‘Long COVID’ may occur in more than half of all hospitalised cases: research

Evelyn Lewin

23/03/2021 1:41:12 PM

Experts are concerned Australia will experience an epidemic of ‘long COVID’ if public health measures are prematurely relaxed.

Young fatigued woman on the couch at home.
Many of the people affected by long COVID so far have been previously healthy and relatively young.

Too many people are unaware how common ‘long COVID’ is and just how severely it can affect people, according to University of Western Australia epidemiologist and biostatistician Dr Zoë Hyde.
And, countries that fail to suppress COVID-19 risk creating a generation affected by disability.
‘Much of the messaging around COVID-19 has been about the risk of death, and I think that’s created a perception that if you recover from infection, you’re fine,’ Dr Hyde told newsGP.
‘In reality, long COVID may actually be an equally serious outcome in terms of its impact on health and quality of life, society, and the economy.’
Her beliefs are supported by research published in JAMA Network on 17 March.
The observational study followed 478 COVID-19 patients for four months after they had cleared the disease and found 51% reported new-onset symptoms, with fatigue being the most common, affecting around one third of respondents.
Associate Professor Hassan Vally, an epidemiologist with a special interest in infectious diseases at La Trobe University, told newsGP that even though current understanding about long COVID is ‘very much in its infancy’, its prevalence and potential for long-term health issues is concerning.
‘It certainly seems to be more common than we might have originally thought,’ he said. 
‘It does seem to be happening at a reasonable frequency.’
Associate Professor Vally points to research published in The Lancet in January that highlights this.
That research examined the outcomes of 1733 patients discharged from a hospital in Wuhan between January and May 2020 who were then followed up between June and September.
‘At six months after symptom onset, most patients endorsed at least one symptom, particularly fatigue or muscle weakness, sleep difficulties, and anxiety or depression,’ the authors wrote.
A key question regarding long COVID centres on whether disease severity influences risk of developing this condition.

Dr Zoë Hyde says anyone who has been infected with COVID-19 is at risk of long COVID, irrespective of the severity of their initial infection.
The Lancet research from January found that ‘more severely ill patients had increased risk of pulmonary diffusion abnormality, fatigue or muscle weakness, and anxiety or depression’.
However, both Associate Professor Vally and Dr Hyde say that even those with mild acute illness with COVID-19 can experience long COVID, including children.
‘Anyone who is infected is at risk [of long COVID], irrespective of the severity of the initial infection,’ Dr Hyde said.
‘The majority of people affected by long COVID were previously healthy, many are relatively young, and most had only mild disease initially. This means we need to urgently re-think who the “at-risk” groups are.
‘Although older people have the highest mortality risk, everyone seems to be at risk of developing long COVID.’
As a result, Dr Hyde believes the risks of long COVID for children and adolescents are ‘under-appreciated’. 
‘While mortality from COVID-19 is thankfully very low in children, the same can’t be said for long COVID,’ Dr Hyde said.
‘Data from the UK’s Office for National Statistics show that 13% of children report persistent symptoms five weeks after testing positive [for COVID-19], compared to 22% for the population overall.’
And even though Australia has recorded relatively few COVID-19 infections, Dr Hyde says the risk of people developing long COVID could be significant if more occur.
‘There’s absolutely no question that we’d see an epidemic of long COVID in Australia if we were to prematurely relax the public health measures that have kept us safe,’ she said.
That is why she believes Australia needs to keep its international borders closed ‘until the majority of the population is vaccinated, including children and adolescents’.
‘This is necessary to achieve herd immunity, and also to protect children from long COVID,’ she said.
‘Fortunately, vaccine trials in children are already underway, and are likely to be complete by the time we’ve finished vaccinating adults.’
Vaccination may have a further impact on long COVID, says Associate Professor Vally.
‘There are reports of the vaccine actually helping to resolve long COVID in people,’ he said.
‘That is really interesting and it kind of may also point towards the mechanisms that lead to long COVID.’
Mara Gay, who is on The New York Times editorial board, tweeted about this on 25 February.
‘This is both anecdotal and early, but many long [COVID] survivors are feeling significantly better after receiving their first vaccine dose. Including me. Fascinating,’ she tweeted.
The results of an informal survey with 473 responses also supports this, finding that one week after their first dose, 9% of patients said their symptoms of long COVID improved. By two weeks that had jumped to 16%.
However, some patients reported feeling the same, or worse.
Associate Professor Vally says there are two main hypotheses regarding why patients with long COVID may experience improvement in their symptoms following vaccination against COVID-19.
One relates to the fact people with long COVID may have the virus lingering in their system.
‘And obviously a vaccine that primes [someone’s] immune system helps you overcome that persistent infection,’ he said.
‘The other most obvious explanation is that long COVID is an immune-mediated effect so your immune system is kind of working against you as a result of your acute COVID infection and somehow the vaccine is able to help the immune system reset,’ he said.
Associate Professor Vally says the anecdotal reports of people with long COVID receiving the COVID-19 vaccine and experiencing improvement of symptoms should be taken seriously and fully investigated.
‘We will all eagerly await the results of more formal research into this,’ he said.
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