Studies of COVID-19 Consequences and Vaccine Update
(Long COVID part 3/4)
This week’s article will provide a brief update on vaccines and will continue the discussion of the long-term consequences of being infected with SARS-CoV-2. Information presented is intended to provide a medical perspective - the articles are not intended as a political statement for or against any public policy. Statements in these articles should be considered coming from myself, not from any organization I represent or my employer.
A few weeks ago, I discussed in an article the cardiovascular problems associated with COVID-19. The article focused on studies documenting cardiovascular problems in kids as well as college and professional athletes. Since then, a very large study has been published analyzing the risks of cardiovascular problems in a wide age range of adults.
A study published February 7, 2022; in the journal Nature Medicine looked at long-term cardiovascular outcomes of COVID-19. Researchers utilized data captured by the United States Veterans Administration medical records system. They studied the incidence of various cardiovascular problems occurring in 153,760 VA patients with COVID-19. The researchers established two other cohorts of patients. They matched 2 groups of people with similar medical histories, ages, genders and other factors that might impact the development of cardiovascular disease. One group of patients was a set of patients with data gathered from the medical record prior to the pandemic. The other set of patients were people who had not tested positive for the virus - they looked at this matched group for cardiovascular problems occurring during the same time period as those who had COVID-19.
They looked at the occurrence of cardiovascular problems that occurred 30 days or more after infection. The researchers concluded that “...individuals with COVID-19 are at increased risk of incident cardiovascular disease spanning several categories, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease. These risks and burdens were evident even among individuals who were not hospitalized during the acute phase of the infection …”.
The details of how the study was conducted and a breakdown of the results is available for those interested in more information by searching “Long-term cardiovascular outcomes of COVID-19” - look for an article in nature.com. The authors present their data in several graphs detailing the results. They include a breakdown of risk for each cardiovascular outcome in groups of patients who were hospitalized for COVID-19 as well as those who were not hospitalized.
The researchers also utilized these 3 groups of people to study the risk for signs, symptoms, diagnoses and prescriptions for neurocognitive decline and mental health problems. The researchers analyzed the records looking for the incidence of predetermined measures occurring at least 30 days after infection. They found that those who had COVID-19 had a substantially higher risk of developing a broad range of neuropsychiatric and mental health problems. The risks of examined outcomes were increased even among people who were not admitted to hospital. In part of the summary the authors of the study stated: “The risk of incident mental health disorders was consistently higher in the covid-19 group in comparisons of people with covid-19 not admitted to hospital versus those not admitted to hospital for seasonal influenza, admitted to hospital with covid-19 versus admitted to hospital with seasonal influenza, and admitted to hospital with covid-19 versus admitted to hospital for any other cause.”
The details of how the study was conducted and a breakdown of the results is available for those interested in more information as the article can be found by searching “Risks of mental health outcomes in people with covid-19: cohort study”. The article was published February 16, 2022 and available online courtesy of the medical journal BMJ .
Next week I will continue the discussion about the long-term consequences of being infected with SARS-CoV-2. I will close out this article with a brief update regarding vaccines.
Vaccine Update:
The Pfizer-BioNTech and the Moderna vaccines are given as a 2 shot primary series (3 shots for immunocompromised individuals) then a booster given at 5 months. The original studies were conducted with the second Pfizer-BioNTech shot being given 3 weeks after the first and for Moderna the interval was 4 weeks. Studies now indicate that the interval can be extended out to 8 weeks with good results. The CDC has now advised based on this and other information that a “8-week interval may be optimal for some people ages 12 years and older, especially for males ages 12 to 39 years”. Extending out the interval between the first and second primary injections may lessen the risk of the rare occurrences of myocarditis that has been seen mainly in 12-39 year old males after second injections of the COVID-19 vaccines.
It is important however to point out two considerations with extending this interval. First it is much more likely that someone in this age group will have myocarditis as a result of being infected (unvaccinated) with the virus than they would from receiving the vaccine. Rates of myocarditis with COVID-19 are much higher than the risk of myocarditis associated with vaccination. Additionally, myocarditis following vaccination is almost always easily treated. Another concern to consider is that the second shot does strengthen the effectiveness of the vaccine - one shot provides good protection but the second bolsters your immunity. For those who are young and healthy this may be of less of a concern as a single shot will likely keep them out of the hospital for the 8-week interval - however for those at higher risk for severe COVID-19: I suggest they discuss the optimal timing of vaccination with their primary care provider.
Russ Coash, PA-C
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