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What is the Risk of Long Covid after Vaccination?

by dawangy1 min read31st May 202110 comments


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I received my 2nd shot of the Pfizer vaccine in the middle of April, but I still have some anxieties about some higher risk activities like indoor dining. Mostly, I'm worried about the possibility of long Covid.

This article, although it presents only one anecdote, does show that long Covid is at least possible after being fully vaccinated. As immunity evasive variants grow as a share of new infections, we might even expect this kind of occurrence to become more common as time goes on. A redditor claims that four vaccinated people he knows still ended up symptomatic. He could be lying, but maybe these variants are getting good at their job. 

I wish I could present better sources for my concerns but I'm afraid scrappy anecdotes and self reported data is really all we have to work with on this front right now. Or so I thought, until I ran into this preprint from the folks from JoinZOE and the Covid Symptom Study app. If you take a look at tables 8 and 9, you can see that the authors found no evidence for reduced incidence of symptoms lasting >28 days after vaccination in the younger age group (given that infection did occur, of course). The effect was significant in the older age group. I should add that this was self reported data and not a trial.

What are we to make of this? Do vaccines not protect us against long Covid in the way that we hoped they might? Of course, if we don't get infected, this isn't an issue. But if we are infected, then are we really at equal risk of developing long Covid as someone who was infected without vaccination? What other sources out there discuss this?

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In areas with a lot of vaccine penetration, case counts mostly are just going to be very low anyway; combined with the vaccine effectiveness against infection (~80-90% for mRNA vaccines) the probability of being infected will be negligible. For example, in my local area and given my demographics, my current best estimate is that I incur around 10 microcovids if I spend an hour indoors breathing right on another random person. (And I am using conservative numbers.) If that's not true in your area, it may well be true in a month or two.

The only way this is going to change is if a new variant comes around and mucks everything up (in which case the current studies won't be very informative.)

So for myself, I don't really care very much about answering this question right now.

As for "long covid" itself, my sense from talking with GPs is that it's mostly misattributed. There's the notorious study which showed that 2/3 of "long covid sufferers" had never been infected with C19 to begin with. It seems like it's just somewhat stronger-than-usual depression? All the risk factors for "long covid" seem to just be risk factors for depression.

On the matter of vaccine effectiveness, do we know what the numbers are for obese vs non-obese? Vaccines commonly don't work (well) for the obese, and given how overweight America is I wonder if this is depressing our numbers. Maybe it's like 98% for thin, 70% for overweight, 40% for morbidly obese or something like that?

4TurnTrout16dDo you happen to have a link on hand?
2matejsuchy16dI'm having trouble finding it. It was a survey done by David Putrino, it's mentioned here: "By contrast, Putrino told me that in his survey of 1,400 long-haulers, two-thirds of those who have had antibody tests got negative results, even though their symptoms were consistent with COVID-19." https://www.theatlantic.com/health/archive/2020/08/long-haulers-covid-19-recognition-support-groups-symptoms/615382/ [https://www.theatlantic.com/health/archive/2020/08/long-haulers-covid-19-recognition-support-groups-symptoms/615382/] Here is a more vague claim that seems to corroborate: "Whereas some “long haulers” were found to be positive for SARS-CoV-2 RNA by RT-PCR at symptom onset, many did not fulfill the criteria for testing at the beginning of the pandemic, or tested negative at a time when respiratory symptoms had subsided. In addition, some “long haulers” did not have detectable antibodies to SARS-CoV-2 when the first serological test (Abbott) became available commercially. https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.51350 [https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.51350] If you look at the demographics of the sufferers, it's also somewhat suspect. Middle-aged well-to-do white women are massively over-represented. If it were a matter of over-active immunity you'd expect young women, and if it were a matter of a weak immunity getting overrun, you'd expect men. So, I'm not sure there's a good reason to suspect this population really would be the main sufferers of some legitimate long-term syndrome. OTOH, middle-aged white women have sky-high rates of depression.
2romeostevensit16dI expect symptoms-consistent-with is broad enough to interact with a whole lot of stuff that is going on medically and culturally.

The risk of death from covid after vaccination is near zero and this seems to be the case despite the variants. The vaccines all seem to be holding up well against the variants so your friends info is anecdote not data. If you’re still worried, keep wearing a mask, taking vitamin d and avoid large gatherings with people of unknown vaccination status. Apart from that, assuming you are living in an area with high vaccinations rates, just get on with your life. I would suggest that the risk to your mental health from continued isolation is higher than the risk of long covid.

The risk of death from covid after vaccination is near zero and this seems to be the case despite the variants

This seems to be true, but this doesn't obviously imply the risk of long COVID is significantly decreased. As far as I'm aware, no one has really studied this. On priors I'd guess that vaccines help a bunch, but I don't understand what's going on here very well.

And I think this is an important question, long COVID seems to represent a lot of the harm of COVID to young people. If case rates in your area aren't that low, this definitely seems like a valid question to ask

3dawangy18dMy thoughts exactly. The only explanation (with the assumption that long Covid risk as a proportion of infections is actually lower in vaccinated individuals) that I can think of for why the JoinZOE paper may have found no significant effect in the reduction of long Covid as a proportion of cases (despite strong priors in favor of the opposite) is that perhaps people think of Covid less now and are more likely to drop off using the app if their symptoms don't persist than they were in say, December 2020 or January 2021.

tbh, I would just ignore the anecdotes and focus on the JoinZOE paper preprint I linked in the post. I'm not worried about death from Covid as much as I am about the long haul symptoms. Death from Covid, as you have noted, is very rare among vaccinated individuals.

I still wear a mask almost everywhere I go. Only exception is for outdoor dining, where it's not possible. But hey, it's outdoors.

1 comments, sorted by Highlighting new comments since Today at 2:17 PM

This doesn't address the exact question you asked, but I think it's important to say. (But it's 1 AM, so I'm not going to say it very well.)

(I'm largely using the general 'you' here rather than specifically calling out OP.)

COVID has put us in a state of fear that doesn't always respond appropriately to new data. It has always been true that you can get sick from being around other people. In fact, it's always been true that you can contract an as-yet-uncurable chronic disease from being around other people.

Is your post-vaccination risk of contracting long COVID significantly higher than that baseline risk? For that matter, what actions do you take every day that have a higher risk of death than contracting COVID does? Do you drive?

How much do you value activities like indoor dining, or concerts? If you didn't really care about going to restaurants or concerts in the first place, then sure, maybe it's costless to continue avoiding them. But if concerts are one of the things you enjoy most in the world, that's a magnitude of sacrifice to your fear that I don't think it makes sense to continue making post-vaccination.

My model is that risk of getting seriously ill from COVID for someone in my demographic, after full vaccination, is zero for all practical purposes. And my point here is, there have always been viscerally terrifying tail risks, like splitting your lip and having your face devoured by flesh-eating bacteria, but fear of flesh-eating bacteria doesn't control your life. You might get seriously injured in a car accident, but if you live somewhere where cars are an everyday necessity, you still drive.

So yes, maybe there is some not-exactly-zero probability of contracting COVID and becoming chronically ill post-vaccination. But going by all of the quantitative models I've internalized over the past 15 months, that probability is still very close to zero, and in any case nowhere near high enough that you should continue avoiding activities because of it. 

You're probably just avoiding activities because you've become so used to it, and now you're putting an unreasonably high burden of proof on the question of whether you should do things that used to seem normal to you. Like, you used to do certain things, then you stopped doing them because of COVID. Now the threat of COVID has been neutralized by the vaccine, so logically you should go back to your Before Times state. But your system 1 doesn't really get this, because it's settled into a new normal where every activity is by default unsafe until proven otherwise. Consider that probably, now that you're vaccinated, all activities are almost exactly as safe as they were before COVID.

As I said this was not particularly well-argued. But I hope I got across the general point.