LongCOVID

Long COVID Update - May 2022

28 April 2022
Update 23 September 2022: Please view the latest ‘Guidance on Myocarditis and Pericarditis after COVID-19 vaccines’ from the Australian Government as endorsed by ATAGI and CSANZ.

What is long COVID and how it is diagnosed?

Long COVID is a condition in which patients who have had COVID-19 still have persistent symptoms at least 30 days later. Another very similar term used sometimes by doctors is chronic COVID – which is very similar to long COVID but has symptoms extending beyond at least 12 weeks after infection.

Symptoms can range from tiredness, a loss of taste or smell, problems with memory, breathlessness and more serious lung and heart complications that can raise the risk of having a heart attack or other heart issues.

Anyone experiencing any long-term side effects should discuss them with their GP or call the National Coronavirus Helpline on 1800 020 080, 24 hours a day.

How widespread is long COVID?

Long COVID is widespread in countries like the US and the UK. It’s estimated that around 1.7 million Brits are affected and in the US, it’s believed that around one third of people infected with COVID-19 have developed some form of long COVID.

In Australia, long COVID is an emerging health problem. A Deakin University study estimated that a few thousand Australians developed long COVID after contracting the virus in the first year of the pandemic.

But despite our high vaccination rates, they estimate between 40,000 - 325,000 people might develop long COVID due to rising case numbers caused by the Omicron variant.

Whilst the number of deaths associated with long COVID are small in Australia – they are rising – and whilst the exact numbers are unclear recent figures suggest they are up from eight in February to 14 in March.

Who is getting long COVID?

Data is clearly showing that it’s the unvaccinated and those who have severe cases of COVID-19 that are most at risk of developing long COVID. Being obese also raises the risk of developing long COVID.

Studies from the US and Israel have revealed that people who are vaccinated have a 50% lower average risk of developing long COVID than unvaccinated people.

Another preliminary study found patients who ended up in hospital with COVID-19 had a higher risk of long COVID, but if you were vaccinated your risk of developing long COVID was reduced.

It is believed that if you are fully vaccinated you have less virus in the body during an infection and are therefore less likely to have a severe case of COVID-19.

Whilst the Omicron variant has proved very effective in causing infections even in those fully vaccinated, being boosted provides significant protection against severe disease, especially in young healthy populations.

How long does long COVID last?

In the UK the Office for National Statistics has reported that around 800,000 people have lived with the condition for more than a year and 74,000 for at least two years.

A UK study published in the Lancet Respiratory Medicine journal also found more than two-thirds of people hospitalised with COVID-19 still suffer symptoms a year later. People who needed mechanical ventilation while in hospital and those who were obese were at even more risk.

It also discovered that women were 33% less likely to make a full recovery than men.

How prevalent are heart complications as a result of having long COVID?

Several news studies demonstrate a significant link between having COVID-19 and developing heart disease.

In the largest study, 153,760 unvaccinated veterans in the US who survived COVID were compared to over 500,000 in a control group. Those who had COVID had a 72% increased risk of heart failure, 63% increased risk of heart attack, and 52% increased risk of stroke compared with controls.

“That study very clearly showed in those who survived at least 30 days after COVID infection, excluding those that died of COVID-related complications, there was a doubling of the risk of heart attack over the next 12 months, and more than doubling of heart failure, cardiac arrest, cardiac shock and a tripling of increased clots to the lungs and double the risk of stroke” Prof Kovacic said.

A University of Sydney study also found significant links between being hosptialised and developing heart complications.

Its study of 644 patients found one in seven had signs of heart injury, one in 25 developed atrial fibrillation or flutter (abnormal heart rhythms which can lead to stroke), almost one in 50 had heart failure and one in 300 suffered heart inflammation.

It’s important to note both studies involved patients who were unvaccinated.

How does COVID-19 affect the heart?

The COVID-19 virus can affect the heart and the blood vessels veins to cause inflammation. This can affect the heart and blood vessels in several ways including causing acute inflammation, pulmonary embolism caused by blood clots, myocarditis, heart failure, and heart attack.

What do we know about Omicron and the risks of Long COVID?

Omicron only took hold at the end of 2021. Researchers around the world are currently studying its effects but the major data has not yet been presented.

Long COVID experts are hoping that Omicron will result in fewer long COVID cases as it has proved less severe than Delta and the original strains of the virus.

But, its increased transmission remains a cause for concern with significant numbers of people still requiring hospitalisation.

What is the treatment for long COVID?

There are no specific therapeutics for long COVID because the causes are still not fully understood.

Many patients with long COVID recover spontaneously (if slowly) with holistic support including rest, symptomatic treatment, and gradual increase in activity

In addition, rehabilitation type programs are showing promise with a small preliminary Irish study demonstrating an improvement in symptoms. Patients underwent a program adapted from helping patients with multiple sclerosis and other chronic conditions.

Australia’s first long COVID clinic has just opened at St Vincent’s Hospital in Sydney which is also offering rehab style programs for those affected.

Key indications for referral and specialist assessment include clinical concern as well as new or persistent respiratory, cardiac, or neurological symptoms.

Additional therapies including anti-inflammatory treatments are being looked into.