Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study
BMJ 2022; 377 doi: https://doi.org/10.1136/bmj-2021-069676 (Published 18 May 2022) Cite this as: BMJ 2022;377:e069676Linked Editorial
Are vaccines a potential treatment for long covid?
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Dear Editor,
The article by Ayoubkhani and colleagues is an essential step for understanding Covid. (1) However, such efforts are not very common in developing parts of the world like southeast Asia.
Only a handful of studies with a limited sample size restricted the scope for drawing inference on the long-term implications of Covid in this part of the globe. One study from India indicated long Covid in 29.2% of patients - 23.4% in mild/ moderate cases and 62.5% in severe/critical cases. Contrary to the present study from the UK, it could not find any protective role of two doses of Covid-19 vaccines. (2) Another study from the northern part of the country estimated that 22% of patients may develop long Covid. (3) A third study found about 8% of the patients reporting ongoing symptomatic Covid and 32% of patients having a post-Covid phase. (4) In Bangladesh, the prevalence of long Covid symptoms at 12 weeks was 16.1%, fatigue being the most common symptom. (5) From Pakistan, 83.7% of patients reported residual symptoms even after one month after Covid-19 infection, body ache being the most common symptom. (6)
As vaccines were seen to reduce the chance of developing long Covid by 50% (7), there is a need for similar evidence from southeast Asia, home to 680 million people.
References
1. Ayoubkhani D, Bermingham C, Pouwels KB, et al. Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study. BMJ2022;377:e069676.
2. Arjun MC, Singh AK, Pal D, et al. Prevalence, characteristics, and predictors of Long COVID among diagnosed cases of COVID-19. medRxiv 2022 preprint; Available from:
https://doi.org/10.1101/2022.01.04.21268536
3. Naik S, Haldar SN, Soneja M, et al. Post COVID-19 sequelae: A prospective observational study from Northern India. Drug Discov Ther. 2021;15(5):254-60.
4. Budhiraja S, Aggarwal M, Wig R, et al. Long Term Health Consequences of COVID-19 in Hospitalized Patients from North India: A follow up study of upto 12 months. medRxiv [Internet]. 2021 [cited 2021 Dec 13]; Available from: https://www.medrxiv.org/content/10.1101/2021.06.21.21258543v1.
5. Hossain MA, Hossain KMA, Saunders K, et al. Prevalence of Long COVID symptoms in Bangladesh: a prospective Inception Cohort Study of COVID-19 survivors. BMJ Glob Health. 2021 ;6(12):e006838.
6. Qamar MA, Martins RS, Dhillon RA, et al. Residual symptoms and the quality of life in individuals recovered from COVID-19 infection: A survey from Pakistan. Ann Med Surg (Lond). 2022;75:103361.
7. UK Health Security Agency. The effectiveness of vaccination against long COVID: A rapid evidence briefing. In: Team UC-E, ed, 2022. www.gov.uk/government/news/ukhsa-review-shows-vaccinated-less-likely-to-...
Competing interests: No competing interests
Dear Editor,
The article 'Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study' asks an important question, and unfortunately misses a large artefact in their data.
Throughout the whole paper, it is assumed that the level of self-reported longcovid remains constant in the absence of vaccination.
This means that all conclusions against that axiom are questionable for any meaningful clinical answer, and only true in the case that the axiom is understood by everyone reading it. The latter seems unlikely to be the case.
The below Lancet article, for example, is one of many reporting remission of self-described long-covid in the months after infection, which found around 5% recovery from week 12-36. (contrast with figure 2 of this paper.) with a downwards trajectory compatible with perhaps 6% at week 48.
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00299-6/fulltext
In this case, this obviously cannot be due to vaccine effects, as there was no vaccine at this time. Other studies have found similar effects in disparate patient populations.
For the 'any severity' graph in Fig 2 and the describing text, it is probably arguable that this error is less significant, as a 6% error in a 3% initial error is 0.7%. It notably changes the shape of the confidence bands.
For the 'activity limiting' - not including the fact that the natural recovery rate is basically identical to the putative vaccine effect is a major problem.
PS.
I have suffered from a longcovid-like illness for the past 40 years, and would be in the 'activity limiting' part of the graph.
I support vaccination of the whole population, absent those that have specific large prompt risks to their health.
Both from the perspective of preventing longcovid onset in those newly infected who have an abortive infection, and those that are not infected by them following any asymptomatic or symptomatic transmission.
Nonrecovered activity limiting longcovid, should be treated from a policy perspective as equal to a significant fraction of a death.
Ian Stirling.
Competing interests: No competing interests
Re: Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study
Dear Editor
In view of the large number of long Covid cases after vaccination it would be of great interest to have a follow up for those excluded in this study, esp those 283 210 individuals that were excluded for not having a positive swab or blood test. See i.e. Davis article below where 10-12% seem to have long covid after vaccination.
Long COVID: major findings, mechanisms and recommendations
Hannah E. Davis, Lisa McCorkell, Julia Moore Vogel & Eric J. Topol
Nature Reviews Microbiology volume 21, pages133–146 (2023)
Competing interests: No competing interests