Lancet journal article - Long COVID: a clinical update

Sadly, just more data analysis and definitions
Thanks tho.

froggiii's comment above is substantially correct, so nothing new here per se.

Here, I'm pasting in some of its observations and conclusions that struck me. YMMV
You may well want to scan through the original article if your curiosity is piqued. It has lots of footnotes and external references. It was actually published last July.

Here goes:

In this interdisciplinary Review, we had three goals. First, to make sense of the extensive research literature on long COVID, including literature on epidemiology, basic science, lived experience, and clinical trials of therapy

Estimates of the incidence of long COVID after acute infection range from 50–85% for unvaccinated people who were hospitalised, 10–35% for unvaccinated people who were not hospitalised, and 8–12% for vaccinated individuals.

Manifestations of long COVID are heterogeneous, multisystemic (the condition can affect any and all organ systems), and can change over time.

The chance of recovery is highest in people who had a less severe acute illness, are in the first 6 months after that illness, and were vaccinated; people whose illness has lasted between 6 months and 2 years are less likely to fully recover. (uh, oh...! : @sandguy)

(it's likely that...) the hypothesis that long COVID is, broadly speaking, “a single, multisystemic multifaceted post-viral disease rather than different pathologically-independent subsyndromes”

There are no definitive data on the role of clotting abnormalities in long COVID and scholars are divided on this issue; ongoing research studies might help resolve these debates.

Krishna and colleagues found that persistent interferon-γ release predicts long COVID symptoms. Its decrease to concentrations in the standard range is associated with symptom resolution.

Many front-line clinicians view such therapies as having little evidence of efficacy; they await the results of randomised controlled trials, of which there are over 400 ongoing at the time of writing

Overall, few if any countries have fully integrated and comprehensive approaches to long COVID, and in most, the mismatch between need and provision is stark

Prevention:
Vaccination is also crucial. A meta-analysis of primary studies involving 620,221 participants estimated that two doses of vaccine reduces the risk of long COVID by 36·9% and three doses reduces the risk by 68·7%. In people who already have long COVID, vaccination has a variable effect on the trajectory of the condition but, overall, reduces the effect of recurrent infections and is therefore recommended in people without contraindications.

A large US Veterans Administration cohort study showed a statistically significant reduction in risk of long COVID in people given molnupiravir or nirmatrelvir within 5 days of symptom onset in acute COVID-19.

Given that reinfection is emerging as a substantial contributor to persistent long COVID, ensuring that health-care settings, especially long COVID clinics, are COVID-safe (e.g, enforcing mask requirements among clinic staff, air quality measures, and testing protocols) is important.

Antiviral vaccines…could theoretically induce a condition mimicking long COVID in a susceptible host by stimulating an overly exuberant immune response. The evidence for whether this process actually occurs is scarce. …the benefits of vaccination greatly outweigh the risks of the disease in the vast majority of vaccinees.
…the incidence of myocarditis from vaccines (more frequent in younger male individuals) is between 30-fold and 10,000-fold less frequent than the incidence from COVID-19 infection

Overall, rare sequelae (after-effects) of COVID-19 vaccination can overlap with the clinical manifestations of long COVID, but causality has not yet been established. The risk of the former appears orders of magnitude lower than the latter.

froggiii's comment above is substantially correct, so nothing new here per se.

Here, I'm pasting in some of its observations and conclusions that struck me. YMMV
You may well want to scan through the original article if your curiosity is piqued. It has lots of footnotes and external references. It was actually published last July.

Here goes:

In this interdisciplinary Review, we had three goals. First, to make sense of the extensive research literature on long COVID, including literature on epidemiology, basic science, lived experience, and clinical trials of therapy

Estimates of the incidence of long COVID after acute infection range from 50–85% for unvaccinated people who were hospitalised, 10–35% for unvaccinated people who were not hospitalised, and 8–12% for vaccinated individuals.

Manifestations of long COVID are heterogeneous, multisystemic (the condition can affect any and all organ systems), and can change over time.

The chance of recovery is highest in people who had a less severe acute illness, are in the first 6 months after that illness, and were vaccinated; people whose illness has lasted between 6 months and 2 years are less likely to fully recover. (uh, oh...! : @sandguy)

(it's likely that...) the hypothesis that long COVID is, broadly speaking, “a single, multisystemic multifaceted post-viral disease rather than different pathologically-independent subsyndromes”

There are no definitive data on the role of clotting abnormalities in long COVID and scholars are divided on this issue; ongoing research studies might help resolve these debates.

Krishna and colleagues found that persistent interferon-γ release predicts long COVID symptoms. Its decrease to concentrations in the standard range is associated with symptom resolution.

Many front-line clinicians view such therapies as having little evidence of efficacy; they await the results of randomised controlled trials, of which there are over 400 ongoing at the time of writing

Overall, few if any countries have fully integrated and comprehensive approaches to long COVID, and in most, the mismatch between need and provision is stark

Prevention:
Vaccination is also crucial. A meta-analysis of primary studies involving 620,221 participants estimated that two doses of vaccine reduces the risk of long COVID by 36·9% and three doses reduces the risk by 68·7%. In people who already have long COVID, vaccination has a variable effect on the trajectory of the condition but, overall, reduces the effect of recurrent infections and is therefore recommended in people without contraindications.

A large US Veterans Administration cohort study showed a statistically significant reduction in risk of long COVID in people given molnupiravir or nirmatrelvir within 5 days of symptom onset in acute COVID-19.

Given that reinfection is emerging as a substantial contributor to persistent long COVID, ensuring that health-care settings, especially long COVID clinics, are COVID-safe (e.g, enforcing mask requirements among clinic staff, air quality measures, and testing protocols) is important.

Antiviral vaccines…could theoretically induce a condition mimicking long COVID in a susceptible host by stimulating an overly exuberant immune response. The evidence for whether this process actually occurs is scarce. …the benefits of vaccination greatly outweigh the risks of the disease in the vast majority of vaccinees.
…the incidence of myocarditis from vaccines (more frequent in younger male individuals) is between 30-fold and 10,000-fold less frequent than the incidence from COVID-19 infection

Overall, rare sequelae (after-effects) of COVID-19 vaccination can overlap with the clinical manifestations of long COVID, but causality has not yet been established. The risk of the former appears orders of magnitude lower than the latter.

To sandguy —

Thank you for the articulate summary of the Lancet article!

I find it important to have in mind the broad landscape in which my LC is occurring. That includes:
- The amount of research currently in progress.
- The benefits (versus risks) of continuing to get boosters while one has LC.
- The length of time my LC is likely to persist.

I do continue to get boosters, so I’m encouraged that professional opinion supports my decision to do so.

Wishing us all the support we need to carry on in spite of LC.

~ friedrich