November 29, 2021

Can ‘breakthrough’ COVID-19 lead to lingering symptoms? – The Boston Globe

“We haven’t had enough time to see what happens,” as more people have become vaccinated, said Dr. Jason Maley, a pulmonologist who leads the Critical Illness and COVID-19 Survivorship Program at Beth Israel Deaconess Medical Center. Maley said he has seen a few cases of long COVID among vaccinated people, but doesn’t yet know how common it will be.

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Dr. Jennifer Possick, medical director of the Post-COVID Recovery Program at Yale New Haven Hospital, said she’s not aware of any vaccinated people seeking treatment for long COVID at her clinic, but she expects to start seeing some soon.

“We’re absolutely anticipating them for sure,” Possick said, “because breakthrough cases are otherwise behaving much like the primary cases we saw.”

In Philadelphia, Dr. Benjamin Abramoff, director of the Post-COVID Assessment and Recovery Clinics at Penn Medicine, said patients who had breakthrough infections have come to his clinic, but in smaller numbers than unvaccinated people.

When vaccinated people become infected with the coronavirus, their illness tends to be milder, and milder illness is less likely to lead to long COVID, he said.

“People who just have a runny nose and a sore throat are less likely to have long COVID than the ones who are bedbound for a month and have severe headaches,” Abramoff said.

By preventing those more severe cases even when it doesn’t prevent infection, the vaccine reduces the risk of long COVID, he said.

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“Certainly [vaccination] protects you against long COVID,” Abramoff said.

A recent study in the United Kingdom, looking at data from 1.2 million adults, backs up this notion. It found that vaccinated people were 50 percent less likely than unvaccinated to still have symptoms four weeks after becoming ill with COVID-19.

“This result suggests that the risk of long COVID is reduced in individuals who have received double vaccination [the two recommended doses], when additionally considering the already documented reduced risk of infection overall,” the authors write in the Lancet Infectious Diseases, published Sept. 1.

Long COVID — sometimes called Post-Acute Sequelae of COVID-19, or PASC — is a little understood condition, or group of conditions, in which people who suffered from COVID-19 remain ill weeks to months after the virus has cleared their systems. It affects an estimated 10 percent to 30 percent of COVID-19 survivors, most of whom were not sick enough to need hospitalization.

In some cases, patients failed to bounce back from their initial illness. Other times, people feel they’ve recovered and then two weeks or a month later get hit with a new array of symptoms.

Among the most common are fatigue, brain fog, insomnia, headaches, breathing difficulties, and heart palpitations. Some people experience numbness in limbs or dizziness. But the fatigue and cognitive difficulties can be the most troubling symptoms, often leaving people unable to work.

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Lauren Bazensky used to run every day, easily traversing 8 miles. But after getting COVID-19 in April, the 41-year-old consultant gets out of breath walking short distances and each day has to parse out a finite store of energy.

“I don’t have the energy to do the things that bring me joy,” she said.

She also suffers from insomnia and muscle stiffness, and most worrisome of all, her thinking feels fuzzy, impaired. She has a hard time retrieving words.

“I don’t have access to my brain like I did before,” she said. “That’s the scary part.”

Bazensky, who lives in Chicago, said she got infected two weeks after receiving her second dose of the Pfizer vaccine. She describes herself as someone who has “a very, very weak immune system” and catches whatever bug is circulating.

When she described her prolonged symptoms to her doctors, they didn’t have much to offer. Only recently did Bazensky learn of a long COVID clinic near her home in Chicago, the Northwestern Medicine Comprehensive COVID-19 Center, which she plans to visit.

The Northwestern clinic is among dozens that have sprung up around the country in response to a growing number of long COVID cases.

Working with the American Academy of Physical Medicine and Rehabilitation, 35 of these clinics — including the one at Beth Israel — have formed a collaborative to develop treatment guidelines. The first guideline, on managing fatigue, was recently published.

But there remains no silver bullet, and treatment typically comes down to managing each symptom one by one, with such measures as breathing exercises, meditation, and physical therapy.

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At Beth Israel, which currently treats about 400 long COVID patients, most patients gradually get better and some have improved so much that they no longer have to come back, Maley said.

There’s one sure way to avoid long COVID, said Possick, the Yale doctor: Avoid getting COVID-19 in the first place. And the vaccine — along with masking and distancing, especially in high-transmission areas — remains the best way to do that, she said.


Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.