Long Covid Weekly #130: Post-Vaccination Syndrome, COPD & Covid & more
Hi everyone!
Our article of the week is titled "COVID-19 and risk of long-term mortality in COPD: a nationwide population-based cohort study," published in BMJ Open Respiratory Research. This study investigates the long-term mortality risk among individuals with Chronic Obstructive Pulmonary Disease (COPD) who have recovered from COVID-19, revealing alarming insights about the heightened mortality in this vulnerable population.
A couple of key findings highlighted in the study include:
"The long-term mortality rate in individuals with COPD after COVID-19 was 4.8% during the study period, which was about twofold higher compared with individuals with COPD who did not experience COVID-19."
"The risk of mortality gradually decreased as the time interval from index date increased," indicating that while the immediate post-recovery phase is particularly dangerous, the risk does lessen over time.`
Media
Long COVID studies stymied by pharma’s lack of cooperation
Summary:
Academic researchers are struggling to repurpose existing drugs for Long COVID due to a lack of cooperation from pharmaceutical companies.
Avindra Nath, a neurologist at the NIH, faced refusals from Merck and Bristol Myers Squibb for supplies of drugs he believes could help treat Long COVID patients.
Historically, pharmaceutical firms have cited the absence of concrete biomarkers as a reason for declining requests for drug trials related to Long COVID.
Few successful trials have advanced, with some firms expressing disinterest in post-COVID treatments due to financial and branding concerns.
Stats/trends:
The wholesale acquisition cost of Keytruda, a potential treatment, is over $11,500 for a dose every three weeks, while Opdualag costs around $15,120 per vial.
Only a handful of compounds have been tested for Long COVID as treatments, with many studies stalled by pharmaceutical companies’ reluctance to provide products.
Mapping comorbidity patterns and associated proteins to help fight “long COVID” - AIP.ORG
Definitions:
Multimorbidity: The coexistence of multiple chronic medical conditions.
Summary:
Tens of millions are estimated to have experienced PASC worldwide, with symptoms persisting long after initial COVID-19 infection.
The study highlights multimorbidity as a significant factor in the progression and severity of long COVID symptoms.
Researchers mapped proteins related to pre-existing diseases that could be targeted for novel or existing treatments.
Key proteins identified, such as NEU1 and INHBW, are linked to lipid metabolism and may provide insights for high-risk COVID-19 patients.
Understanding molecular mechanisms involved in long COVID could lead to improved treatments and prevention strategies.
Stats/trends:
1) The study explored electronic health records data from the Hong Kong Hospital Authority, encompassing a large patient cohort.
2) More than a dozen proteins were identified that link post-infection complications to pre-existing conditions.
Research
Article: COVID-19 and risk of long-term mortality in COPD: a nationwide population-based cohort study | BMJ Open Respiratory Research
DEFINITIONS:
Chronic obstructive pulmonary disease (COPD): A progressive lung disease characterized by airflow limitation that interferes with normal breathing, often associated with chronic bronchitis and emphysema.
Mortality risk: The likelihood of death occurring within a specified period, often used in clinical studies to assess the impact of diseases or conditions.
SUMMARY:
Individuals with chronic obstructive pulmonary disease (COPD) recovering from COVID-19 face a significantly higher long-term mortality risk compared to those without the virus.
The risk of mortality rises markedly in severe COVID-19 cases, particularly within the first 180 days post-recovery, peaking in the initial 30 days.
During the follow-up, 4.8% of individuals in the COVID-19 cohort died, nearly double the mortality rate of matched controls.
The mortality risk for those with severe COVID-19 was over five times greater than that of controls, emphasizing COVID-19's severe impact on COPD patients.
These findings highlight the importance of active surveillance and specialized post-recovery care for COPD patients who have endured severe COVID-19.
Immunological and Antigenic Signatures Associated with Chronic Illnesses after COVID-19 Vaccination | medRxiv
Definitions:
Post-Vaccination Syndrome (PVS): A chronic condition reported after COVID-19 vaccination, characterized by persistent debilitating symptoms similar to Long COVID.
Summary:
The study analyzed immune profiles from 42 PVS participants and 22 healthy controls, revealing significant immune differences.
PVS participants exhibited lower levels of circulating memory and effector CD4 T cells, along with higher TNFα+ CD8 T cells.
The PVS cohort had lower anti-spike antibody levels, linked to receiving fewer vaccine doses than controls.
Serological evidence of recent Epstein-Barr virus (EBV) reactivation was more prevalent in PVS participants.
Elevated circulating spike protein levels were observed in individuals with PVS, suggesting a potential link to chronic symptoms.
The findings highlight the need for further investigation into immunological mechanisms behind PVS.
Stats/Trends:
Approximately 35.7% of PVS participants reported a history of SARS-CoV-2 infection, compared to 45.5% among healthy controls.
PVS participants received significantly fewer vaccine doses (median of 2) than controls (median of 4), with a statistically significant difference (p < 0.01).
Article: Should we be careful with exercise in post-exertional malaise after long COVID? | Nature Communications
DEFINITIONS:
Post-exertional malaise: A worsening of symptoms following physical or mental exertion, often experienced by individuals with chronic illnesses, including those recovering from viral infections like COVID-19.
Maximal oxygen consumption (VO2 max): The maximum rate at which an individual can uptake oxygen during intense exercise; an important indicator of aerobic fitness.
SUMMARY
The study by Appelman et al. highlights that patients with long COVID exhibit lower maximal oxygen consumption compared to healthy controls, indicating significant exercise limitations.
Although long COVID patients were found to be physically active on average, their exercise capacity remains severely diminished.
The authors observe that strenuous exercise may worsen muscle damage and inflammation, challenging the notion of safe exercise in this population.
More research is needed to explore appropriate exercise training regimens that could enhance muscle fitness and overall health for long COVID patients.
My Take:
This is very refreshing to see this being covered by Nature
Article: Full article: Effectiveness of nirmatrelvir/ritonavir and molnupiravir on post-COVID-19 outcomes among outpatients: a target trial emulation investigation
DEFINITIONS:
Target trial emulation: A methodological approach that mimics the design and analysis of a randomized controlled trial using real-world observational data for causal inference.
Post-acute sequelae of SARS-CoV-2 infection (PASC): A term referring to a range of health issues that persist for weeks or months after the acute phase of COVID-19.
SUMMARY:
The study investigates the effectiveness of nirmatrelvir/ritonavir and molnupiravir in preventing post-COVID-19 outcomes, such as mortality and hospitalizations, in outpatients.
Nirmatrelvir/ritonavir demonstrated a significant reduction in post-acute mortality, with relative risks of 0.71 and 0.64 at 31–180 days and 181–360 days, respectively.
While molnupiravir was associated with lower 30-day mortality, it showed no significant long-term benefits in preventing post-acute outcomes compared to no treatment.
Patients treated with nirmatrelvir/ritonavir had a notably lower risk of post-acute hospitalization and adverse sequelae, including atrial fibrillation.
The findings support current clinical guidelines, which recommend nirmatrelvir/ritonavir as the preferred treatment for symptomatic COVID-19 in high-risk outpatients.
Article: Poor Association Between Clinical Characteristics and Seropositivity in Children With Suspected Long COVID—A Single‐Centre Study - Olsson‐Åkefeldt - Acta Paediatrica - Wiley Online Library
DEFINITIONS:
SARS-CoV-2: The virus responsible for COVID-19, formally known as severe acute respiratory syndrome coronavirus 2.
Seropositivity: The presence of specific antibodies in the blood, indicating previous infection or vaccination against SARS-CoV-2.
Post-exertional malaise: A condition characterized by a significant worsening of symptoms following physical or mental exertion, often associated with chronic fatigue syndromes.
SUMMARY:
A study evaluating children with suspected long COVID revealed that 52% had a serological link to SARS-CoV-2 infection.
Despite differing serological status, both seropositive and seronegative children reported multiple symptoms, including fatigue, dizziness, and concentration difficulties.
The research highlighted poor self-reported health across both groups, indicating a substantial impact on daily functioning and well-being.
Children without SARS-CoV-2 antibodies exhibited a higher number of symptoms and greater school absence compared to their seropositive counterparts.
The findings underscore the need for multidisciplinary assessments to address the broad spectrum of symptoms in long COVID among children.
Article: Prevalence of erectile dysfunction as long-COVID symptom in hospitalized Japanese patients | Scientific Reports
DEFINITIONS:
Erectile dysfunction (ED): The inability to achieve or maintain an erection sufficient for satisfactory sexual performance, influenced by psychological, physical, and situational factors
Anxiety and Depression Scale-D (HADS-D): A questionnaire designed to assess levels of anxiety and depression in various patient populations.
SUMMARY:
A recent study found that 19% of male COVID-19 survivors in Japan developed erectile dysfunction (ED) as a long-term symptom within two years of hospitalization.
Patients with ED reported lower perceived recovery and higher scores for breathlessness and fatigue compared to those without ED.
The study identified significant associations between erectile dysfunction and psychological distress, including higher levels of anxiety and depression.
Sleep disturbances were also suggested as a potential factor linked to the prevalence of ED among the patients surveyed.
Notably, the study found no correlation between the severity of COVID-19, vaccination status, or antiviral treatments and the development of erectile dysfunction.
My Take:
This study highlights the critical link between COVID-19 and sexual health, showing that the virus's impact extends beyond respiratory symptoms. Healthcare providers must prioritize mental health in post-COVID care, as conditions like ED significantly affect quality of life and can often go unaddressed. Integrating psychological support into long COVID management strategies is essential, as the repercussions of the pandemic continue to unfold.
I fully understand why the PVS study is a hot button issue: anti-vaxxers are using it to support their claims and pro-C19 researchers are basically dismissing it for small sample size and the claim that many of these PVS patients may have had COVID at some point, including asymptomatically.
As for the small sample size, in the many LC social media groups and patient Zooms I’ve been on, a large number are PVS patients (or parents of PVS young people). There are many thousands more of these people out there than our COVID-denying government (Reps AND Dems) and the minimizing media want to admit. I commend Yale for including PVS folks in their LC studies - I’ve yet to see other researchers do so. (Full disclosure: I am an LC subject in the Yale LISTEN study. PVS subjects were often well-represented on the LISTEN patient engagement Zoom meetings).
But the other thing I want to say is it’s very dismissive to write off many of these PVS patients as having had a prior infection (so how can we know it was really the vaccine that essentially gave them LC?). Patients KNOW when something went wrong in their bodies. Whether the vaccine in this case was the catalyst or the cause (an important distinction, I admit), we should still be believing these patients and continuing to look for answers. We should not sweep away this important preliminary research with the wave of a hand (not suggesting you guys are doing this, but in many of the media articles about the study, there are researchers quoted as basically doing so, with no regard for the fact that Akiko Iwasaki is a world class immunologist and researcher).
To be clear, I’m not at all anti-vax. But I have as a virus long hauler and as someone with a PVS-afflicted family member, the truth is we just don’t know who out there will react to the virus or the vaccine in a way that induces LC symptoms and quite often, disability. I am a little tired of hearing the argument that the vaccines are safe for the majority of people. While that may be true, it is still a bit of Russian roulette, as those whose lives have been upended by vaccine injury will attest to.