Two and a half years into the COVID-19 pandemic, we now have a very good idea of where the disease first made the jump to humans. Three separate studies, summarized in Nature, indicate that the so-called “wet market” in Wuhan, China was in fact the source of the disease. In fact, the disease seems to have made the jump to humans at least twice, with both occurrences happening in this market, which sold live animals in addition to meat. The suspect carrier has still not been definitively confirmed, but suspicion is primarily at an animal known as the “raccoon dog” (which is neither a dog nor a raccoon, but most closely related to foxes). The theory that COVID-19 was either manufactured in, or escaped from, a genetics laboratory is not supported by any of these studies.
But even as we’re finally coming to grips with where the SARS-CoV-2 virus originated, we’re only starting to get a handle on where it’s going. In particular, what does it mean to live with a virus that is capable of reinfecting the same person over and over, with each infection offering anything from the sniffles to death? What can we expect in terms of long-term disabilities from a virus when even those with a mild infection can be left with detectable heart damage? What other effects can we expect long term as COVID-19 continues to circulate in the population?
Now, a series of studies provides more information about the damage COVID-19 infection does to the heart and vascular system, and just what the new generation of bivalent vaccines may do to help.
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Right now, the United States is sill averaging over 60,000 new reported cases of COVID-19 each day. That’s an order of magnitude lower than in January, but “reported” may be the key word. Because in an era of home testing, it’s difficult to know just how many positive-but-unreported cases there are.
While most of these reported cases have mild symptoms, the seven-day average of deaths directly attributed to COVID-19 is still hovering at 475. That’s 173,000 Americans dying from this disease, and that number has been disturbingly stable for over five months. On average, 4,500 Americans are admitted to the hospital with COVID-19 symptoms each day. Over the course of a year, that’s over one-and-a-half million making hospital visits from this single disease—a huge burden on individuals and on the health care system.
With business, travel, and schools ripping away mask requirements, and the New York City subway signaling “you do you,” the pandemic shows no sign of ending.
When it comes to long COVID, the best estimate we have, according to Stat, is that this is about 20% of those infected with COVID-19. So far in the United States, there have been over 95 million recorded cases of COVID-19 reported to the Centers for Disease Control and Prevention (CDC). Depending on how many of these are repeats from the same individual, that represents an estimated 10-19 million people who now have long COVID, or somewhere between 3% and 6% of the population. That number is still increasing.
So what does it mean?
A recent study in Nature Medicine shows that when it comes to the heart, the results of long COVID are little short of awful.
We show that, beyond the first 30 d after infection, individuals with COVID-19 are at increased risk of incident cardiovascular disease spanning several categories, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease.
Having mild symptoms was not an indicator that there would not be severe problems later as these same increased risks affected even those who were not hospitalized. However, those who were hospitalized for COVID-19 had greatly increased risks down the road.
Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial. Care pathways of those surviving the acute episode of COVID-19 should include attention to cardiovascular health and disease.
When I wrote a year ago that “We cannot live with endemic COVID-19,” it was exactly because of early studies showing these sorts of results. Even as we’re pretending that the pandemic is “behind us” and both media and regular folks talk about “back during the pandemic” as if it’s over, the true weight of what’s happening is still ahead. The cost—in terms of people and in terms of money—is unsustainable. A Harvard study suggests that COVID-19 could be endemic in 2024, with 15% of the population infected with COVID-19 at any one time. That’s not an end to the epidemic. That’s just … an end. It’s not one we can live with.
So what can we do about it? Well, thankfully, there is some bright light amid all this gloom. First, there’s this new peer-reviewed study showing that getting vaccinated and keeping up your booster levels can greatly reduce the chance of getting long COVID.
Of the 951 infected, 637 (67%) were vaccinated ... those who received two vaccine doses were less likely than unvaccinated individuals to report any of these symptoms (fatigue, headache, weakness of limbs, persistent muscle pain) by 62%, 50%, 62%, and 66% respectively.
So, people who were fully vaccinated with two doses cut their risk of long COVID symptoms at least in half. Assuming these symptoms are indicative of the level of damage caused by the disease, this is also a huge decrease in the health threat generated by long COVID. Finally, it also means that vaccinated people are able to get back to work sooner after a COVID-19 infection. Which is a good thing for them, their families, their employers, the government, etc.
But wait. It gets better.
Compared to the 2447 included individuals who never reported SARS-CoV-2 infection, double-vaccinated participants were no more likely to report any of the mentioned symptoms.
The reports of these symptoms for people who were double-vaccinated was the same as people who had never been infected. This certainly doesn’t mean that people who are vaccinated can’t experience long COVID, but getting vaccinated, and keeping booster levels up, is fantastically effective not just in avoiding acute symptoms at the outset, but long COVID symptoms later. This is seriously good news. This study looked specifically at BNT162b2, the vaccine developed by BioNTech and distributed by Pfizer in the United States. However, there’s no reason to believe the Moderna vaccine isn’t at least as effective. Also note that only a portion of the people in this study had boosters. Just getting both rounds of vaccine was enough to give this boost.
Vaccines save lives now. Vaccines save lives later. And vaccines make all the time that comes after infection a lot more livable.
And there is even more good news. The preprint of a study now at bioRxiv looks at how effective the new generation of bivalent vaccines—those that contain portions of the spike protein from the originally sequenced form of COVID-19 as well as a matching protein from a more recent omicron variant—are at both preventing infections and reducing effects.
… the bivalent vaccines induced greater breadth and magnitude of neutralizing antibodies compared to an mRNA-1273 booster. Moreover, the response in bivalent vaccine-boosted mice was associated with increased protection against BA.5 infection and inflammation in the lung.
And yes, okay, this is a mouse study. Mouse studies of new drugs have a bad reputation for a good reason. However, this kind of study is exactly how most annual vaccines are tested. Once a mouse model has proven to be a good match for human reactions with a disease/vaccine combination, that generally makes it a very good predictor in testing updates of that vaccine.
What these mice are telling us is that the bivalent vaccines are not just more effective at keeping people from getting sick with omicron BA.5, by far the most common form of the virus now circulating, these vaccines are actually better at keeping people from getting infected in the first place. And the good results were seen no matter which version of omicron was used in creating the bivalent vaccine.
Let’s review (also know as tl;dr):
- Long COVID can cause heart damage that persists even when symptoms go away. For those with acute COVID-19 symptoms, that damage is very often profound.
- Being fully vaccinated greatly decreases the chances of having long COVID symptoms, so much so that it brings the chance of these symptoms back to the baseline of people who were never infected in the first place.
- New bivalent vaccines are much better at protecting against acute illness from omicron variants, and can even prevent omicron infection in the first place.
So when can you get a dose of that sweet new omicron-blocking bivalent vaccine? Right now. They are appearing in pharmacies and clinics near you right this moment. If you’re near a Walgreen’s, they are taking appointments for the booster for everyone 12 and over. If you’re in CVC territory, they’re rolling out the new stuff as well. Or just check the link below and let the CDC be your guide. And hey, wear a mask. Masks work.
CDC: Find COVID-19 Vaccines or Boosters Near You