Exploring the Continued Need for COVID-19 Vaccines and Boosters - Episode 4

Long-Term Adverse Events from COVID-19 Infections

Medical experts discuss potential long-term adverse effects associated with COVID-19.


Mitchel Rothholz, RPh, MBA: Let’s talk a little about the disease itself in terms of its significance. Some people who have had it say, “It wasn’t so bad,” but we’re also seeing reports about the long-term effects of COVID-19 on individuals. Give us a little insight on what you’re seeing in the literature on patient experiences regarding how long this symptomatic component of COVID-19 is playing in the community.

Jeff Goad, PharmD, MPH: When a disease has an acute presentation, such as COVID-19, adding in long COVID or postacute COVID-19 syndrome makes people also think about and second-guess their choices of things like not being vaccinated or not using a mask. Certainly, it adds another level of complexity to the management. We’re learning more about long COVID. For example, certain symptoms may persist longer, such as loss of taste, brain fog, or lethargy. We’re understanding the damage that the SARS [severe acute respiratory syndrome] virus is doing to our organ systems, that the older you get, the more likely the damage will be long-lasting. We’re discovering trends. We’re learning from the trends.

We don’t have a great strategy going forward. But we know that if you don’t get COVID-19, especially if you’re older and if you have more comorbid conditions, you’re less likely to develop long-COVID syndrome. It isn’t that vaccines necessarily prevent it, but if you aren’t getting COVID-19 or a severe disease—especially if you have comorbid conditions, such as obesity or diabetes—then it’s less likely that you’ll go on to have long-COVID syndrome. A few years from now, we may understand it a lot better.

Mitchel Rothholz, RPh, MBA: Which also makes the case for the importance of being vaccinated when you look at it from a benefit-vs-risk standpoint of long COVID vs the vaccine and its limited adverse effects. The benefit definitely outweighs the risk of the disease impact. We could encourage our community and our patients about the importance of being vaccinated. It’s to prevent what we don’t know: the long-term effect of the disease itself.

Another thing we hear from folks is, “I just had COVID-19, and then I got it again. I got vaccinated, and I got COVID-19 again.” Give a little insight in terms of what the thinking is at the CDC [Centers for Disease Control and Prevention] in terms of somebody who gets COVID-19 again. Is the vaccine still of value to them? [What’s the thinking on] somebody who got a treatment of Paxlovid who’s still testing positive, may have symptoms, and may get COVID-19 again and another regimen?

Jeff Goad, PharmD, MPH: The evolution of disease has forced us to rethink some of our recommendations. With Omicron, especially as we get into BA.2 but also BA.4 and BA.5, were able to evade our immune system. The vaccines are trying to stimulate our immune system, and they’ve been able to evade that better than in the past. We’ve learned that it’s a full assault on the virus by getting boosters to increase your immune reserve to get a more robust immune response. By adding the bivalent, which gives us a wider array of antigens that give us a wider array of antibodies, we might be able to overwhelm this new variant, Omicron, or whichever one of Omicron’s ugly children head our way. Each prodigy is even worse as it makes its way and becomes evolutionarily successful in its mutations.

The message is that especially with influenza, getting a flu shot every year increases your immune reserve, even when there are variants and mutations coming down the line. The same applies for COVID-19. For the medications, such as Paxlovid, we’ve learned that you can get a resurgence of symptoms. That doesn’t necessarily mean that you have a reinfection. It just means that it treats it to a level. It knocks it down. These are antiviral agents. It knocks it down so that you’re less likely to end up in the hospital or have more severe complications, but the symptoms may come back. The CDC doesn’t recommend restarting therapy or initiating another course of it. It’s just how the disease progresses. It’s still doing its job, potentially keeping you out of the hospital and keeping you from severe disease, but you may get a resurgence in symptoms.

Transcript edited for clarity.