Q&A: Risk for long COVID has declined, remains ‘substantial’
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Key takeaways:
- The risk for long COVID has declined with each new variant but remains “substantial,” according to researchers.
- Vaccination lowers a patient’s risk for long COVID, the researchers found.
The risk for developing long COVID declined over the course of the pandemic but has remained significant, researchers reported.
“The research on declining rates of long COVID marks the rare occasion when I have good news to report regarding this virus,” Ziyad Al-Aly, MD, director of the Clinical Epidemiology Center and chief of research and education service at Veterans Affairs St. Louis Health Care System, said in a press release. “The findings also show the positive effects of getting vaccinated.”
Al-Aly and colleagues examined the de-identified medical records of 441,583 veterans with SARS-CoV-2 infections and more than 4.7 million uninfected veterans included in a database maintained by the U.S. Department of Veterans Affairs between March 1, 2020, and Jan. 31, 2022. They estimated the cumulative incidence of long COVID cases 1-year after SARS-CoV-2 infection in the pre-delta, delta and omicron eras of the COVID-19 pandemic.
Results showed that 10.4% of COVID-19 unvaccinated veterans experienced long COVID during the pre-delta era, 9.5% experienced long COVID during the delta variant era and 7.7% developed long COVID during the omicron era, according to the researchers.
Among vaccinated veterans, 5.3% developed long COVID during the delta era and 3.5% developed long COVID during the omicron era.
The researchers found that roughly 70% of the decline in long COVID risk was attributed to vaccinations and roughly 30% to changes in the virus from variant to variant. We asked Al-Aly about the significance of the new findings.
Healio: Is it surprising that the risk for long COVID has declined over the course of the pandemic?
Al-Aly: A lot of things have changed during the pandemic. I am not surprised that the risk for long COVID has changed. The pandemic was — very likely — the most highly dynamic global event of our lifetime. With all of this dynamicity, we expected to see some changes in the epidemiology of long COVID.
Healio: How concerned should people be about developing long COVID if they are infected with SARS-CoV-2?
Al-Aly: While the risk has declined a bit, the remaining risk is substantial. Among vaccinated individuals infected during the omicron era, three-to-four out of every 100 infected adults developed long COVID. This is not a trivial or inconsequential risk.
Healio: What is the main takeaway from this study?
Al-Aly: From my perspective, the most important message is that while long COVID risk has declined, the remaining risk of 3.5% is still substantial. Multiplied by the large number of people who get infected and reinfected, this could lead to many more cases of long COVID, adding to an already high toll.
I would also add that the fingerprints of long COVID may have evolved over time. While the risk of overall long COVID has declined, the risk for sequelae in the gastrointestinal and metabolic systems has gone up, suggesting a shift in the phenotypic characteristics of long COVID from one variant to another.
Al-Aly reports consulting for Gilead Sciences, Pfizer and the VA. Please see the study for all other authors’ relevant financial disclosures.
References:
- Risk of long COVID declined over course of pandemic. https://medicine.wustl.edu/?p=126656. Published July 17, 2024. Accessed July 17, 2024.
- Xie Y, et al. N Engl J Med. 2024;doi:10.1056/NEJMoa2403211.
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