DOCTOR'S NOTE with DR AMIR KHAN | AL JAZEERA
(AL JAZEERA) — Although most people make a full recovery from a COVID-19 infection, for some the symptoms can last weeks or even months, a condition known as long COVID. According to the World Health Organization (WHO), long COVID is defined as a condition that occurs in “individuals with a history of probable or confirmed SARS CoV-2 infection, usually three months from the onset of COVID-19 with symptoms that last for at least two months and cannot be explained by an alternative diagnosis”.
It is estimated that up to one in 10 people who get infected with SARS-Cov-2 will suffer symptoms of long COVID which may vary from mild to severe. A study carried out by the University of Washington put the incidence of long COVID even higher, showing up to 30 percent of those who tested positive for COVID-19 had symptoms months later.
The symptoms of long COVID can vary and many are still coming to light. The most common include extreme fatigue, shortness of breath, chest pain, palpitations, poor memory, joint pains, headaches, depression, anxiety, nerve pain, loss of sense of smell and taste, abdominal pain, loose motions and sickness.
Scientists are still looking into why some people develop long COVID while others do not. An Australian study published this month looked at blood samples of those who tested positive in the initial wave of the pandemic. They found evidence of persistent inflammation in those who remained symptomatic and were suffering from long COVID. They compared the blood samples with those who did not have COVID-19 and found the presence of elevated levels of proteins called interferons long after the virus had been cleared. They also concluded that people did not have to have severe symptoms in the acute phase of the COVID-19 infection to suffer from long COVID.
Other studies have found elevated levels of immune cells called cytokines and autoantibodies in blood samples taken from those suffering from long COVID. These can cause the immune system to attack normal healthy body tissue instead of the virus, as well as cause inflammation leading to ongoing symptoms.
It is fair to say there are more questions than answers when it comes to the causes of long COVID at present, and treatment options are limited. With any disease, prevention is better than a cure and long COVID is no different. So, can the COVID-19 vaccines reduce the risk of getting long COVID?
Although the vaccines do not completely remove the risk of contracting COVID-19, they have been shown to be effective in preventing serious illness from it. With Omicron, we are seeing more breakthrough infections in vaccinated people, and while they are less sick than they would have been had they been unvaccinated, we know the severity of illness does not correlate with the chances of getting long COVID.
In the initial weeks after being vaccinated, a person will have high levels of neutralising antibodies. These tend to stop the virus in its tracks before it has a chance to infect lots of cells, thereby reducing the risk of long COVID in the future. We have seen these wane over time, and it is thought longer acting memory immune cells then take over, which are slower to respond, allowing time for the virus to infect some cells before they are galvanised into action to kill the virus and the infected cells. This level of infection may be enough to trigger long COVID in some.
According to one study, being fully vaccinated does reduce a person’s chances of getting long COVID. Of the 592 fully vaccinated people with COVID-19, who continued to provide data for more than a month, 31 went on to get long COVID (defined as illness lasting 28 days or more after a positive test). It accounted for 5 percent of the cohort. Meanwhile, in the unvaccinated group, this figure was about 11 percent. This indicates the vaccines were able to cut the risk of developing long COVID after a breakthrough infection by more than half.
However, another study that analysed the health records of more than 10,000 people with breakthrough infections found vaccination did not protect against several conditions associated with long COVID. The vaccinated group was compared with a control group comprising people who had not had any COVID-19 vaccines and found similar rates of long COVID in both sets. The study is yet to be peer-reviewed.
This highlights the need for more data on long COVID in both vaccinated and unvaccinated populations. If vaccines are not the answer to long COVID, then what is?
Clearly reducing the chances of contracting the virus in the first place is key. We then go back to measures that governments must focus on to make indoor spaces safe for all. This means massive investment in clean air in workplaces, indoor social spaces and schools. Air filters and mask wearing remain effective measures when it comes to infection reduction.
As many countries declare an end to restrictions, it may feel to some that the pandemic is approaching its final phases. But for people suffering from long COVID, it is far from over and it is vital that research and funding go into finding causes, treatments and cures for this potentially disabling condition.
Good news: Why the Djokovic saga sends out a clear message
I believe that taking a vaccine or any medical treatment should always be down to individual choice. People should be able to make an informed decision that involves balancing out the benefits of any medical intervention against any risks. When it came to the COVID-19 vaccines, for me and the majority of those who were offered the jabs, the balance swung very much in favour of the benefits, and we got vaccinated. Some others, however, decided not to.
These decisions have been more difficult given there is a flood of misinformation online. The decision then is no longer informed but misinformed. To counteract this, governments have invested in public health campaigns, so that people have access to the correct information based on scientific evidence. Despite all of this, many people choose not to get vaccinated and that is fine, it is their choice. But with vaccine passports and mandates introduced in some countries, especially for travel purposes, this choice has started to have consequences for those who remain unvaccinated.
We are not living in normal times; we have had two years of a global pandemic which has claimed millions of lives worldwide. This is a simple and very sad fact.
The vaccines have been shown to be an effective tool in protecting against further loss of life from COVID-19. They may not prevent the transmission of the virus, but they significantly reduce severe illness and therefore the burden on healthcare systems. At the height of the pandemic, many healthcare systems across the world were dealing with so many COVID-19 patients that they had to put a temporary stop to other medical treatments. This has created a huge backlog of patients needing treatment for non-COVID related medical conditions and we need to get on with treating them.
By not being vaccinated, people are increasing the risk they pose to their country’s healthcare system. They are more likely to get sick and end up in hospital. In order to protect healthcare systems and those who are vaccinated, many countries have introduced strict rules, restricting the freedoms of those who choose to remain unvaccinated. Some have gone as far as making vaccinations mandatory, something I understand but remain uncomfortable about.
Tennis player Novak Djokovic encountered these rules when he flew into Australia to participate in the Australian Open tournament.
On January 4, Djokovic put up an Instagram post stating, “I’m heading Down Under with an exemption permission.” He was referring to the exemption form issued by Tennis Australia, which granted him temporary medical exemption from the country’s vaccine requirements on the grounds of a previous infection. In the letter, the organisers of the Australian Open said the exemption had been approved by a panel of medical experts and by the authorities in the state of Victoria, where the tournament was being held.
The previous infection being referred to was when Djokovic tested positive for COVID-19 on December 16, 2021.
When he got to Australia on January 5, 2022, he was detained by the country’s border force. After a period of detention, a judge quashed the government’s decision to cancel his visa on the grounds that it was unreasonable to do so. The decision caused uproar across the world, with many people saying he was getting special treatment for being an elite athlete. This did not come as a surprise, especially since Australians have had to endure some of the strictest pandemic restrictions in the world, with many unable to travel to see family for two years.
And then a day after Djokovic was included in the Australian Open draw, his visa was cancelled for a second time by the government, a decision that his legal team challenged without success. The player was eventually deported, and his bid to win his 21st men’s tennis Grand Slam title ended before he had the chance to play a single game.
It has been a complicated saga, but also an important one. Djokovic chose not to get vaccinated and he had the right to do so. But the rules apply to each one of us, and none of us is exempt from them. There are some people who cannot have the vaccines for legitimate reasons, such as having severe allergies to the contents of the vaccine. But those who choose not to have the vaccines for non-medical reasons must be prepared to face the consequences, and no amount of looking for loopholes will help.