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big study

One long-COVID study had 20 million people in it.

Will we ever get away from the vaccine question? Probably not but at least we’re getting studies on their effects not just on COVID-19 but on getting long COVID and even healing from it.

While they’re not on chronic fatigue syndrome (ME/CFS) they’re particularly interesting for an ME/CFS community that has been wondering about their impact for years.

Eric Topol provided a nice entrée to a bunch of vaccine studies that recently popped up in his Ground Truths Substack. Topol – one of the most distinguished researchers in the country – is all over long COVID (and other matters as well). (He’s said he’s more afraid of long COVID than of dying from the coronavirus.) He covers complex areas but writes clearly and is, in fact, a published author.

Again, as someone who’s been following chronic fatigue syndrome (ME/CFS) research for decades, I just have to shake my head at the size of some of the long-COVID studies that we’re seeing. People in the ME/CFS world have been wondering about vaccinations for decades and now we’re getting some data on them.

Mega Study Indicates Coronavirus Vaccines Helpful in Preventing Long COVID

Take this UK-Spain-Estonia study, “The effectiveness of COVID-19 vaccines to prevent long COVID symptoms: staggered cohort study of data from the UK, Spain, and Estonia“, published in the Lancet. It’s a 20-million-person-strong electronic records study! Note that the study did not assess the incidence of the ME/CFS type of long COVID – it required that one long-COVID symptom be present. The fact that several cohorts in different countries were included increased the robustness of the findings.

Overall, the findings suggested that the vaccines were from 29% to 52% effective in preventing “long COVID” from occurring. (The Pfizer vaccine was a bit more protective than the AstraZeneca vaccine).

This is in line with at least six other studies indicating that vaccination can help protect against coming down with long COVID. The authors of the 3-country study point out that vaccine effectiveness is probably higher than study findings indicate. This is because the past studies have focused on people who’ve come down with COVID-19 and the vaccines may prevent that from happening.

Topol noted that a Swedish study found the more vaccines a person had, the more protected they were from long COVID. After 3 vaccinations, vaccination effectiveness rose to a rather remarkable 73%. A RECOVER vaccine study in children found similar vaccine effectiveness rates in children. The overwhelming takeaway, thus far, is that if you can handle the vaccines, they can be helpful in warding off long COVID.

vaccine effectiveness

The more vaccines a person had, the better protected they were from coming down with long COVID after a coronavirus infection.

THE GIST

  • In the end, the vaccines were both – they protected more people but also exacerbated things for a small but significant minority of people.
  • Studies make it clear that if you can handle them, the vaccines can help protect against long COVID. One study suggested that the more vaccines you take, the better protected you are, with the protection level reaching almost 75% after three vaccinations.
  • The effect vaccines have on people with long COVID is more muddled. The Yale study was too small to settle that question but its results were in line with another study and with the Survivor Corps and Health Rising’s ME/CFS polls. Somewhere around 40% of people with long COVID improved while about 15-20% worsened.
  • Fatigue was not impacted, but the number of symptoms decreased and the physical and social effects of long COVID were reduced.
  • The vaccines did boost the immune response (antibodies and T-cells) and may have assisted in clearing the virus in those who improved. They did not appear to affect herpesvirus reactivation, inflammation, or autoimmune processes.
  • A machine learning process plucked out immune factors found at baseline which predicted whether the vaccine would benefit or not. Finding an immune signature that indicated whether a vaccine would help or hurt would be a huge step forward.

What about vaccines causing a long-COVID/ME/CFS-like condition? We, of course, know that can happen and these studies aren’t addressing that question. The 3-country study, for instance, not only did not address the cause of long COVID, but the authors missed the boat on vaccine-induced long COVID.

They asserted long COVID can only occur in people infected by the virus (“post-acute COVID-19 complications can only occur in people who were previously infected with SARS-CoV-2”). Since we know that vaccines can cause long COVID in some people, the study must have had vaccine-induced long COVID.

All in all, studies suggest that for most people, the vaccines are helping. What we need, though, are studies that follow vaccinated individuals and determine whether the long COVID they come down with is associated with a coronavirus infection or with the vaccine.

Can Vaccines Help Long COVID?

In the meantime, Harlan Krumholz and Akiko Iwasaki from Yale asked a different question: can a coronavirus vaccination help people after they’ve come down with long COVID? They suggested that a coronavirus vaccination might be able to boost the immune response, clear the virus, and perhaps reduce inflammation and/or autoimmune processes, and help T and B cells fight off the herpesviruses in people with long COVID.

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Their preprint, “Impact of COVID-19 vaccination on symptoms and immune phenotypes in vaccine-naïve individuals with Long COVID”, was as close to an ME/CFS vaccination study as we’ve gotten so far. While they didn’t assess the participants for ME/CFS – and some clearly did not have ME/CFS – the participants experienced a large number of symptoms.

The small 16-person study was triggered by a Survivor Corps poll which showed that 40% of people with self-reported long COVID improved (from mild to full improvement) after vaccination, while 14% got worse.

The study’s results were blunted by a lack of controls (long-COVID patients receiving sham vaccinations) and the study’s small size (n=16). (The original study aimed for 100 people, but the researchers had trouble finding unvaccinated long-COVID patients.)

Results

The results suggested the vaccines helped reduce the physical and social impacts of long COVID. A larger, placebo-controlled study is needed to validate the results.

Twelve weeks after vaccination, 10 out of 16 (62%) reported better health, while 3 (19%) reported the same health and 3 (19%) reported worse health.

Symptom scores suggested a moderate but meaningful improvement. The median number of symptoms decreased from 23 before vaccination to 15.5 12 weeks after vaccination. The percentage of patients reporting fatigue, heart palpitations, and anxiety did not change but concentration improved. Most prominently, the physical effect score, which measured how much a person was physically affected by a symptom improved from 68.5 before vaccination to 38.5 12 weeks after vaccination. The social effects score improved as well.

Biological tests found that while the vaccines had little effect on “cytokine dynamics”, people who did not improve showed an overall elevated cytokine pattern, suggesting: a) the vaccines failed to clear the virus – leaving their immune systems activated and still trying to fight it off; and/or b) they had reactivated herpesviruses and autoimmune processes that the vaccines weren’t able to touch.

Indeed, while the vaccines did increase the participants’ T-cell and antibody responses against the virus, they were unable to alter autoantibody levels (possible autoimmune processes), impact Epstein-Barr virus or other herpesviral reactivation, or reduce inflammation.

The vaccine’s inability to touch autoimmune processes or herpesvirus reactivation could mean that just getting rid of the virus is not enough. Skip Pridgen’s early data suggests that going after both the coronavirus and herpesvirus reactivation might be more effective.

Triple Antiviral Coronavirus/Herpesvirus Approach Scores in Very Early Long COVID Testing

We’ll see if the more intense efforts that are underway to clear the virus using Paxlovid (4 studies) and monoclonal antibodies (1 study) will be helpful when those studies are published.

A machine learning process plucked out immune factors (IFN-I, CNTF, and sIL-6R) found at baseline which predicted whether the vaccine would benefit or not. That’s, of course, what we in the ME/CFS community are looking for – some guidelines that can help indicate whether vaccines will help or hurt. Let’s hope some bigger studies are underway.

The study was small, but its findings are in general agreement with another larger (n=83) Canadian study, which found a reduction in symptoms in long-COVID patients following vaccination, increases in well-being scores, and reduced levels of several pro-inflammatory cytokines/chemokines. It’s also in pretty close agreement with Health Rising’s ME/CFS/FM vaccine polls which found that most people did OK but that 10-15% were still ill a month later, and that about 30% of ME/CFS/FM people getting the vaccine improved at least for a time.

ME/CFS/FM Experts On Whether to Get Vaccinated – Take II, Plus the Coronavirus Vaccine Improvements Poll and a Roundup on Past Poll Results

Conclusion

In the end, the vaccines were both – they protected more people but also exacerbated things for a small but significant minority of people. Enough studies have been done to make it clear that if you can handle them, the vaccines can help protect against long COVID. They’re not perfect but they are helpful. One study suggested that the more vaccines you take, the better protected you are with the protection level reaching almost 75% after three vaccinations.

The effect vaccines have on people with long COVID is more muddled. The Yale study was too small to settle that question, but its results were in line with another study and with the Survivor Corps and Health Rising’s ME/CFS polls. Somewhere around 40% of people with long COVID improved while about 15-20% worsened.

Fatigue was not impacted, but the number of symptoms decreased, and the physical and social effects of long COVID were reduced.

The vaccines did boost the immune response (antibodies and T-cells) and may have assisted in clearing the virus in those who improved. They did not appear to affect herpesvirus reactivation, inflammation, or autoimmune processes.

A machine learning process plucked out immune factors found at baseline which predicted whether the vaccine would benefit or not. Finding an immune signature that indicated whether a vaccine would help or hurt would be a huge step forward.

 

 

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