Vaccines may not prevent many symptoms of long covid, study suggests - The Washington Post

A large U.S. study looking at whether vaccination protects against long covid showed the shots have only a slight protective effect: Being vaccinated appeared to reduce the risk of lung and blood clot disorders, but did little to protect against most other symptoms.

The new paper, published Wednesday in Nature Medicine, is part of a series of studies by the Department of Veterans Affairs on the impact of the coronavirus, and was based on 33,940 people who experienced breakthrough infections after vaccination.

The data confirms the large body of research that shows vaccination greatly reduces the risk of death or serious illness. But there was more ambiguity regarding long covid.

Six months after their initial diagnosis of covid, people in the study who were vaccinated had only a slightly reduced risk of getting long covid — 15 percent overall. The greatest benefit appeared to be in reducing blood clotting and lung complications. But there was no difference between the vaccinated and unvaccinated when it came to longer-term risks of neurological issues, gastrointestinal symptoms, kidney failure and other conditions.

What is long covid?

“This was disappointing,” said Ziyad Al-Aly, lead author and chief of research and development service at VA Saint Louis Health Care System. “I was hoping to see that vaccines offer more protection, especially given that vaccines are our only line of defense nowadays.”

“Long covid” refers to the constellation of symptoms that many people have reported months after their initial infections. Early in the pandemic, some patients who complained of lingering symptoms were dismissed by physicians who thought the manifestations might be psychological. But the condition has since become a major concern for the medical community.

For these three long haulers, debilitating symptoms and fatigue has kept them from returning to work — and in return, struggling to navigate their new normal. (Video: Drea Cornejo, Joy Yi, Colin Archdeacon/The Washington Post, Photo: Carolyn Van Houten/The Washington Post)

The World Health Organization has defined post-covid syndrome as symptoms that last for at least two months and cannot be explained by alternate diagnoses. It cited evidence suggesting that as many as 20 percent of the half-billion people worldwide estimated to be infected with coronavirus may experience mid- and long-term effects.

This week, the Centers for Disease Control and Prevention released new estimates of the syndrome’s toll in the United States, suggesting it affects one in five adults younger than 65 who had covid, and one in four of those aged 65 and older. People in both age groups had twice the risk of uninfected people of developing respiratory symptoms and lung problems, including pulmonary embolism, the CDC found. Those in the older age group were at greater risk of developing kidney failure, Type 2 diabetes, neurological conditions and mental health issues.

The Veterans Affairs study, believed to be the largest peer-reviewed analysis in the United States on long covid based on medical records, looked at patients who either had two doses of the Moderna or Pfizer—BioNTech vaccines, or one dose of the Johnson & Johnson vaccine. It did not assess the impact of booster shots. While the study population contained a wide range of ages and racial and ethnic backgrounds, it did skew older, Whiter and more male than the United States as a whole.

The VA study also had no way to tell how different variants may change the risk of long covid. These breakthrough infections, for example, took place at a time when alpha, delta and prior variants were at high levels in the United States. It does not cover the period when the omicron variant and its subvariants began circulating in late 2021.

How long covid is accelerating a revolution in medical research

The findings add to the debate surrounding similar analyses trickling out from the United Kingdom, Israel and other countries that have shown conflicting results in terms of whether vaccines protect against long covid.

One British study published in the medical journal Lancet, for example, based on self-reported data from an app, showed a 50 percent reduction in risk among those who were vaccinated. On the other hand, a paper by University of Oxford researchers based on electronic records from the United States found that vaccination did not appear to reduce the risk of long covid for most symptoms.

The question of vaccines and long covid has been a critical one for doctors. Some patients have claimed a vaccine has cured them, while others have avoided the shots for fear of triggering symptoms.

Igor Koralnik, chief of neuro-infectious diseases at Northwestern Medicine, said recent research suggests neither is true. In a paper published in the Annals of Clinical and Translational Neurology on Tuesday, Koralnik and his colleagues found that 77 percent of the 52 long-covid patients they are following had been vaccinated against the coronavirus, but the shots did not appear to have a positive or negative impact on cognitive function or fatigue.

“There is a neutral effect of vaccination. It didn’t cure long covid. It didn’t make long covid worse,” Koralnik said.

At the Dartmouth Hitchcock Medical Center’s Post-Acute COVID Syndrome Clinic, Christina Martin, an advance practice nurse, said that since November, her staff has noticed a “worrying trend” of vaccinated people having breakthrough infections and developing long covid.

When the clinic was founded a year ago, she said, they anticipated seeing fewer new patients by this time as more people became vaccinated. Unfortunately, they’ve seen the opposite, with patient numbers going up.

“We now feel that long covid is here to stay. … This will have profound implications on our health-care system and resources,” Martin said.

David Putrino, a long-covid researcher who serves as director of rehabilitation innovation at the Mount Sinai Health System in New York, shares those concerns. He worries that public health leaders are not taking the current surge seriously enough because they are discounting the risks of long covid.

Putrino said that demand for appointments at his medical center’s long covid clinic continues to increase and he does not anticipate a slowdown any time soon. The clinic has seen about 2,500 patients since opening in May, 2020.

“We failed in our health messaging that death is not the only serious outcome of a covid-19 infection,” Putrino said. “. . . I’m very concerned that what this is going to do is lead us into a continuation of this mass-disabling event we are seeing with long covid.”

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Monkeypox virus hasn't mutated, can be contained in non-endemic countries: WHO - Hindustan Times

• Monkeypox outbreak: The European Union said the risk of monkeypox spreading widely was 'very low', but high for certain groups.

As cases of monkeypox are detected in Europe and North America, some scientists are baffled by the unusual disease's spread in developed nations. (AP)

Published on May 23, 2022 07:58 PM IST

ByHT News Desk

The World Health Organisation (WHO) on Monday said there was no evidence yet to support that the monkeypox virus had mutated. 

A senior official of the global health body said the infectious disease that was endemic in west and central Africa had tended not to change.

WHO's emerging diseases lead Maria Van Kerkhove said the outbreaks in non-endemic countries can be contained and human-to-human transmission of the virus stopped.

"We want to stop human-to-human transmission. We can do this in the non-endemic countries... This is a containable situation," Kerkhove said during a live interaction on the UN health agency's social media channels.

The more than 100 suspected and confirmed cases in the recent outbreak in Europe and North America had not yet been severe, Kerkhove added.

Rosamund Lewis, head of the smallpox secretariat, part of the WHO Emergencies Programme, said mutations were typically lower with this virus, although genome sequencing of cases would help in the understanding of the current outbreak.

According to the health agency, the outbreaks were atypical as they were occurring in countries where the virus did not regularly circulate. 

Scientists were seeking to understand the origin of the cases and whether anything about the virus had changed.

Meanwhile, the European Union said the risk of monkeypox spreading widely was 'very low', but high for certain groups. Over 100 cases were reported from some European nations, besides the United States, Canada and Australia. 

"Most of the current cases have presented with mild disease symptoms, and for the broader population, the likelihood of spread is very low," ECDC director Andrea Ammon said, adding that the likelihood of further spread through close contact among persons with multiple sexual partners was considered "high".

(With agency inputs)

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Monkeypox can be stopped outside endemic countries: WHO - RFI English

Issued on: 23/05/2022 - 17:12Modified: 23/05/2022 - 17:10

Geneva (AFP) – The monkeypox outbreaks in non-endemic countries can be contained and human-to-human transmission of the virus stopped, the World Health Organization said Monday.

Fewer than 200 confirmed and suspected cases had been recorded so far, the WHO's emerging disease lead Maria Van Kerkhove said.

"This is a containable situation, particularly in the countries where we are seeing these outbreaks that are happening across Europe, in North America as well," Van Kerkhove told a live interaction on the UN health agency's social media channels.

"We want to stop human-to-human transmission. We can do this in the non-endemic countries.

"We're in a situation where we can use public health tools of early identification, supported isolation of cases.

"We can stop human-to-human transmission."

Van Kerkhove said transmission was happening via "close physical contact: skin-to-skin contact", and that most of the people identified so far had not had a severe case of the disease.

Rosamund Lewis, who heads the smallpox secretariat on the WHO emergencies programme, said monkeypox had been known for at least 40 years and a few cases had appeared in Europe over the last five years in travellers from the endemic regions.

However, "this is the first time we're seeing cases across many countries at the same time and people who have not travelled to the endemic regions in Africa", she said.

She cited Nigeria, Cameroon, the Central African Republic and the Democratic Republic of the Congo.

"It is primarily in the animal kingdom in forested areas. Now we're seeing it more in urban areas," she said.

Mutation studies

Lewis said it was not yet known whether the virus had mutated but viruses in the wider orthopoxvirus group "tend not to mutate and they tend to be fairly stable.

"We don't yet have evidence yet that there is mutation in the virus itself," she said. Virologists will be studying the first genomic sequences of the virus coming through, she added.

Van Kerkhove said a major global meeting next week would discuss research, epidemiology, diagnostics, therapeutics and vaccines.

Andy Seale, strategies advisor at the WHO's global HIV, hepatitis and sexually transmitted infections programmes, stressed that while the virus could be caught through sexual activity, it was not a sexually transmitted disease.

"While we are seeing some cases amongst men who have sex with men, this is not a gay disease, as some people in social media have attempted to label it. That's just not the case.

"Anybody can contract monkeypox through close contact."

Van Kerkhove added that as surveillance widened, experts did expect to see more cases.

© 2022 AFP

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Weight bias in health-care has 'crushing' impact, says patient - CBC.ca

Theresa Babb was 12 when a birthday gift from a doctor broke her spirit.

Doctors were trying to determine why the pre-teen was overweight. A hospital stay in Halifax coincided with her birthday.

With a flu making the rounds, visitors weren't allowed to enter the hospital. A doctor gave her a birthday card that had an elephant on the front.

"I think that's when, as a child, I recognized and understood that I was never going to get any help," said Babb, now in her 60s. "Didn't matter where I went, who I spoke with. That just continued on for the rest of my life."

Whether it was a doctor who remarked that her hiking boots were just "for show," or a doctor who asked if she was going to get a fat bike when she expressed an interest in cycling, Babb has encountered weight bias many times.

In a health-care setting, this happens when the provider holds negative thoughts or incorrect beliefs about weight, which either unintentionally or intentionally impacts the quality of care they provide.

Some of these beliefs could be that obesity is a personal choice, or that obese people are lazy or gluttonous.

Dr. Michael Mindrum hopes to change how obesity care is provided in Nova Scotia. (Submitted by Dr. Michael Mindrum)

A recent Public Health Agency of Canada report says Babb is not alone in the experiences she's had. It found that after adjusting for sex, income and other characteristics, higher-weight people were "significantly more likely" to report discrimination in health care.

"It's just so crushing," said Babb, a Dartmouth, N.S., resident.

"You know, that's the only word that I can think of when I think about how many times I've left a doctor's office just feeling even worse about myself than I did when I went in."

The report notes that weight bias is associated with adverse physiological and psychological outcomes. 

"Consequences of weight stigma may include avoidance of medical care, provider distrust, medication nonadherence, disordered eating, physical inactivity and poorer mental health," says the report.

Dr. Michael Mindrum, who practises medicine in Nova Scotia's Annapolis Valley, recently wrote a blog post about weight bias and discussed instances where he's been guilty of it.

"I'm sure I've said words that were not the best in the past, despite good intentions," he told CBC News.

Mindrum said the curriculum in medical school didn't examine the science behind obesity, and his residency didn't provide further insight. He learned about it through going to conferences and talks.

The science behind obesity

Mindrum said weight is regulated in a part of the brain called the hypothalamus.

"It's genetically conferred. It's a disease that exists in a deep structure in the brain that regulates our appetite as it interacts with an environment that is prone to causing obesity in those that have genetic susceptibility, so all this really is beyond an individual's control," he said.

He said the hypothalamus also regulates other vital functions, such as body temperature, thirst and thyroid function.

Mindrum said that while things such as behaviour change, nutrition and movement can lead to weight loss, they're just part of the solution.

He wants to see an overhaul in how obesity care is provided in Nova Scotia, including additional support for obesity medication — which isn't covered by pharmacare — and bariatric surgery.

Mindrum said bariatric surgery reduces the risks of dying and heart failure, and can make Type 2 diabetes go into remission and reduce blood pressure.

He said increasing access for bariatric surgery would pay for itself. He views it as an essential surgery.

Weight bias results in people not seeking care

Mindrum said overhauling obesity care also means making more subtle changes in health-care environments, such as having larger chairs and gowns at hospitals.

"Patients don't feel welcome when they don't feel cared for — or through the language that we use — and many will avoid care, and that's the last thing we really want," he said.

Babb said there have been times where she avoided seeing a doctor because she was worried about how they would make her feel.

Through the help of a new doctor, medication and other lifestyle changes, Babb has dropped 150 pounds in recent years.

"What works is having a physician who supports you and does everything that they can to understand what it is that you're experiencing," she said.

Treatment in Nova Scotia

Earlier this year, Mindrum wrote to officials including Premier Tim Houston and Health Minister Michelle Thompson. He outlined his concerns about obesity care in the province and also offered to help create a provincial obesity care strategy.

Tanya Penney, a senior executive director with the Department of Health and Wellness, replied. She wrote that obesity is a chronic disease that requires attention.

As part of Nova Scotia Health's "focus on wellness, risk factor management, and prevention, its Primary Health Care team has made wellness programming available across the province for all Nova Scotians wishing to access it. Programs focus on many areas of wellness, including physical activity, food nutrition and weight management," she wrote.

The letter also noted that Nova Scotia Health's Obesity Network oversees resource planning for obesity services and offers information for services and treatment. It can be reached by phone on Tuesdays and Thursdays by phone at 902-473-4672.

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Long Covid Symptoms and Treatment: What We Know So Far - The New York Times

There is no universal definition of the complex condition, but clues about causes and potential treatments are beginning to emerge.

Among the many confounding aspects of the coronavirus is the spectrum of possible symptoms, as well as their severity and duration. Some people develop mild illness and recover quickly, with no lasting effects. But studies estimate that 10 to 30 percent of people report persistent or new medical issues months after their initial coronavirus infections — a constellation of symptoms known as long Covid. People who experience mild or moderate illness, as well as those without any underlying medical conditions, can nonetheless experience some debilitating long-term symptoms, including fatigue, shortness of breath, an erratic heart rate, headaches, dizziness, depression and problems with memory and concentration.

Such lingering medical issues are so varied that one study by a patient-led research group evaluated 203 symptoms that may fluctuate or even appear out of the blue after people seem to have recovered.

As Dr. Ziyad Al-Aly, the chief of research and development at the VA St. Louis Healthcare System and a clinical epidemiologist at Washington University in St. Louis, said, “If you’ve seen one patient with long Covid, you’ve seen one patient with long Covid.”

How doctors currently diagnose long Covid

There is little consensus on the exact definition of long Covid, also known by the medical term PASC, or post-acute sequelae of Covid-19. While the World Health Organization says long Covid starts three months after the original bout of illness or positive test result, the Centers for Disease Control and Prevention sets the timeline at just after one month.

Some researchers and health care providers use other time frames, making efforts to study and quantify the condition more difficult, said Dr. Al-Aly, who has conducted many studies on long-term post-Covid issues.

When patients experiencing persistent symptoms go to their doctors, tests like electrocardiograms, chest X-rays, CT scans and blood work don’t always identify physiological problems, Dr. Al-Aly said. Researchers are working to pinpoint certain biological factors, called biomarkers, that correlate with persistent Covid symptoms. These could include signs of inflammation or certain molecules produced by the immune system that might be measured by blood tests, for example.

For now, doctors must rely on their patients’ descriptions of symptoms and rule out alternative explanations or causes. Some post-Covid clinics have multidisciplinary teams of specialists evaluate patients to figure out the best treatment options.

What causes long Covid?

It’s unclear what exactly drives long Covid, but research has begun to offer some clues. Some experts theorize that an immune response that goes into overdrive when you first get sick may lead to inflammation and damage throughout the body, eventually resulting in long Covid symptoms, said Dr. Michael Peluso, an infectious disease physician at the University of California, San Francisco.

“We know that during acute Covid-19, some people have a really revved-up immune response and some people have a reduced immune response, and that response can determine the trajectory of how well somebody does,” he said.

Another explanation, experts say, could be that your immune system never fully shuts down after the initial infection.

Who is at risk?

Research offers some hints about which patients might face a greater risk of long-term symptoms. In a study of 209 patients published in January, researchers found four factors that could be identified early in a person’s coronavirus infection that appeared to correlate with an increased risk of having ongoing symptoms two to three months later.

One factor was the level of coronavirus RNA in the blood early in the infection, an indicator of viral load. Another was the presence of autoantibodies — antibodies that mistakenly attack tissues in the body as they do in conditions like lupus and rheumatoid arthritis. A third factor was the reactivation of Epstein-Barr virus, which can cause mononucleosis and infects most people, often when they are young, and then usually becomes dormant.

The fourth factor was having Type 2 diabetes, although experts say that in studies involving larger numbers of patients, diabetes might be only one of several medical conditions that increase the risk of long Covid.

Studies from post-Covid clinics have also found other pre-existing medical conditions that may put people at risk for long Covid. In a report on the first 100 patients treated for neurological and cognitive symptoms at a post-Covid clinic at Northwestern Memorial Hospital in Chicago, 42 percent reported previously having depression or anxiety, though such patients might simply be more comfortable seeking neurological treatment, doctors said. Other pre-existing conditions included autoimmune diseases and headaches.

Studies also suggest that the risk of developing long Covid peaks in middle age, Dr. Peluso said. The average age of patients in the Northwestern study was 43. An analysis of 78,252 private health insurance claims across the United States found that people between the ages of 36 and 64 made up about two-thirds of the long Covid patients. (But that study did not include most Medicare recipients, so it involved relatively few older patients.)

Women may be disproportionately affected, with some studies finding that about 60 percent of patients are female. A similar pattern has emerged in other long-term conditions like ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), which has several symptoms similar to those of long Covid.

Because the pandemic has had a significant impact on Black and Latino communities in the United States, and those groups have more limited access to medical care, they may have high numbers of long Covid cases as well, Dr. Peluso said.

Can vaccines protect against long Covid?

The picture is still coming into focus, but several studies suggest that getting a Covid vaccine can reduce — but not eliminate — the risk of longer-term symptoms.

The United Kingdom’s Health Security Agency conducted an analysis of eight studies that had looked at vaccines and long Covid before mid-January. Six found that vaccinated people who then became infected with the coronavirus were less likely than unvaccinated patients to develop symptoms of long Covid. The remaining two studies found that vaccination did not appear to conclusively reduce the chances of developing long Covid.

In that analysis, one study, which has not been peer-reviewed, of about 240,000 U.S. patients found that those who had received even one dose of a Covid vaccine before their infections were seven to 10 times less likely than unvaccinated patients to report symptoms of long Covid 12 to 20 weeks later. But another large study of electronic patient records at the U.S. Veterans Health Administration, also not yet peer reviewed, found that those who were vaccinated had only a 13 percent lower risk than unvaccinated patients of having symptoms six months later. Vaccinated patients mostly benefited by being less likely to develop lung problems and blood-clotting difficulties, said Dr. Al-Aly, one of the study’s authors.

“Reliance on vaccination as a sole mitigation strategy is wholly inadequate,” Dr. Al-Aly said. “It is like going to battle with a shield that only partially works.”

Seeking medical care

If you are concerned about any lingering symptoms after a confirmed or suspected coronavirus infection, don’t be afraid to ask for help. Checking in with your primary care provider is a good first step. More doctors are becoming aware of long Covid symptoms and can recommend tests that might at least rule out other causes of your symptoms.

“Even though we say that long Covid is when symptoms last for a month or three months after infection, you don’t have to wait that long to get help,” Dr. Al-Aly said. “People should really honor their symptoms.”

If you’re not getting help from a primary care doctor, you may want to seek out a post-Covid clinic, though Dr. Al-Aly acknowledged that “it’s easier said than done.” Access to post-Covid clinics can be difficult for those without adequate medical insurance. And, in some states, people may have to travel hundreds of miles to get to the nearest one. You can look up post-Covid clinics near you on the Survivor Corps database.

Bring your medical records if you’re visiting a new provider and make a list of all your symptoms, especially if you’re experiencing cognitive issues and are likely to forget some health concerns when your appointment comes around.

Some long Covid issues can be managed with existing medications or treatments for symptoms like headaches or gastrointestinal problems. Physical therapy and “cognitive rehab,” including approaches often used for patients who have experienced strokes or brain injuries, can also be helpful over time. Some people benefit from tailored physical and mental health rehabilitation services and breathing exercises, which can help them slowly build back strength and endurance for physical activities.

Other possible tools against long Covid, including antiviral treatments, are only beginning to be studied. The National Institutes of Health is devoting more than $1 billion to a major research effort called the Recover Initiative, but progress has been slow so far. Lawmakers are pushing for better funding for long Covid research and medical care.

Several groups, such as Body Politic, Long Covid Alliance and Survivor Corps, provide emotional support, as well as resources for seeking treatment, disability benefits and patient advocacy.

People with long Covid may also want to consider joining a research trial, Dr. Peluso said. You may be able to find continuing clinical studies at universities and academic centers near you, or sign up to be part of the Recover Initiative.

“Participating in research can be very empowering,” Dr. Peluso said.

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