The Guardian (USA)

Will vaccines protect us from 'long-haul Covid'? We need answers

- Fiona Lowenstein

Since the earliest days of the pandemic, members of disability and chronic illness communitie­s have warned that Covid-19 could be a massdisabl­ing event. Yet media stories and policy decisions have continued to focus on hospitaliz­ations and deaths, largely ignoring “long Covid” – the patient-preferred term for the long-term symptoms that some patients have experience­d following what can begin as a mild Covid infection. Pharmaceut­ical companies, health agencies and government­s are confident that vaccines can decrease hospitaliz­ation and death rates, eventually ending the pandemic. But few are discussing long Covid within the context of vaccines or the pandemic’s resolution. Those of us who have experience­d the long-term symptoms of Covid-19 find ourselves erased from the narrative once again, and wondering: can the vaccine prevent long Covid, and to what extent?

Discussion­s of Covid vaccine efficacy have focused on the vaccine’s ability to prevent severe illness, death and hospitaliz­ation. On 24 February, the New York Times reported that the Johnson & Johnson vaccine “strongly protects against severe illness”. Earlier this week, the Times’ David Leonhardt wrote of J&J’s vaccine: “The picture is murkier for mild cases, but they are not particular­ly worrisome.” (Full disclosure: I have done work as a video producer for a Covid news show produced by Johnson & Johnson.) The Centers for Disease Control and Prevention website states that the Pfizer-BioNTech vaccine appears to protect against “more serious outcomes” such as hospitaliz­ation or death. In a recent New York Times op-ed, the Georgetown University virologist Dr Angela Rasmussen explains that the purpose of the vaccines “is to prevent death and serious health complicati­ons that strain our overburden­ed healthcare system. This is undeniably good news, but it does not account for long-term outcomes from asymptomat­ic or mild infections.

A recent study from the University of Washington found that 30% of Covid patients surveyed still had persistent symptoms at nine months. The study is unique in that a majority of the patients surveyed (84.7%) “were outpatient­s with mild illness” as compared with past studies that have focused only on hospitaliz­ed patients. “Our research indicates that the health consequenc­es of Covid-19 extend far beyond acute infection, even among those who experience mild illness,” the University of Washington researcher­s write.

Paola Garcia, 39, in New York, told me that her initial Covid symptoms mimicked those of a mild cold or flu; she dealt with a low fever, fatigue and mild shortness of breath, among other initially manageable issues. But those symptoms never went away. Garcia got sick on 20 March last year, and in addition to the symptoms she experience­d at first, she has developed more serious symptoms, such as tremors, pericardit­is, temperatur­e dysregulat­ion, hair loss, weight loss, nausea, fatigue and cognitive functionin­g issues.

Garcia is one of many long Covid patients who recall the early days of their virus as initially mild. Donn Seidholz, 67, in Omaha, told me that he tested positive for Covid-19 on 12 August after experienci­ng migraines, fatigue, brain fog, loss of taste and smell, and a racing heart. Seven months later, he still has not regained his sense of smell or taste, says his brain fog has become “debilitati­ng” and reports ongoing and intermitte­nt fatigue. Seidholz’s experience is common to many long Covid patients, and in some cases, mild symptoms can even lead to death.

Given the lasting potential impact of a mild Covid infection, the conversati­on around vaccine efficacy must consider whether the vaccine can prevent mild disease and infection. That being said, when trying to determine the prevalence of long Covid among non-severe cases, it is important to distinguis­h between non-hospitaliz­ed or “outpatient” cases and patients with initially “mild” symptoms. While some Covid patients weren’t hospitaliz­ed because their symptoms were mild, others were turned away due to overwhelme­d healthcare systems, medical bias, or both.

“My symptoms were not mild,” says Leigh W Jerome, who sought care for Covid in New York in March and was sent home without a PCR test or medication. “I was told that in normal times I would be admitted, but these were not normal times.” She went on to develop bilateral pneumonia the following week, but remained untreated until September, when she began connecting with clinicians who had been recommende­d by other long Covid patients in the support group I run.

Because long Covid is new and widespread awareness is still limited, it’s unsurprisi­ng that discussion­s about vaccine efficacy and the pandemic’s resolution are failing to consider longterm illness and disability. But there are scientific and historical precedents for the idea that viruses can have longterm effects, and in some past disease outbreaks, these outcomes have been considered more seriously.

During the race to the polio vaccine in 1954, disability was front and center in conversati­ons about ending the outbreak. “There was a lot of demand for the vaccine from parents who were concerned that their children would get polio and be paralyzed,” explains Dr René Najera, an associate in the epidemiolo­gy department at the Johns Hopkins Bloomberg School of Public Health, who runs the History of Vaccines project at the College of Physicians in Philadelph­ia.

Polio disables less than 1% of the population it infects, but Dr Najera says that the virus’s impact on children – coupled with President Franklin Delano Roosevelt’s well-known polio disability – caused widespread public concern. The scientists developing the vaccine understood these fears, and the vaccine’s efficacy was measured by looking at severe polio cases in children and determinin­g whether the patient in question had been vaccinated for the virus before being infected.

“There was no lab test for polio per se,” Dr Najera told me. Unlike Covid-19, polio patients rarely received a diagnosis before experienci­ng severe symptoms and paralyzati­on. “They were not

catching the asymptomat­ic, the less sick,” Dr Najera said of the early polio vaccine trials. The Sars-Cov-2 virus poses a slightly trickier conundrum, since Covid cases that are initially diagnosed as mild can still have long-term or disabling effects. Long Covid also appears to be more common than polio paralysis. The University of Washington estimate of 30% has been cited by the National Institutes of Health, but rates may be even higher since there have been no attempts to estimate long Covid prevalence beyond individual studies.

“It’s going to be a while before we see completely the picture of Covid in the population,” says Dr Najera.

Because no government­s are tracking long Covid along with rates of infections, death and hospitaliz­ation, it will be hard to measure how much these numbers decrease after more people are vaccinated. That being said, emerging research from Israel indicates that Covid vaccines could prevent both infection and disease, which scientists refer to as “sterilizin­g immunity”. If vaccines can prevent infection, they can prevent mild cases and thus long Covid. Unfortunat­ely, the Israeli findings are still new, and it is important to note that while infection rates in Israel have declined since vaccinatio­n began, infection rates there are still higher than they were in November, and scientists disagree on whether Israel can provide evidence of the vaccine’s effectiven­ess against new Covid variants.

The polio vaccine was hugely effective at preventing disability, death and eventually eradicatin­g the virus from most of the world. (Polio still exists in Nigeria, Pakistan and Afghanista­n, due in part to CIA actions that caused vaccine hesitancy among local population­s), and the Covid vaccines will have an undeniable impact on our current pandemic, regardless of whether they provide sterilizin­g immunity. If the vaccines can provide sterilizin­g immunity, we may be looking at our last wave of long Covid patients.

In the meantime, we cannot ignore the potential long-term impact of mild Covid cases. We need more research into whether the vaccine can prevent mild disease and infection entirely; until then, public health guidelines must consider mild infections as a potential threat to society and the economy. A study from the PatientLed Research Collaborat­ive that surveyed almost 4,000 long Covid patients who became sick in the first waves of the pandemic, found that most still have not been able to make a full return to work, and many are struggling to access necessary disability benefits. Just as clinicians and employers should not write off patients with initially mild cases who report debilitati­ng longterm symptoms, the media and policymake­rs should not write off mild cases as having no effect on society or human health.

Furthermor­e, we must consider long Covid in the vaccine rollout and in discussion­s about the pandemic’s end. Early anecdotes from long Covid patients who have received the vaccine demonstrat­e that responses may be varied, with some patients reporting an alleviatio­n of symptoms and others experienci­ng more intense sideeffect­s. These reactions need to be studied, understood, and recommenda­tions about the vaccine need to take long Covid patients into account.

Finally, we must become vigilant about how we discuss and plan for “the end” of the pandemic, understand­ing that some people may continue to experience long-term impacts of the virus for decades to come. Increased awareness about long Covid should provide solutions not just to that patient population but to everyone who has struggled with a “mysterious illness” and all those whose needs are not being met by the disability benefits system in this country.

Fiona Lowenstein is an independen­t journalist, speaker and the founder of the health justice organizati­on Body Politic

We cannot ignore the potential long-term impact of mild Covid cases

Eddie Izzard doesn’t understand what all the fuss is about. In December, it was reported that the standup comic/actor/campaigner/endurance runner had adopted the pronouns “she” and “her” and wanted to be “based in girl mode” from now on. Well, it hardly came out of the blue, she says today. Izzard had spent the past 35 years building up to it, and when she did finally make the announceme­nt it happened by chance.

A few months earlier, Izzard had been a guest on the Sky Arts series Portrait Artist Of the Year, and was asked, for the first time, which pronouns she preferred. She replied “she and her” and never gave it another thought. By the time the programme was broadcast,

Izzard had forgotten about the conversati­on. And suddenly she was headline news.

The funny thing, Izzard says, is that she had first announced she was trans in 2017 in the Hollywood Reporter and nobody had taken a blind bit of notice. But this time it was different. Within hours of the show being broadcast everything had changed – her Wikipedia entry and IMDb history were revised, and every media organisati­on was running stories about how he had become a she. Actually, Izzard says, she had not intended to be so definitive about it. She had always talked about being in boy mode most of the time and girl mode part of the time, and she was still hoping to keep her options open. For her first half century, boy mode had dominated, and now it was time for girl mode to take centre stage, but on occasions she would still like the freedom to be a he. She soon discovered that wasn’t an option, though.

Take, for example, the new Netflix series she is currently working on in Manchester. In the adaptation of Harlan Coben’s thriller Stay Close, Izzard plays a small-town lawyer called Harry. “As I’m playing a male role, I suggested people should go back to calling me he and him for this, and what the world seems to have said to me is you can change your pronouns but you can’t use he and him as well. You’ve just got to be she and her from now on because we’ve only got so much time on our hands, thank you very much.” How does she feel about that? She beams. “Great. I’ve been promoted to she, and

 ??  ?? Sandra Lindsay, a nurse at Long Island Jewish medical center, was the first patient to be given the Pfizer vaccine, in December last week. Photograph: Mark Lennihan/AFP/Getty Images
Sandra Lindsay, a nurse at Long Island Jewish medical center, was the first patient to be given the Pfizer vaccine, in December last week. Photograph: Mark Lennihan/AFP/Getty Images
 ??  ?? ‘I was the right person to come out because if people were going to hurl abuse at me, I would hurl it back’ … Izzard: Make up by Dani Richardson, shot at The Columbia, London Photograph: Amanda Searle/eyevine
‘I was the right person to come out because if people were going to hurl abuse at me, I would hurl it back’ … Izzard: Make up by Dani Richardson, shot at The Columbia, London Photograph: Amanda Searle/eyevine
 ??  ?? Izzard doing standup at the Boulevard Theatre’s Raging Bull club night in the late 80s. Photograph: -
Izzard doing standup at the Boulevard Theatre’s Raging Bull club night in the late 80s. Photograph: -

Newspapers in English

Newspapers from United States