Even though 43% of the people in the USA have been fully vaccinated against Covid-19, this is not enough. Only 5.9% of the world’s population has been vaccinated. So, President Biden announced that the USA bought 500 million doses of the Covid-19 vaccine from Pfizer and will deliver them to nearly 100 countries of low and moderate income. About 76% of these will be donated to the Covid-19 Vaccines Global Access program, also known as COVAX. This is in addition to the 80 million doses of Pfizer, Moderna, AstraZeneca and Johnson & Johnson vaccines already promised. Moreover, Russia and China have provided hundreds of millions of doses of their Sputnik V, Sinovac and Sinopharm vaccines to over 100 countries. China is currently administering nearly 60% of all Covid-19 vaccine doses globally1. China has already administered one billion doses of the Sinovac and Sinopharm vaccines to about 75 nations. About 20 million people are being vaccinated against Covid-19 every day in China. Globally, China now accounts for more than half of the 35 million people receiving a Covid-19 jab each day. The recent approval by the WHO will lead to further distribution to low-income countries. On 14 June, it was announced that the Novavax vaccine, NVX-CoV2373, was 90% effective in a phase 3 clinical trial with over 30,000 participants in the USA and Mexico2. So, it will probably be approved for emergency use soon. Still, this will not be enough if too many people refuse to be vaccinated. We may not reach herd immunity before new mutants of the SARS-CoV-2 virus emerge that are deadlier than the current forms of the virus. The best way to avoid post-Covid-19 complications and the emergence of deadly new variants is to prevent infection with the SARS-CoV-2 virus. It’s important to try to present compelling reasons why people, including children, should be vaccinated. So, the goal of my article for this month is to describe long term effects of Covid-19.
Long term effects of Covid-19
Most people who get Covid-19 recover completely within a few weeks3,4. However, some people continue to experience symptoms after their initial recovery. This has been called post-Covid-19 syndrome or "long Covid-19." The problem has several names, including persistent post-Covid syndrome (PPCS)5. The National Institutes of Health refer to long-term Covid-19 symptoms as PASC, which stands for post-acute sequelae of SARS-CoV-2. More common terms are post-Covid syndrome, long Covid or long-term Covid. These health problems are sometimes called post-Covid-19 conditions. They are generally considered to be effects of Covid-19 that persist for more than four weeks after initially testing positive for the SARS-CoV-2 virus. By this time, the patients test negative for the virus. It has been effectively removed from their bodies by their immune systems. Still, they suffer the long term effects. Even those who had mild versions of the disease are vulnerable. Common signs and symptoms that linger over time include: fatigue, shortness of breath or difficulty breathing, cough, joint pain, chest pain, problems with memory, concentration or sleep, muscle pain or headache, fast or pounding heartbeat, loss of smell or taste, depression or anxiety, fever, dizziness when you stand, worsened symptoms after physical or mental activities.
The SARS-CoV-2 virus can attack the body many ways, causing damage to the lungs, heart, nervous system, kidneys, liver and other organs4. Also, mental health problems can arise from grief and loss, unresolved pain or fatigue, or from post-traumatic stress disorder (PTSD) after treatment in the intensive care unit (ICU). A bad case of Covid-19 can produce scarring and other permanent damage in the lungs. They can recover after, but it can take months for lung function to return to pre-Covid-19 levels. Breathing exercises and respiratory therapy can help. SARS-CoV-2 infection can leave some people with heart problems, including inflammation of the heart muscle. One study found that many people who recovered from Covid-19 had signs of ongoing heart inflammation, which could lead to the common symptoms of shortness of breath, palpitations and rapid heartbeat. The SARS-CoV-2 virus has also caused kidney disease. Some people suffer from a loss of smell and taste. For about a quarter of people with Covid-19 who have these symptoms, the problem resolves in a couple of weeks. In others, these symptoms persist. Though not life-threatening, prolonged distortion of these senses can be devastating and can lead to lack of appetite, anxiety and depression. Some people also suffer from brain fog, fatigue, headaches and dizziness. After surviving Covid-19, some people are left with lingering anxiety, depression and other mental health issues. Physical changes such as pain and weakness can be complicated by long periods of isolation, stress from job loss and financial difficulties, and grief from the deaths of loved ones and the loss of good health. Patients who were hospitalized have a particularly challenging recovery. People who have spent time in the ICU have a higher risk of problems with mental health, cognition and physical recovery. Prolonged time in the ICU can cause delirium. The strange surroundings, multiple mind-altering medications, isolation and loss of control can leave patients with lasting and recurrent sensations of terror or dread, including PTSD. Long-term Covid-19 symptoms also occur in other diseases. So, it is important to seek medical attention to see if there are other problems, such as cardiovascular or lung disease. A loss of smell, depression, anxiety or insomnia should not be dismissed as unimportant or simply psychosomatic, or all in your head. Any symptom that interferes with one’s daily life should be reported to your doctor, who can help you address these problems and improve the quality of your life. If you experience new chest pain, difficulty breathing, bluish lips or any other sign of a life-threatening problem, call emergency services right away4.
Some children have had experienced long-term Covid-19. It has even affected some who were quite healthy before being infected by the SARS-CoV-2 virus. Heart inflammation after Covid-19 is a concern, especially among young athletes returning to their sports after a mild or even asymptomatic case. They should be screened for any signs of heart damage to ensure it is safe for them to resume activity. As discussed in my previous article, multisystem inflammatory syndrome in children (MIS-C) can develop 1–2 months after the acute infection with the virus and cause high fever, organ dysfunction and inflammation6.
A prospective multicenter study was done with seventy-nine patients aged one month to 19 years who were admitted into ICUs in Brazil7. Those who had comorbidities and chronic diseases were most likely to need invasive mechanical ventilation. In Brazilian pediatric ICUs, there was low mortality. Being less than one year old was not associated with a worse prognosis.
However, new variants of the SARS-CoV-2 virus could emerge that are deadlier – even to children. That hasn’t happened yet, but the longer that this pandemic continues, the more time the virus has to undergo mutations that make it deadlier and more contagious. So far, new variants have been more contagious. This continues with the one such variant, B.1617.2, emerged in India and is spreading to the USA8,9. It’s called the delta (δ) variant. It is part of the B.1.617 lineage that emerged in October 2020 in India. It has since then become dominant in some regions and spread to other countries. The lineage includes three main subtypes (B1.617.1, B.1617.2 and B.1.617.3) that have mutations in the spike protein. B.1.617.2 is believed to spread faster than the other versions. The Pfizer vaccine generated a neutralizing response that efficiently targeted all three viral subtypes or strains.
Is this important for children?
The potential dangers of long-term Covid-19 and the emergence of deadlier variants of the virus should make people more likely to get their children vaccinated. They are very sociable and have close personal interactions with friends and relatives. This makes them potential supercarriers and superspreaders. The existence of this phenomenon was shown in a recent study from the University of Colorado Boulder, where more than 72,500 saliva samples were tested for viral load10. All samples were collected from individuals who reported no symptoms associated with Covid-19 on the day of collection. From these, 1405 positive cases were identified. They found that only 2% of individuals carry 90% of the virions circulating within communities. This makes them viral supercarriers and possibly also superspreaders.
Rates of vaccination by country
At least 211 countries and territories have administered more than two billion doses of a Covid-19 vaccine11. The rates of vaccinations can be tracked daily. Hopefully, this article and others with a similar message will help convince many people to get vaccinated and to vaccinate their children who are age 12 years and over, while clinical trials are being conducted on younger children.
1 Mallapaty, S. China is vaccinating a staggering 20 million people a day. Nature News, 9 June, 2021.
2 Winsor, M. Novavax announces its Covid-19 vaccine is over 90.4% effective against symptomatic disease. The vaccine also provided 100% protection against moderate and severe disease. ABC News, 14 June, 2021.
3 Mayo Clinical Staff. Covid-19: Long term effects, 2021.
4 Chung, T. et al. Covid ‘long haulers’: long term effects of COVID-19, Johns Hopkins Medicine, 2021.
5 Roronsky, B et al. A review of persistent post-Covid syndrome (PPCS). Clinical Reviews in Allergy & Immunology, 2021.
6 Smith, R.E. In response to the COVID-19 pandemic. Total Quality Leadership (TQL). Wall Street International, 24 March, 2021.
7 Prata-Barbosa, A. et al. Pediatric patients with Covid-19 admitted to intensive care units in Brazil: a prospective multicenter study. Jornal de Pediatra, Volume 96, p. 582-591, 2020.
8 Planas, D. Reduced sensitivity of infectious SARS-CoV-2 variant B.1.617.2 to monoclonal antibodies and sera from convalescent and vaccinated individuals, bioRxiv preprint, 27 May, 2021.
9 Shahab, M.S et al. "A review on the contemporary status of mutating coronavirus and comparative literature study of current Covid-19 vaccines". International Journal of Pharmaceutics & Pharmacology, Volume 5, 153. 7 June, 2021.
10 Yang, Q. et al. Just 2% of SARS-CoV-2−positive individuals carry 90% of the virus circulating in communities, Proceedings of the National Academy of Sciences, USA, Volume 118, Article e2104547118, 2021.
11 Pettersson, H. et al. Tracking Covid-19 vaccinations worldwide, 13 June, 2021.