A recent Israeli study tries to deflate the haunting specter of long COVID by examining the association of mild SARS-CoV-2 infection and long-term health outcomes.
“Although the long COVID phenomenon has been feared and discussed since the beginning of the pandemic, we observed that most health outcomes arising after a mild disease course remained for several months and returned to normal within the first year,” the authors concluded.1
Electronic medical records revealed that 1.9 million patients at Maccabi Healthcare Services had a polymerase chain reaction (PCR) test for SARS-CoV-2 between March 1, 2020, and Oct. 1, 2021.The researchers used a list of 70 reported long COVID outcomes to assess patients with a breakthrough SARS-CoV-2 infection compared with unvaccinated infected controls.
Risks were compared using hazard ratios and risk differences per 10,000 patients measured during the early (30-180 days) and late (180-360 days) time periods after infection, they explained.
“This nationwide dataset of patients with mild COVID-19 suggests that mild disease does not lead to serious or chronic long-term morbidity in the vast majority of patients and adds a small, continuous burden on healthcare providers,” they found. “Importantly, the risk for lingering dyspnea was reduced in vaccinated patients with breakthrough infection compared with unvaccinated people, while risks of all other outcomes were comparable.”
The Israeli researchers also addressed a recurrent topic: “Despite the cumulative evidence of the COVID-19 vaccines’ ability to reduce disease burden and severity, whether immunization protects against the long-term sequelae of breakthrough COVID-19 infection is still unknown.”
HCW with Long COVID for Three Years
Daniel Griffin, MD, a clinician who treats SARS-CoV-2 patients at Columbia University in New York City, was not part of the study but speculated that the Israeli researchers wanted to counter some of overwhelming negative media narratives about long COVID.
“The spin is mainly positive, and I think that’s supported by other studies and with what we’re seeing, but, unfortunately, (long COVID recovery) is not for everyone and not for all the issues,” Griffin said in a videocast.2
The hazard ratios still showed fairly significant risks for cognitive impairment, dyspnea, and weakness, he noted.
“Weakness really seems like it gets better and then comes back, unfortunately,” Griffin said. “We see that cognitive impairment, memory impairment, [and] concentration are persisting out. It is true that 95% of people are going to be better at a year, but you still have that chunk of individuals who continue to suffer, and that’s real.”
Griffin treats patients with long COVID, some who have had symptoms since the pandemic began in the United States in 2020. A healthcare worker with long COVID told him she seemed to be crying at inappropriate times, and remaining unemotional during entertainment and events that normally would induce tears.
He recommended she watch the Disney classic “Old Yeller,” noting that everybody cries at the end of the movie.
“I figured this is a good one to find out if they cry at the right times,” he said. “I told a little spoiler alert — at the end the dog gets rabies and has to be shot. “She said that’s okay, it’s not a spoiler.”
However, later, the healthcare worker did not remember the gist of the conversation and didn’t seem to realize that Griffin had told her the “spoiler” detail.
“This is just to really point out that here’s a high-functioning individual, a healthcare professional, who now, almost three years later, is having cognitive impairment,” Griffin said. “So not everyone gets better.”
XBB.1.5 Is Next
In a related development, the predominance of the recombinant Omicron subvariant XBB.1.5 has raised considerable concern in some quarters. Eric Topol, MD, director and founder of the Scripps Research Translational Institute in La Jolla, CA, said the virus is “not done with us.”
“The XBB strain is the first fast-spreading recombinant variant — meaning it is a fusion of two Omicron lineages,” he wrote in a commentary. “Its original version led to a wave of infections in Singapore. Then it added two critical mutations to become XBB.1.5, which was first detected in New York.”3
As of Jan. 14, 2023, the XBB.1.5 subvariant was the leading cause of COVID-19, representing 43% of genomic isolates, according to the Centers for Disease Control and Prevention.4 “These two mutations maintain the high level of immune escape of XBB, while also adding more infectivity advantage, giving the virus better ability to attach itself to the receptors that get it into our cells,” Topol said. “The variant identified has rapidly become dominant throughout the Northeast and is destined to do so across the country in the weeks ahead.”
While there is no indication that XBB.1.5 is more virulent, its rapid spread means more people will be infected, which increases the chances that some in high-risk groups will be among them.
As of Jan. 12, 2023, the COVID-19 daily average over two weeks of 45,600 hospitalizations is a 9% increase. Deaths were up 95% from the prior two weeks, with a daily average of 564 people.5
- Mizrahi B, Sudry T, Flaks-Manov N, et al. Long covid outcomes at one year after mild SARS-CoV-2 infection: Nationwide cohort study. BMJ 2023;380:e072529.
- Racaniello V, Griffin D. TWiV 974: Clinical update with Dr. Daniel Griffin. Published Jan. 12, 2023. https://www.youtube.com/watch?v=p76g1p1oybA
- Topol E. Opinion: The coronavirus is speaking. It’s saying it’s not done with us. The Washington Post. Published Jan. 8, 2023. https://www.washingtonpost.com/opinions/2023/01/08/xbb-covid-variant-immune-evasive-pandemic/
- Centers for Disease Control and Prevention. COVID Data Tracker. Variant proportions. Jan 14, 2023. https://covid.cdc.gov/covid-data-tracker/?utm_medium=email&utm_source=govdelivery#variant-proportions
- The New York Times. Coronavirus in the U.S.: Latest Map and Case Count. Jan. 12, 2023. https://www.nytimes.com/interactive/2021/us/covid-cases.html