The Morning: Long Covid and the vaccinated

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August 16, 2021

By Tara Parker-Pope

Good morning. Long Covid remains a worrisome complication after a Covid-19 infection. Are the vaccinated at risk, too?

A Covid-19 test last week in Visalia, Calif.Tomas Ovalle for The New York Times

Can the vaccinated develop long Covid?

Despite concerns about the Delta variant and breakthrough coronavirus cases, it's clear that the vaccines are protecting us from hospitalization and death. Typically, breakthrough infections result in mild to moderate symptoms or no symptoms at all.

That's good news. But it doesn't answer one big question: What's the risk of so-called long Covid after a breakthrough infection?

While most people recover from mild to moderate Covid-19 in a few weeks, long Covid is a perplexing set of symptoms — brain fog, fatigue and muscle pain, to name a few — that can persist for weeks or months after the active infection has ended. And it doesn't happen only to people who had serious illness; sometimes long Covid affects people who had mild illness or no symptoms at all. And while many viruses, like influenza, also can lead to long-term fatigue and other symptoms, long Covid appears to be more common, although more data is needed. Several studies suggest that 10 percent to 30 percent of adults who catch the virus may experience long Covid.

But most of what we know about long Covid comes from people who were infected before vaccines became available.

What we know

Much of what we know about long Covid in fully vaccinated people comes from a single study of antibody levels in Israeli health care workers who had breakthrough infections. Among 36 health workers with breakthrough infections, seven (19 percent) had lingering symptoms after six weeks, including loss of smell, cough, fatigue or trouble breathing.

But even the study's own authors say the study wasn't designed to assess the risk of long Covid. "It was not the scope of this paper," said Dr. Gili Regev-Yochay, the study's senior author and the director of the infection prevention and control unit at Sheba Medical Center in Israel.

While we can't draw conclusions about the risk of long Covid from the experiences of seven patients, the finding confirms that long Covid can occur after a breakthrough infection. It isn't clear, though, how common it might be or when those who have it might recover.

What we don't know

Several physicians and scientists have told me they are frustrated that we don't have more data about the risk of breakthrough infections and the course of illness that follows.

"If mild breakthrough infection is turning into long Covid, we don't have a grasp of that number," Akiko Iwasaki, an immunologist at the Yale School of Medicine, told me.

One of the reasons we know so little is that the C.D.C. collected nationwide data on all breakthrough infections for just four months before ending the practice in May. Now the agency tracks only breakthrough cases that result in hospitalization or death. The C.D.C. director, Dr. Rochelle Walensky, defended the decision last month, noting that the agency was collecting additional data from more than 20 cohorts, including groups of medical workers and people in long-term-care facilities.

"We are absolutely studying and evaluating breakthrough infections in many different sites, many different people across the country," Dr. Walensky said. "We are looking at those data on a weekly to biweekly basis, and we will be reporting on those soon."

The bottom line

In some ways, the fact that we know so little about long Covid after breakthrough infection is good news. The fact that doctors haven't seen large numbers of post-vaccination cases of long Covid suggests that breakthrough infections are still relatively uncommon, and long Covid after vaccination remains a relatively low risk.

We may learn more in the near future, as the Delta variant causes new infections, including, presumably, more breakthrough cases. If some of those breakthrough patients develop symptoms of long Covid, they'll start showing up in doctor's offices in the coming months, said Zijian Chen, medical director of post-Covid care at Mount Sinai Health System in New York.

Of course, the best way to avoid long Covid is to avoid getting Covid in the first place: get vaccinated, wear a mask and avoid spending time in enclosed public spaces when you don't know the vaccination status of others. "The fewer infections we have in the general population, the fewer cases of long Covid we're going to have," Chen said.

You can read more in my article today about long Covid after vaccination.

Tara Parker-Pope is the founding editor of Well. You can follow her on Twitter at @taraparkerpope.

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Afghanistan

Taliban fighters on a Humvee in Kabul, Afghanistan, yesterday.Jim Huylebroek for The New York Times

The Taliban entered the capital city of Kabul, effectively sealing the insurgency's swift takeover of Afghanistan two decades after the U.S. invaded.
Panic reigned as thousands of residents rushed to the airport in Kabul, and President Ashraf Ghani fled the country as the government collapsed Hours later, Taliban leaders ensconced themselves in the presidential palace.
The U.S. State Department said that it was working to secure control of the airport, with core employees moved to a military-controlled section there. Thousands of other U.S. citizens and Afghans who aided the U.S. military are still in the country.
The Taliban's rapid advance surprised U.S. officials. And it produced images of a scramble to evacuate that President Biden, just weeks ago, vowed would not happen.
Fears intensified on Monday about reprisal killings and looting after the police abandoned their posts in Kabul. Afghan officials in other cities were filmed handing over power to insurgent leaders.
The Taliban ruled in the 1990s using intimidation tactics and enforcing a harsh Islamist code. Here's what life is like now in a city it captured last week.

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A new must-have for TV and movie shoots

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The jobs vary: Some projects bring in therapists before filming to help writers work with dark material. Other times, therapists are available to the cast and crew once filming begins. When Amazon's series "The Underground Railroad," about people escaping slavery, was filming in Georgia, the therapist Kim Whyte was on the set. "Some of the cast and crew were disturbed by the content — just the institution of slavery," Whyte said. Others wanted to talk about issues at home.

It's part of an effort to make film productions healthier workplaces. "You're pushed, pushed, pushed and pushed to the limit, all the time," Sue Quinn, a location manager, told The Times. The priority is often to make sure projects remain on budget, she said, and crew and actors are often bullied or asked to work exhausting hours.

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