Long-haul COVID theory tested
Vaccine could help those whose symptoms linger
Vaccination could offer a glimmer of hope for people who are still enduring symptoms weeks or months after recovering from COVID-19.
Among people who catch COVID-19, 10% to 30% end up with long-term symptoms referred to colloquially as LONG-COVID or long-haul COVID. Although most of the people with lingering problems had a bad bout with the disease, some barely had symptoms.
A theory is emerging, though still preliminary, that getting a COVID-19 vaccine could help some of these longsuffering people.
In a survey of nearly 600 people who self-reported lingering symptoms after COVID-19, 47% saw no difference after vaccination, 39% improved after getting a vaccine and 14% felt worse. The survey was conducted by Survivor Corps, a grassroots group of people with longterm COVID-19.
Their most common lingering symptom was fatigue, which was reported by nearly everyone and lasted 100 or more days. Other frequent long-term symptoms included shortness of breath or difficulty breathing, difficulty concentrating, inability to exercise or be active, diarrhea, headache and loss of smell and/or taste.
It’s biologically plausible that vaccination could help address some of these symptoms, said Akiko Iwasaki, a professor of epidemiology and immunobiology at Yale, who developed the theory. It may be that their bodies still harbor particles or pieces of the virus that causes COVID-19.
The vaccine could theoretically stimulate their immune system to hunt down these remaining bits and clear them away so they can no longer cause inflammation.
“We know that the vaccine elicits very robust antibodies that can bind to the virus and viral remnants and clear it,” Iwasaki said.
Iwasaki said it would be terrific if this
works, because that would make vaccination a “cure” for many people with lingering symptoms. “Get rid of the source, and that’s it.”
But that’s probably not the whole answer.
It might be that in some people, a COVID-19 infection pushed their immune system into overdrive.
For them, a vaccine might provide only temporary relief, toning down this overresponse while the vaccine circulates in the body but not addressing the underlying problem.
Even in this case, knowing that would be important, Iwasaki said, because it would suggest that treatment to turn down an immune overreaction could be helpful.
“We really need to study their immune system,” she said.
Iwasaki and several colleagues are organizing a large, prospective trial to see whether vaccination clears up some people’s symptoms – either short-term or forever.
“I think this is especially important because it not only could represent the first and only treatment for long COVID, but it could help us understand the mechanism in the people for whom it helps,” said Dr. Eric Topol, founder and
director of the Scripps Research Translational Institute in California, which is collaborating on the research.
The group applied for federal funding to support the trial.
Angela Rasmussen, a virologist at the Center for Global Health Science and Security at Georgetown University, said she thinks Iwasaki’s hypothesis makes sense, and she’s eager for research to show whether it’s right.
“That would be a huge achievement if something we all should be doing anyways really fixes that problem,” Rasmussen said of vaccination. “I’d be the most pleasantly surprised person in the world that it was that easy . ... It may not be that simple, but I really do hope it is.”
Anthony Fauci, the nation’s most prominent infectious-disease expert, said in a congressional subcommittee meeting Wednesday that the National Institutes of Health considers these lingering symptoms to be a major public health issue and allocated more than $1 billion to studying LONG-COVID.
He said a large trial is essential to ensure that vaccination should truly get the credit for these improvements, rather than simply the passage of time, which does make a difference for most people.
Fauci described two types of longsuffering patients: those who had a severe bout with the disease that left them with permanent damage to their heart, lungs or liver, which is unlikely to resolve with vaccination; and those who didn’t suffer as much at first but have struggled to shake physical symptoms in the months since.
Brent Boschetti, 44, of Los Angeles, fits into the second category.
Boschetti, a medical sales rep and workout enthusiast, was diagnosed with COVID-19 on March 10, 2020, before lockdowns or mask-wearing were recommended. By March 15, he had lost his sense of smell and taste; by April, he was having heart palpitations, severe migraines, breathing difficulty, fatigue, muscle and joint aches.
“I was pretty much in bed until May,” Boschetti said.
He finally tested negative for the virus and was ready to get back to his sixday-a-week workout routines and daily runs. But his body wasn’t.
“The energy wasn’t there,” he said. “I just wasn’t bouncing back.”
Every time he pushed himself, he’d retrigger symptoms and land back in bed for several days.
He managed to keep up with his work Zoom calls but spent much of the summer shuttling among specialists: a rheumatologist, cardiologist, immunologist, gastroenterologist. He began weekly acupuncture sessions and joined Survivor Corps for moral support.
By November, he was mostly better. “People would say, ‘How do you feel, and I’d say 90%.’ I just didn’t feel like I was completely myself,” Boschetti said.
He got an appointment for a vaccine in early February, though he was nervous that it might retrigger his symptoms.
Within a day, he felt like his old self again. His energy was back at 100%. “It was like something just cleared, whatever was lingering in me,” Boschetti said.
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