COVID Transmissions for 8-18-2021
Can breakthrough COVID-19 be Long COVID-19?
Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 638 days since the first documented human case of COVID-19. In 638, the Plague of Amwas spread through the Rashidun Caliphate—the new Arabic Empire, that had just conquered what today we know as Israel and Palestine. This plague was a singular event in the context of a centuries-long plague pandemic. That pandemic had begun around 541 in the Byzantine Empire, and continued until the 8th century. I don’t like to make a lot of bold predictions, but I do feel confident predicting that the COVID-19 pandemic will not last for 200+ years. We will reach a global balance with this virus before then—I think at worst within another couple of years.
Today I discuss a recent NYT article about Long COVID in vaccine breakthrough cases of COVID-19. It’s not an area where there are a lot of facts to chew, but I want to provide some comment since this is something I get asked about a lot.
Bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
Long COVID-19 in vaccinated patients: the question I still can’t answer
Is Long COVID-19 possible in vaccinated patients? According to some reports collected by a recent article in The New York Times, the answer is yes: https://www.nytimes.com/2021/08/16/well/live/vaccine-long-covid-breakthrough-infection.html
However, as the article rightly points out, we don’t know how common such events are. Just because something is possible does not make it common. For example, we know it is possible for life to emerge on a planet where it’s possible to have liquid water. However, so far, of all the planets that we’ve found, ours is the only one where it has happened, and we don’t know what the actual odds of life emerging really are.
Similarly, just because we know breakthrough COVID-19 can lead to long-term outcomes, we just don’t have a clear sense of how often it does do that. The studies we have right now are too small, too sporadic, and too unreliable.
Why are they small, sporadic, and unreliable? I’m glad you asked, reader. It’s because VACCINES WORK! Breakthrough cases that are symptomatic remain rare, even in this world of variants. Rare—but not unheard of. Still, with them being rare, the odds that they occur in a population that is feeding into a database that we can then study, and the chances of getting enough of those cases together to do a study, remain low. We don’t have enough cases or enough follow-up to be able to say definitively right now.
Also, and this is a wider issue, we don’t have a clear sense of what “Long COVID” is. There is a cluster of symptoms that people describe which look a lot like ME-CFS; this is what many people are talking about when they say “Long COVID.” On the other hand, studies of symptom duration, which typically follow patients for weeks or months, look for almost anything that remains unresolved. The CDC has actually moved away from using the term “Long COVID” or “Long Hauler” in favor of PACS, a term meaning “post-acute COVID-19 syndrome.” This term is more clinical and precise, and captures any disease symptoms that linger beyond 4 weeks. PACS and the concept of Long COVID are often confused with one another, and the press reports studies that looked for the case definition of PACS as though they say something about Long COVID—the latter being less well-defined and difficult to characterize. Even in the patients who are not vaccinated, we don’t have a clear survey and sense of the various ways that symptoms may linger, is what I’m really getting at. This research topic remains in its infancy. We know that symptoms can persist, but we don’t have a clear sense of how different persistent symptoms may cluster together or how long they may particularly linger.
There may be, for example, a constellation of symptoms like cough that stick around for a while because a patient got hit particularly hard by the virus. There may also be patients whose PACS includes long-term loss of sense of smell. Then there are people who have persistent fatigue and shortness of breath. All of these can last for different periods of time. When they’re shorter in one person but longer in another—does that mean we’re looking at different types of PACS? Or are these different syndromes altogether, manifested by different mechanisms? Could the loss of sense of smell be nerve damage that can gradually be repaired, or is the persistent fatigue an immune system problem that will never go away?
We have questions, but I do not think we have definitive answers.
At this time, what I can answer definitively is that PACS happens very frequently in people who are unvaccinated and get COVID-19. Unvaccinated people are, at this point, going to get infected with SARS-CoV-2 at some time. They might get infected multiple times in their lives, even. Each time there is a chance of any of the negative outcomes of COVID-19.
Meanwhile, COVID-19 doesn’t happen frequently in vaccinated people at all. Symptomatic disease is rare in people who are vaccinated, according to all data I have seen from everywhere. It seems to me that if symptomatic disease is rarer in vaccinated people, then PACS will be rarer as well. My advice to society is, as it has been, that the best defense here is to get vaccinated. After that, I think our best measures are wearing a mask, avoiding indoor crowding, trying to prefer well-ventilated spaces, and getting a COVID-19 test if you experience new or unusual symptoms of disease. Doing all these things together is not a guarantee you will avoid PACS or COVID-19, but it is a combination of our best strategies for doing so.
What am I doing to cope with the pandemic? This:
Childbirth classes
One of those things you just have to do, when the time is coming.
Carl Fink commented on the last issue:
Hi, John,
To clarify: my comment about other vaccines was meant in the context of the disease being a global problem(as you have written about), thus my mention of Sinovac. It now seems that the commonly-exported China-manufactured vaccines are not very effective (emphasis on "seems" as I am not an expert), and at this time I believe they're the most-widely-administered worldwide. Of course, nations that can't afford more effective vaccines can't afford truly widespread testing, either.
You mention the Taliban apparently banning vaccination. Could this be because a CIA pretense of working for a vaccination program resulted in the death of their buddy, Osama bin Laden? That's a rhetorical question, inevitably that contributes to their attitude. The CIA may well have killed more people than Osama ever managed with that poor decision.
I’m curious to hear more about the potential real-world effectiveness of Chinese COVID-19 vaccines. I really haven’t heard much, so I asked Carl for further reading in my response:
I have not seen a lot of real-world evidence with Chinese vaccine products, so I am not sure if what you're claiming here is true or not. Do you have a source?
And yeah, I do think that the exploitation of vaccination by the CIA as a means to track Osama Bin Laden was terrifyingly irresponsible and almost certainly killed more people than it should have. Whether it killed more than the thousands of people that he killed, that's hard to say. Polio causes paralysis that can be managed and recovered from in most cases, and there are very few cases globally since it only exists in Afghanistan and Pakistan, now--and certain labs, where it is closely tracked. On the other hand, if we lose containment on polio in those countries and it returns, then the CIA's decision there looks particularly short-sighted.
They could have found another way, in my opinion.
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Always,
JS