Long COVID, or post-acute sequelae of SARS-CoV-2 (PASC), is a condition in which individuals who were ill with COVID-19 continue to experience a range of physical and/or psychological symptoms long after their initial infection 1. More than half of COVID-19 survivors are estimated to suffer from such symptoms 6 months after recovery, according to some data 2. Since these effects can result in hospitalization or at least impacts on daily life, long COVID is a problem that has the potential to overload existing health care capacity 3. It is thus critical to identify the factors that reduce the risk of long COVID.
One to three months after testing positive, long COVID symptoms are wide-ranging. These can include tiredness and fever, as well as pulmonary and digestive issues. In addition, they can include neurological impairments in addition to impaired functional mobility. Mental health disorders can also affect patients with long COVID 2.
Some people may be more readily affected by post-COVID conditions. These include but are not limited to patients who experienced more severe COVID-19 illness, including unvaccinated patients 4. Older patients or those with pre-existing medical conditions are also more likely to experience persistent COVID symptoms one month or more following infection 5. Although pre-existing conditions are factors that cannot be controlled, reducing infections in general and reducing the severity of infections may be beneficial for decreasing long COVID risk.
The most effective way to protect individuals against long COVID is to prevent them from contracting COVID in the first place. Getting vaccinated and staying up to date on vaccines are critical in this respect. Even individuals who are vaccinated but still experience a breakthrough infection remain less likely than unvaccinated individuals to suffer from post-COVID conditions. A study of older U.S. veterans demonstrated a 15% reduction in risk of long COVID after vaccination; however, the study was limited by its low number of women and suboptimal vaccination schedules 6. Another study from the United Kingdom found that two doses of a COVID vaccine was associated with a 40%+ decrease in the chance of experiencing long COVID 7. Finally, a more recent study focused on a broader patient population revealed that getting two or three doses of a COVID vaccine reduced the odds of developing long COVID, respectively, by 75% and 85%. Receiving a single dose did not 5.
In the event of infection, relevant factors for reducing long COVID risk may include the ability to control disease severity. Early diagnosis and treatment to minimize how long and how severely a person remains ill are thought to be important in preventing long COVID. The sicker a person becomes with COVID, the greater their risk of developing long COVID. This means that swiftly beginning treatment may be helpful. To this end, oral antivirals available to treat COVID should be started within five days of symptom onset.
For some patients, monoclonal antibody treatment may be another treatment option to reduce the symptoms of COVID infection. These medications thwart viral replication and reduce the amount of virus in a patient’s body—a key predictive factor of long COVID.
It remains unclear whether or not over-the-counter medications are factors that affect one’s risk of long COVID. It also unclear whether prednisone or dexamethasone—steroids used to lower inflammation in COVID patients—affect one’s risk of long COVID.
Researchers from the Veterans Health Administration found that taking the antiviral pill Paxlovid may reduce the risks of developing long COVID 8. For patients at high risk of developing severe COVID, this prescription drug is provided for free by the federal government at pharmacies across the country.
1. Long COVID. Available at: https://health.ny.gov/diseases/long_covid/index.htm. (Accessed: 21st November 2022)
2. Groff, D. et al. Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 Infection: A Systematic Review. JAMA Netw. Open (2021). doi:10.1001/jamanetworkopen.2021.28568
3. Chen, C. et al. Global Prevalence of Post-Coronavirus Disease 2019 (COVID-19) Condition or Long COVID: A Meta-Analysis and Systematic Review. J. Infect. Dis. 226, (2022). doi: 10.1093/infdis/jiac136.
4. Long COVID or Post-COVID Conditions | CDC. Available at: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html. (Accessed: 21st November 2022)
5. Azzolini, E. et al. Association Between BNT162b2 Vaccination and Long COVID After Infections Not Requiring Hospitalization in Health Care Workers. JAMA 328, 676–678 (2022). doi: 10.1001/jama.2022.11691.
6. Al-Aly, Z., Bowe, B. & Xie, Y. Long Covid after Breakthrough COVID-19: the post-acute sequelae of breakthrough COVID-19. Nat. Portf. (2021). doi: 10.1038/s41591-022-01840-0.
7. Self-reported long COVID after two doses of a coronavirus (COVID-19) vaccine in the UK – Office for National Statistics. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/selfreportedlongcovidaftertwodosesofacoronaviruscovid19vaccineintheuk/26january2022. (Accessed: 21st November 2022)
8. Xie, Y., Choi, T. & Al-Aly, Z. Nirmatrelvir and the Risk of Post-Acute Sequelae of COVID-19. medRxiv 2022.11.03.22281783 (2022). doi:10.1101/2022.11.03.22281783