What do we know about long COVID?

Echo Dale Regional Park in Medicine Hat, Alberta. (Dr. Noorali Bharwani)
Echo Dale Regional Park in Medicine Hat, Alberta. (Dr. Noorali Bharwani)

Three months ago, my friend contracted COVID-19 infection. He is 75+ years old with cardiac and other medical conditions. He got COVID-19 infection although he was fully vaccinated with four COVID immunization shots. His COVID test was positive for about 10 days. At-home antigen tests may return positive results for 10 days – or even longer, up to 14 days. He was seriously ill for four days. He survived.  He is currently negative for COVID-19. But he continuous to have multiple symptoms.

He has significant fatigue and joint and muscle ache. Lower back stiffness and pain comes and goes several times a day.  His memory is not very good. He thinks he has “brain fog”. His symptoms sound like long COVID. He wonders how long is this going to last.

1. What is long COVID?

Most people recover fully after contracting COVID-19 infection. But current evidence suggests approximately 10 to 20 per cent of people experience a variety of mid- and long-term effects after they recover from their initial illness.

World Health Organization (WHO) website says, “If you have recovered from COVID-19 but are still experiencing some symptoms, you could have what is known as post-COVID condition. This is also referred to as ‘long COVID’ sometimes.”

2. How common is long COVID?

WHO estimates 10 – 20 per cent of people who have COVID will develop post-COVID conditions, which would mean that Canada has at least 388,000 long COVID patients. To date, 3.8 million Canadians have had COVID-19 (COVID-19 epidemiology update – Health Canada website).

Among people age 65 and older, 1 in 4 has at least one medical condition that might be due to COVID-19. Women, and people who already had poor physical or mental health have increased risk of long COVID.

3. What are the symptoms? How long do the symptoms last?

Some of the most common symptoms of post COVID-19 condition include shortness of breath, cognitive dysfunction, which people call “brain fog”, as well as fatigue. Those are the three most common. Cognitive dysfunction involves difficulty with mental process to learn, process and communicate.

It is estimated more than 100 to 200 symptoms can be associated with long COVID. Symptoms can get worse with physical and mental effort. Statistics show nine per cent of people are unable to return to work after three months.

4. Diagnosis

Diagnosis of long COVID is made by ruling out other disorders with similar symptoms. Right now, there is no test to confirm the diagnosis.

Diagnosing long COVID remains a big challenge. And long COVID symptoms like fatigue, dizziness, and other symptoms are fairly nonspecific.

5. What is “brain fog”?

“Brain fog” is not a medical condition. If you have difficulty thinking then you have “brain fog”. It has been found some patients after recovering from COVID-19 infection have short-term memory loss, confusion and difficulty concentrating. It feels as if you’re driving through a fog.

6. Conclusion

A research paper published on September 7, 2022 in the journal JAMA Psychiatry from Harvard says people who felt stressed, anxious, lonely, depressed or worried about COVID before getting infected were at higher risk of developing long-term symptoms from their illness.

Physical activity and relaxation techniques can be valuable tools to help you remain calm and continue to protect your health during this time. WHO recommends 150 minutes of moderate- intensity or 75 minutes of vigorous-intensity physical activity per week, or a combination of both

So, I say to my friend, post COVID-19 symptoms may last anywhere from three months to a year. Nobody knows. Sometimes the symptoms can go away and come back. We are still learning about this disease.

It is important to prevent COVID-19 infection, that will prevent the development of post COVID- 19 condition. Prevention is better than cure.

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COVID-19 Reinfection Among Vaccinated Individuals

Photo of African artwork. (Dr. Noorali Bharwani)
Photo of African artwork. (Dr. Noorali Bharwani)

This virus is smarter than us!

According to Dr. Anthony Fauci, President Biden’s chief medical adviser and director of the National Institute of Allergy and Infectious Diseases, the highly contagious Omicron variant will find just about everybody.  Fauci also said, if you are vaccinated you will fare better. Your risk of hospitalization and death is reduced.

But those who are not vaccinated are going to get the brunt of the severe aspect of the disease fueled by the highly transmissible Omicron variant. However, small number of people amongst fully vaccinated may not do well. For example, the very old, very young, and immunocompromised will have weakened responses.

Now the focus should be on making sure hospitals and essential services continue to function effectively. COVID-19 is going to be part of our life. The best way of controlling the infection is for people to get vaccinated, wear a mask in public places and avoid large indoor gatherings.

Third dose of vaccine is 95 per cent effective against hospitalization and death. It also brings vaccine efficacy to 97 per cent for Delta and 61 per cent for Omicron. Unfortunately, only 56 per cent of Canadians 12 and older have at least three doses of a COVID-19 vaccine.

Getting a third dose is important to boost our immunity. Experts believe each shot you receive reduces the severity of disease. Canada’s vaccine advisory body recommends ‘rapid deployment’ of fourth dose for people aged 80 and over.

Scientists are trying to figure out why some fully vaccinated individuals keep avoiding Covid-19 infection and why other fully vaccinated individuals keep getting recurrent infection.

Scientists are warning against lowering our guard. Our current defenses like vaccine may not hold up against the latest version of Omicron, BA.5, which is remarkably good at spreading and evading vaccine protection.

Experts agree avoiding infection is more challenging with BA.5. Omicron and its subvariants have made our social interaction riskier. BA.5, in particular, has increased the odds that people who’ve avoided COVID thus far will get sick.

BA.4 and BA.5 are subvariants of the Omicron variant that popped up late last year and then spread like wildfire all over the world. They were first discovered in South Africa and have recently grown to dominate the transmission of COVID.

BA.5 accounts for more than 50 per cent of new cases and BA.4 20 per cent. These two new subvariants seem better able to evade immunity afforded by vaccination and previous infection.

Majority of people in the U.S have had COVID-19 at least once – likely more than 70 per cent of the country. Other statistics from U.S. show many have been infected multiple times. Canada is no different. COVID-19 has infected roughly half of the Canadian population.

The emergence of an even more contagious version (Omega BA.4 and BA.5) of the virus means some people may be in for another round of infection. We don’t know the long-term effect of Omega variants on infected people.

Scientists are warning people that even if you are fully vaccinated including booster shots and have had COVID-19 after that, there is no guarantee you will not be infected again and again. But the risk of severe outcome may be quite low.

Who is getting reinfected and why? Scientists are looking for an answer to this. Risk of reinfection will always be there. We have to be careful. Hopefully, immunity in the population, whether from vaccines or prior infection, will build up and allow us to reduce transmission and hospitalization. We hope!

How many types of other variants are going to be there? Nobody knows.

Loss of smell and taste. Research shows five per cent of people who had COVID are dealing with long-lasting loss of smell or taste. Some 27 million people worldwide are estimated to have suffered a long-lasting loss of smell or taste. Losing smell has been linked to higher death rates in older adults and has been shown to have major impacts on people’s emotional and psychological well-being.

Get vaccinated. Get your booster shot. Remember, this virus is smarter than us!

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How effective are different types of masks?

A farm in Alberta, Canada. (Dr. Noorali Bharwani)
A farm in Alberta, Canada. (Dr. Noorali Bharwani)

“Face masks work best to prevent the spread of SARS-CoV-2 when everyone wears one. But experts say it is still worth wearing a mask to protect yourself, even if no one else does,” says an article in the Canadian Medical Association Journal (CMAJ March 16, 2022) written by Lauren Vogel, news editor with CMAJ.

Our government has given in to public demand for freedom from wearing a mask to protect oneself and protect others. If you go to a party or shopping mall then almost nobody is wearing a mask. You go to a popular busy restaurant which is packed with people and nobody is wearing a mask.

There is a price to pay for this kind of freedom – more people are starting to get sick. People who are fully vaccinated with third and fourth booster shots are getting sick.

A friend of mine, who had his fourth COVID-19 vaccine shot three months ago recently came down with all the classic symptoms of COVID-19 infection. After two weeks of isolation, he is still recovering. What people forget is that vaccines do not provide 100 percent protection.

Third dose of vaccine is 95 percent effective against hospitalization and death. It also brings vaccine efficacy to 97 percent for Delta and 61 percent for Omicron. What about Omicron BA.4 and BA.5 subvariants? Do the current vaccines protect us from these variants?

The other thing people forget is the protection you get from COVID-19 vaccines can wane over time (4-6 months); so, booster doses are necessary. Boosters can help improve protection against severe outcomes by up to 90 percent. They may also reduce the risk of post COVID-19 condition.

What kind of mask is worth using to protect yourself and others?

Wearing a mask is very important especially if you are indoor in a crowded place with poor ventilation.

I will take the liberty of going back to Lauren Vogel’s article titled, “Is one-way masking enough?” She makes the following points:

  1. Quality of mask: Better quality masks offered greater protection. Wearing an N95 or KN95 respirator lowered the odds of infection by 83 percent, whereas wearing a surgical mask or cloth mask lowered the odds by 66 percent and 56 percent, respectively.
  2. Indoor public settings: Recent data from the United States shows that people who always wore a face mask in indoor public settings were less likely to test positive for SARS-CoV-2 than those who never wore a mask. Crowded indoor environments with poor ventilation is very risky.
  3. Mask fitting: Properly fitted N95 respirators should filter at least 95 percent of virus particles. That’s notably better than the protection offered by universal masking with cloth and surgical masks, which would have fallen on the lower end of 75 – 91 percent.
  4. Other types of masks: Surgical masks filtered 47 – 50 percent of particles, while a simple cotton mask filtered 17 – 20 percent. Cloth or surgical masks are very poor in protecting the wearer or other people.

We need to find more effective masks which are affordable and available to all levels of population. Our fight for survival is not over yet. Governments could also offer clearer guidance on separating good quality masks from the sea of unregulated and sometimes counterfeit options. Some European countries are making it mandatory for people to use high-quality masks and respirators that block 90 – 95 percent of particles.

Wearing a mask is like wearing a seat belt in a vehicle. It saves lives.

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What do we know about COVID-19 vaccine booster shots?

A mosque in Cairo, Egypt. (Dr. Noorali Bharwani)
A mosque in Cairo, Egypt. (Dr. Noorali Bharwani)

Like many of you, I am curious to know what kind of protection am I getting after third and fourth dose of COVID-19 vaccine.

Is it necessary to have third and fourth dose?

What is meant by “fully vaccinated” against COVID-19?

How many vaccine doses do we need to remain protected against COVID-19?

As you may know, some medical conditions, such as measles or polio, completing the primary vaccination series usually provides lifelong protection against disease. For others, such as tetanus, diphtheria, and pertussis, periodic booster doses of vaccine are required.

With COVID-19 we have learnt levels of protection begin to wane over time, resulting in breakthrough infections. Breakthrough infection is usually not serious.

Many experts believe people are “fully vaccinated” either two weeks after they receive their second dose in a two-dose series, or two weeks after their first dose for single-dose vaccines.

However, “fully vaccinated” is not the same as “optimally protected”, says CDC (US Center for Disease Control and Prevention). “To be optimally protected, a person needs to get a booster shot when and if eligible.”

We know one- or two-dose series remains extremely effective at preventing severe infection and death. How can we maintain this level of protection?

On 30 March, 2022 the CDC recommended a fourth dose of COVID-19 vaccine for everyone over 50 years of age.

No vaccine is 100 per cent effective. Breakthrough infections can happen with every vaccine, and do not mean that the vaccine does not work.

According to data from the US CDC, unvaccinated people are at 11 times the risk of death from COVID-19 than vaccinated people.

WHO (World Health Organisation) says, “Even once you are fully vaccinated, continue to practice the same prevention measures to protect yourself. Stay at least one metre away from other people, wear a well fitted mask over your nose and mouth when you can’t keep this distance, avoid poorly ventilated places and settings, clean your hands frequently, stay home if unwell and get tested.”

Why do we need booster dose?

The protection you get from COVID-19 vaccines can wane over time (4-6 months); so, booster doses are necessary. Boosters can help improve protection against severe outcomes by up to 90 per cent. They may also reduce the risk of post COVID-19 condition.

Many Canadians are reluctant to go for booster shots (third and fourth shot). According to an article in the Canadian Medical Association Journal (CMAJ April 11, 2022) only 56 per cent of adults, and far fewer children, have received three doses of a SARS-COV-2 vaccine. Meanwhile, vaccine manufacturers are warning that fourth doses may be necessary to maintain immunity.

Third dose is 95 per cent effective against hospitalization and death. It also brings vaccine efficacy to 97 per cent for Delta and 61 per cent for Omicron. However, it’s unclear how long good protection from a third shot will last.

Is fourth vaccine dose necessary?

Canada’s National Advisory Committee on Immunization currently recommends four doses for people who are immunocompromised, but most provinces are also offering fourth shots to seniors. Both groups may face increased risks of severe illness and greater declines in vaccine efficacy than the general population. Otherwise, experts remain divided on the value of repeat boosters.

Some argue the goal of vaccination should be to prevent severe disease and deaths, not infections, so three shots may be sufficient for most people so long as efficacy against hospitalizations holds, says CMAJ article.

Others argue it makes more sense to focus on distributing vaccines globally and developing new variant-specific vaccines rather than repeatedly using the same shots in a few wealthy countries, with diminishing returns. The evidence to support four doses is limited.

So, what do you think? Is fourth dose necessary?

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