Sfrom the early days of the pandemic, members of communities with disabilities and chronic illnesses warned that Covid-19 could be a mass deactivation event. However, media stories and political decisions continued to focus on hospitalizations and deaths, largely ignoring “Long Covid” – the patient’s preferred term for the long-term symptoms that some patients experienced as a result of which can start as a mild Covid infection. Pharmaceutical companies, health agencies and governments are confident that vaccines can reduce hospitalization and death rates, eventually ending the pandemic. But few discuss Covid at length in the context of vaccines or pandemic resolution. Those of us who have experienced the long-term symptoms of Covid-19 find ourselves wiped from the narrative once again and asking myself: can the vaccine prevent Covid for a long time and to what extent?
Discussions about the effectiveness of the Covid vaccine focused on the vaccine’s ability to prevent severe disease, death, and hospitalization. On February 24, the New York Times reported that the Johnson & Johnson vaccine “strongly protects against severe disease.” Earlier this week, David Leonhardt of the Times wrote about the J&J vaccine: “The picture is blurry for mild cases, but I’m not particularly worried.” (Full disclosure: I work part-time as a video producer for a Covid news show produced by Johnson & Johnson. The show is on hold and my involvement has been fairly minimal since December.) The Centers for Monitoring and Prevention website The disease states that the Pfizer-BioNTech vaccine appears to protect against “more serious outcomes”, such as hospitalization or death. In a recent issue of the New York Times, Dr. Angela Rasmussen, a virologist at Georgetown University, explains that the purpose of vaccines “is to prevent death and serious health complications that strain our overloaded health care system. This is undoubtedly good news, but it does not take into account the long-term results of 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 the majority of patients surveyed (84.7%) “were outpatients with mild illnesses” compared to previous studies that focused only on hospitalized patients. Our research indicates that the health consequences of Covid-19 extend far beyond acute infection, even among those with mild illness, write researchers at the University of Washington.
Paola Garcia, 39, of New York, told me that her initial Covid symptoms mimicked those of a mild cold or flu; she experienced low-grade fever, fatigue, and mild breathing difficulties, among other initially manageable problems. But these symptoms never went away. Garcia fell ill on March 20 last year and, in addition to the symptoms he initially experienced, developed more severe symptoms such as tremors, pericarditis, temperature disorder, hair loss, weight loss, nausea, fatigue, and cognitive functioning problems.
Garcia is one of many Covid patients who remember the early days of the initial virus as mild. Donn Seidholz, 67, of Omaha, told me he tested positive for Covid-19 on August 12 after suffering from migraines, fatigue, brain fog, loss of taste and smell and heart in race. Seven months later, he has not yet regained his sense of smell or taste, says his brain fog has become “debilitating” and reports continuous and intermittent fatigue. Seidholz’s experience is common for many patients with long-term Covid, and in some cases, mild symptoms can even lead to death.
Given the potential long-term impact of a mild Covid infection, the conversation about the vaccine’s effectiveness should consider whether the vaccine can prevent mild diseases and infections. That being said, when trying to determine the prevalence of Covid long between non-severe cases, it is important to distinguish between cases that are not hospitalized or “outpatient” and patients with initially “mild” symptoms. While some Covid patients were not hospitalized because their symptoms were mild, others were rejected due to overwhelmed health systems, medical prejudice, 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 or medication. “I was told that in normal times I would be admitted, but they were not normal times.” She continued 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-term patients in the support group she leads.
As Covid is new and widespread awareness is still limited, it is not surprising that discussions about vaccine efficacy and pandemic resolution fail to take into account long-term disease and disability. But there are scientific and historical precedents for the idea that viruses can have long-term effects, and in some past disease outbreaks, these results have been taken more seriously.
During the race for the 1954 polio vaccine, disability was at the center of discussions about ending the outbreak. “There was a high demand for the vaccine from parents who were worried that their children might get polio and would be paralyzed,” said Dr. René Najera, an associate in the epidemiology department at Johns Hopkins Bloomberg School of Public Health. leads the Vaccine History Project at the College of Physicians of Philadelphia.
Polio deactivates less than 1% of the population it infects, but Dr. Najera says the impact of the virus on children – along with President Franklin Delano Roosevelt’s well-known polio disability – has caused widespread public concern. The scientists who developed the vaccine understood these fears, and the vaccine’s effectiveness was measured by examining severe cases of polio in children and determining whether the patient had been vaccinated against the virus before becoming infected.
“There was no laboratory test for polio itself,” Dr. Najera told me. Unlike Covid-19, patients with polio have rarely been diagnosed before experiencing severe symptoms and paralysis. “They did not catch asymptomatic, much less sick,” said Dr. Najera about the first studies on the polio vaccine. The Sars-Cov-2 virus presents a slightly more difficult enigma, as 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. The University of Washington estimate of 30% was cited by the National Institutes of Health, but rates may be even higher because there have been no attempts to estimate the long prevalence of Covid beyond individual studies.
“It will be some time before we completely see the image of Covid in the population,” says Dr. Najera.
As no government is tracking the long Covid along with rates of infections, deaths and hospitalization, it will be difficult to gauge how much these numbers fall after more people are vaccinated. That being said, emerging research in Israel indicates that Covid vaccines could prevent both infections and diseases that scientists refer to as “sterilizing immunity.” If vaccines can prevent infection, they can prevent mild cases and thus Covid. Unfortunately, Israeli findings are still new and it is important to note that although infection rates in Israel have declined since the start of vaccination, infection rates are still higher than in November, and scientists disagree with whether Israel can provide evidence of the vaccine’s effectiveness against the new Covid variants.
The polio vaccine has been extremely effective in preventing disability, death and ultimately eradicating the virus from most of the world. (Poliomyelitis still exists in Nigeria, Pakistan and Afghanistan, due in part to CIA actions that have caused the vaccine to falter among local people), and Covid vaccines will have an undeniable impact on our current pandemic, whether it provides sterilizing immunity. If vaccines can provide sterilizing immunity, we may be looking at our latest wave of patients with Covid.
In the meantime, we cannot ignore the potential long-term impact of mild Covid cases. We need more research to determine if the vaccine can completely prevent mild disease and infection; until then, public health guidelines need to consider mild infections as a potential threat to society and the economy. A study conducted by the Patient-led Research Collaborative, which studied nearly 4,000 patients with Covid who became ill in the first waves of the pandemic, found that most had not yet been able to return to work completely and many is struggling to access the necessary disability benefits. Just as clinicians and employers should not dismiss patients with initially mild cases who report debilitating long-term symptoms, the media and policy makers should not dismiss mild cases as having no effect on society or human health.
Moreover, we must consider the long Covid in the launch of the vaccine and in the discussions about the end of the pandemic. Early anecdotes from long-term Covid patients who received the vaccine show that responses may be varied, with some patients reporting a improvement of symptoms and others facing more intense side effects. These reactions should be studied, understood and the vaccine recommendations should be considered by patients with Covid.
Finally, we need to be vigilant about how we discuss and plan the “end” of the pandemic, understanding that some people may continue to experience the long-term impact of the virus in the coming decades. Raising awareness of Long Covid should provide solutions not only to that patient population, but to all those who have struggled with a “mysterious disease” and to all those whose needs are not met by the disability benefit system. from this country.