Dr. Yaniv Dotan, director of the Institute of Pulmonology at Rambam Health Care Campus (Rambam) in Haifa, Israel comments on a new US study that sheds light on the risk factors associated with “Long COVID.”
Dr. Yaniv Dotan. Credit: Rambam HCC.
Long COVID is a condition distinguished by numerous health problems persisting or developing after an initial COVID-19 infection. It is characterized by lasting symptoms such as weakness, fatigue, hair loss, and skin problems. The phenomenon has been particularly observed in women and individuals with pre-existing cardiovascular conditions. The research underscores the importance of vaccination to mitigate these risks.
It continues to affect many, despite an overall decrease in the number of severe acute COVID-19 cases. Furthermore, in Israel, the Ministry of Health has noted a recent upward trend in COVID-19 cases; 70 patients were hospitalized in June alone, 14 in serious condition. Since COVID emerged in 2020, patients have been reporting lingering symptoms months after recovery, often developing new, persistent issues shortly after having recovered from the infection.
Dr. Dotan, who also heads Rambam’s COVID Follow-up Clinic comments on the recent study, published in JAMA which involved over 4,700 participants and revealed that more than one in five adults experienced recovery times exceeding three months. Vaccination or infection during the less virulent Omicron wave were associated with shorter recovery periods. Key findings indicated that Long COVID is more common in women, those with cardiovascular conditions, and Native Americans/Alaska Natives. Chronic lung disease, diabetes, asthma, and smoking history led to prolonged acute illness but not persistent symptoms.
Dr. Dotan notes that even at Rambam’s COVID Follow-up Clinic, the incidence of long COVID was higher among women. However, contrary to the study, in Israel, the syndrome developed more frequently among healthy and young individuals rather than those with pre-existing conditions.
Dotan explains that the researchers actually confirmed the great importance of being vaccinated against COVID. “Indeed, there are quite a few opponents of the coronavirus vaccine,” he remarks. “Although there have been several cases in which the vaccine caused various side-affects in the immune system, including pericarditis and joint pain, the vaccine significantly reduces the severity of the COVID during the acute illness; now we know it also reduces the risk of developing Long COVID. If at the beginning of the epidemic we saw a high incidence of Long COVID cases, later, after the majority of the population was vaccinated, we witnessed a significant decrease in severe morbidity and development of a prolonged condition. In my opinion, and this research supports it, the change in COVID-19 strains also played a significant role in this phenomenon.”
Despite the study's insights, Dotan notes its limitations, highlighting the high prevalence of Long COVID among young and healthy individuals in Israel, contrary to global trends. “Approximately 40 percent of those who developed Long COVID in the study are Latino, which is difficult to correlate with Israeli data, since there are important genetic differences between the two populations that affect disease severity and the recovery time. For example, at the beginning of the epidemic, when I was working as a pulmonologist and intensive care physician in the United States, we saw that Latino-Americans suffered from more severe and prolonged illness.”
In 2022, at the height of the COVID-19 epidemic, Dotan and Dr. Ronen Bar-Yoseph, director of Rambam’s D. Dan and Betty Kahn Pediatric Pulmonary Unit in collaboration with other physician-scientists from Rambam, conducted a study among COVID-19 patients, which was published in the Journal of Personalized Medicine.
They compared the results of cardiopulmonary stress tests in mild COVID-19 patients who developed Long COVID with those who had severe COVID-19 with lung damage. Dotan shares, “What amazed us was that the heart and lung stress test was normal in patients with mild COVID-19 who developed prolonged shortness of breath; we could find no physiological explanation for their complaints. In contrast, a decrease in lung function was observed in patients who had experienced lung damage concomitant with serious COVID; hence, the observed decrease in lung function could explain their complaints.” He goes on to explain, “Those who developed Long COVID had normal cardiopulmonary stress tests but continued to feel unwell for a long time. Some of their reported symptoms were shortness of breath, widespread pain in the muscles and joints, fatigue, general weakness, memory problems, concentration problems, lack of energy, taste and smell disturbances, tingling, and numbness. These patients also experienced significant hair loss, skin problems, and rashes.”
In summary, while Long COVID remains a complex and multifaceted condition, ongoing research and vaccination efforts are crucial to understand the condition and mitigate its impact. The global medical community continues to work towards better prevention and treatment strategies for those affected by this lingering illness.
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