to public health in the United States.

People who acquire persistent difficulties following a breakthrough infection, such as Zaleski and Kern, may be disregarded and left out of essential attempts to discover remedies if this is not understood. The National Institutes of Health has set up more than a billion dollars for Long COVID research, but it must include a varied and representative group of people to be most effective.

To understand how to support Long COVID sufferers, Nichols says health professionals should turn to the past, relying on the lived experience of those who developed other post-infectious chronic illnesses including myalgic encephalomyelitis/chronic fatigue syndrome and chronic Lyme disease.

Better access to specialized treatment centers, support for patient-led advocacy and research organizations, and engagement with the whole chronic disease community, she says, are all ideal places to start.

Meanwhile, according to Nichols, public health organizations must inform the public that Long COVID is a potential for both unvaccinated and vaccinated people.

Any policy that inhibits the spread of COVID-19, such as vaccine and mask mandates or prohibitions on large indoor meetings, according to Ranney, will be doubly effective. It will not only prevent acute cases of the virus, but it will also reduce the danger of Long COVID since fewer people will become infected.

“The goal needs to be transmission reduction from a policy standpoint,” she says. Period.”




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