DOC­TOR'S NOTE with DR AMIR KHAN | AL JAZEERA

● With treat­ment op­tions for long COVID still lim­it­ed, and new symp­toms com­ing to light all the time, we look at whether be­ing vac­ci­nat­ed of­fers pro­tec­tion against it ●

(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.