Jim Shalom
A semi-retired physician

Long COVID Concerns – Another Reason to Consider Vaccination

Two arguments have been used to promote mass vaccination against COVID-19.  The first is the necessity to confer immunity on as many people as possible, and especially on those who have a relevant health risk.  The second is the mass vaccination effect – the assumption that if a high enough percentage of the population is immunized, a positive cascade reaction will ensue: fewer asymptomatic or symptomatic infections, fewer deaths, a reopened economy and less need for isolating protocols.  Recently, a third reason has emerged – Long Covid syndrome, which I believe should be considered too.

Although the first two arguments seem to make perfect sense, large swathes of the population do not find them sufficiently persuasive to seek out vaccination.  Philosophical opposition aside, practical arguments against vaccination hinge on concerns about side effects and on the unforeseeable possibility of long-term complications.  From our present experience with the vaccines, apart from rare instances of serious immediate allergic reaction (anaphylaxis), many people do suffer from local or general side effects after the first or second injection, or sometimes after both.  But these side effects, which invariably resolve after 2-3 days, are probably not the main reason for hesitation.  The dominant concerns relate to potential serious complications.  Even though there are no hard facts to back them up, rumors of severe reactions to the vaccination abound on social networks.  These assertions are blatantly spurious.  Quite simply, the incidence of immediate medical complications is no higher among the vaccinated population than among the unvaccinated.  More fervent objections stem from the long-term uncertainty factor – what are flippantly termed horns and tail concerns: fears that those who receive the vaccine will suffer unforeseeable permanent damage to their health. While it is true that, because we are dealing with a new vaccine, no one can know for certain how likely serious long-term effects may be, these concerns, while theoretically legitimate, are highly overstated, and collapse in the face of our experience to date.  In addition to amassing significant amounts of data about COVID vaccines, in recent decades the world has accumulated vast experience with hundreds of millions of similar like vaccine shots administered for other diseases.  Only very rarely have severe complications followed vaccination, and even then, cause and effect between the vaccine and the subsequent medical problem has not always been firmly established.  The likelihood, therefore, of scores of vaccinated people’s developing serious complications in the future due to a COVID vaccine manufactured in much the same way as older vaccines, while not zero, is exceptionally low.

If the vaccines do have shortcomings, these may be the converse of the long-term side effects that people fear: the vaccines may well be insufficiently effective – especially against a future mutation – rather than over-effective, or perhaps effective for only a short period.  Time will tell.

The vaccination turnout of younger people is lower than that of their elders.  I believe that many young people minimize the perceived danger of catching COVID because of their double presumption that they are unlikely to contract the virus, and that if they do, it is unlikely to make them seriously ill.

Before reaching a final decision for or against any one of the vaccines, I suggest adding a third variable to this equation: Long COVID, which causes patients to feel unwell long after the virus has been eliminated from the body and COVID tests are negative and is not uncommon in previously infected younger people.

This condition, which is not frequently seen after other viral illnesses, appears to be specific to COVID.  It is not an attenuation of the active infection, but, more probably – at least in part – a separate syndrome.  Let us see why: The Center for Disease Control (CDC) now claims that cases of mild to moderate COVID-19 remain infectious for only 10 days after symptom onset.  Even if we extend this period to two weeks, this means that within 14 days of contracting the disease most people will be virus free and COVID negative.  Therefore, if they continue to feel unwell after that time, their symptoms cannot be due to continuing viral infection.

Long COVID is also referred to as long-haul COVID or chronic COVID syndrome.  Both  terms imply an unpleasant and persistent burden and thus reflect what many sufferers are experiencing.

The British Medical Journal (BMJ) has defined Long COVID as: “not recovering for several weeks or months following the start of symptoms that were suggestive of COVID.”

Wikipedia writes: “Those who suffer from the condition are people who were infected with COVID and despite recovering, continue to suffer from symptoms such as fatigue, headache, shortness of breath, persistent loss of sense of smell, muscle weakness and cognitive dysfunction or brain fog.”  Some findings such as loss of smell may have begun with the acute illness while other complaints such as “brain fog” may appear after the infection itself has resolved.

A previously healthy and energetic colleague of mine, who is now into her second month from the date of diagnosis, may serve as an example: she describes how she now feels short of breath when she sweeps the floor and is not as focused as she was before she became ill.  I am also dealing with an elderly nursing home resident who, though COVID-positive, was mainly asymptomatic.  Even though all her laboratory test results remain unchanged, her level of function has not returned to what it was before she contracted the virus.  In a BMJ article, a recovered patient described the fluctuations of her illness as follows: “It’s a constant cycle of disappointment, not just to you but to people around you, who really want you to recover.”  Laura Holson, a previously healthy award-winning New York Times reporter came down with COVID in April and was treated at home.  Three months later, after twice having tested negative, she was still suffering from fever, had lost 8 pounds and was extremely fatigued.  Over the months that followed, she experienced numerous additional symptoms, including hair loss and brain fog.  She had not yet fully recovered when her descriptive article was published in the Times on January 21st, 9 months after her diagnosis.  Prior to COVID, she had never experienced any of the symptoms from which she has been suffering ever since.

One might intuitively assume a direct correlation between those whose acute phase illness was severe, and the persistence and / or severity of Long COVID symptoms.  Early findings, however, suggest NO such correlation.  In other words, even people who contract only a mild case of COVID could still end up with a litany of extended post-COVID complaints.  Furthermore, in cases where the severity of the symptoms fluctuates, the sufferer’s day-to-day well being is unpredictable, and maintaining a regular routine becomes difficult.

In terms of numbers and percentages, a study of 4 million COVID patients in England carried out by King’s College, London found that 10% of them reported symptoms a month after infection, while 1.5-2% had not fully recovered after 3 months. Let me add the caveat that, as we are still learning about the syndrome, and some of the symptoms are subjective, the incidences quoted may change with future research.

We may hope that in the months to come Long COVID syndrome will be better understood.  In the meantime, when evaluating the pros and cons of vaccination versus non-vaccination, I recommend that the risk of Long COVID be taken into account.

This is how, in my view, non-vaccination compares and contrasts with vaccination:

With vaccination, the likelihood of contracting COVID is almost negligible. Early data arriving now from Israel, which has a high vaccination rate and a centralized data registry, has so far supported this conclusion.  Assuming you are not allergic to the vaccine, at most, you run a risk of mild side effects for up to 2-3 days.  Among the millions of people who have received COVID vaccines to date, no long-term serious complications have yet been found.  Probably the greatest problem with the vaccines is not their excesses, but, rather, their potential shortcomings: for how long will they confer immunity, and will they be effective against new COVID mutations?

If you decide against vaccination, you risk becoming infected.  If you are asymptomatic, you are at especially high risk of inadvertently spreading the infection to someone dear to you.  It is true that a younger person who develops symptomatic COVID runs only a small risk of becoming severely ill, and an even smaller one (probably in the range of 2% or less) of dying from the disease.  However, we also need to take the capricious nature of COVID into account: some cases have taken a dramatic turn for the worse that was not predicted by factors such as age or health status.  Furthermore, we should appreciate that cases of illness or death from COVID and its complications could probably all have been prevented by vaccination.  The possibly preventable nature of death from COVID is a particularly bitter pill for grieving family members to swallow.

Those who recover from COVID, whether they were seriously ill or not, run the risk of suffering from upsetting symptoms that they have never previously experienced and which may well last for 3 months or more after infection.  To date, there is little understanding or treatment of this syndrome.  While feeling unwell is always distressing, my impression from following Long COVID personal reports is that, in addition to their physical symptoms, sufferers’ level of distress tends to be unusually high.  Living with a high level of distress is not pleasant.  Thus, when comparing long term concerns, we see that anti-vaccine arguments have no factual basis, while long COVID symptoms are real, distressing and unpredictable.

People who rely on the media or social networks for information about COVID should be aware of the ubiquitous presence of fake news promoted with a fervor and style that often drowns out the dry, restrained and erudite explanation of the professional.  If you are going to make a rational decision, it should be based on accurate information.  There is a style imbalance between responsible specialists who present data in an accurate, unemotional and qualified manner and those who make emotionally charged, far-reaching and all-encompassing declarations with exaggerated confidence.  In these circumstances, the non-professional dilettante can sound more persuasive than the responsible expert.  Reader beware.

For me, the bottom line is: “Is remaining unvaccinated really worth the risk and danger involved?”

About the Author
Jim Shalom is a specialist in family medicine, with interests in end-of-life care and the Israeli political scene. He resides in Galilee. He has spent most of his adult life living and working in Israel.
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