Long Covid: Could the coronavirus jab be a cure?

Judy Dodd began struggling with symptoms of long Covid last spring: shortness of breath, headaches, exhaustion. Then she got the vaccine.

After her first Pfizer/BioNTech shot, in late January, she felt so physically miserable that she had to be persuaded to get the second. For three days after that one she also felt awful. But on the fourth day everything changed.

“I woke up, and it was like, ‘Oh, what a beautiful morning’” says Dodd, an American school teacher who is also an actor and director. “It was like I’d been directing Sweeney Todd for months, and now I’m directing Oklahoma!”

Dodd, who continues to feel good, is among a number of people who are reporting that the post-Covid symptoms they have experienced for months have begun improving, sometimes significantly, after they have been vaccinated. It is a phenomenon that doctors and scientists are watching closely, but, as with much about the year-long coronavirus pandemic, there are many uncertainties.

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It's like my cells went kerflooey last year when they met Covid, and the vaccine said, 'Wait, you dopes, that isn't how you fight this; do it this way'

Scientists are only beginning to study any potential effect of vaccines on long-Covid symptoms. Anecdotes run the gamut: besides those who report feeling better after the shots, many people say they have experienced no change, and a small number say they feel worse.

Reports from doctors vary too. Dr Daniel Griffin, an infectious-disease physician at Columbia University, in New York, says about 40 per cent of the long-Covid patients he has been treating cite symptom improvement after the vaccine. "They notice, 'Hey, over the days, I'm feeling better. The fatigue isn't so bad. Maybe smell is coming back,' " Griffin says.

Other doctors say it is too early to know. "Too few of our participants have been vaccinated so far to really be able to provide insight into this question," says Dr Michael Peluso, an infectious-disease specialist working on a study of long-term Covid patients at University of California, San Francisco. "I've heard anecdotes as well, but I've seen too little data so far."

This month a small study by British researchers that has not yet been peer-reviewed found that eight months after people were hospitalised for Covid-19, those who were vaccinated experienced improvement in more long-Covid symptoms than those who were not yet vaccinated. The 44 vaccinated patients in the study were older and had more underlying medical conditions, as people with those characteristics qualified for vaccines earlier.

One survey of 345 people found that two weeks or more after their first vaccine dose, 93 felt slightly better and 18 felt back to normal – a total of 32% reporting improved long-Covid symptoms

One month after vaccination, those patients reported improvement in 23 per cent of their long-Covid symptoms, like joint pain and breathing, while 5.6 per cent of their symptoms had worsened. The 22 unvaccinated people questioned at that time said 15 per cent of their symptoms were better, while 14 per cent of their symptoms were worse. There was no difference in response between people who received the Pfizer/BioNTech and AstraZeneca vaccines.

Additional information comes from two surveys of several hundred people with long-Covid symptoms, many of whom were never hospitalised for the disease.

One survey of 345 people, mostly women and mostly in the United Kingdom, found that two weeks or more after their first vaccine dose, 93 felt slightly better and 18 felt back to normal – a total of 32 per cent reporting improved long-Covid symptoms.

In that survey, by Gez Medinger, a London-based film-maker who has experienced post-Covid symptoms, 61 people, just under 18 per cent, felt worse, most of them reporting only a slight decline in their condition. Nearly half – 172 people – reported feeling no different.

Another survey, by Survivor Corps, of a group of more than 150,000 Covid survivors found that as of March 17th this year, 225 of 577 respondents reported some improvement, while 270 felt no change, and 82 felt worse.

Jim Golen, a 55-year-old American former hospice nurse who lives in Minnesota, says some long-Covid symptoms have worsened since his vaccination. Golen, who also has a small farm, had experienced months of difficulty, including blood clots in his lungs, chest pain, brain fog, insomnia and shortness of breath with any exertion. Late last year, after seeing several doctors, "I was finally starting to get better," he says.

Since receiving the second dose of the Pfizer vaccine, in mid-January, he says, his chest burning and shortness of breath have returned with a vengeance, especially if he taxes himself with activities like collecting sap from the maple trees on his farm. Nonetheless, Golen says he is "very happy" to be vaccinated, emphasising that the effects of Covid are worse and preventing it is crucial.

Some people share stories of stark symptom improvements that took them by surprise.

Laura Gross, who is 72, and lives in New Jersey, rattles off a lengthy list of debilitating long-Covid symptoms she had experienced since April last year, including exhaustion, joint pain, muscle aches and a "zizzy-dizzy-weaky thing that was like an internal, headachy, all-over-body vibration".

Her cognitive fuzziness and forgetfulness were so intense that “brain fog barely describes it”, she says. “It’s more like brain cyclone.” She also felt uncharacteristically “hopeless, sad, lonely, unmotivated”.

Three days after her first Moderna shot, in late January, everything changed. “It was like a revelation,” she says. The brain fog cleared completely, muscle aches were gone, joint pains were less intense, and she suddenly had much more energy. It felt, she says, “like the old me”.

That continued after the second dose. “It’s like my cells went kerflooey last year when they met Covid,” Gross says, and the “vaccine said, ‘Wait, you dopes, that isn’t how you fight this; do it this way.’”

Recently, she walked briskly for 23 minutes and even “ran a little bit, because I was so happy,” she says.

You could feel better from the placebo effect, but it's unlikely your heart rate's going to go from 100 to 60 because of a placebo effect

Scientists say that understanding whether vaccines help some long-Covid patients but not others could help unravel the underlying causes of different symptoms and potential ways to treat them.

"They might be different disease processes, and you manage them differently," says Dr Adam Lauring, a virus expert and infectious-disease physician at the University of Michigan. "It might be that there's a subset of people who have a certain type of long Covid who respond well to vaccines, but there might be other people who have a different subtype that we haven't quite defined yet."

Akiko Iwasaki, an immunologist at Yale University, says that a vaccine, by generating antibodies to the coronavirus's spike protein, could potentially eliminate vestiges of the virus or remnants of viral RNA that may linger in some patients. If this is occurring, she says, it could suggest that the vaccine "might be like a permanent cure" for those patients.

Iwasaki says the vaccine might also help people whose long-Covid symptoms may be caused by a postviral response resembling an autoimmune disease if “the vaccine stimulates innate immune responses that dampen these kinds of autoreactive responses”. But based on experiences of people with other autoimmune diseases, that relief would “not be very long-lasting, and they would kind of revert back” to having symptoms like fatigue, she says.

One day after Hayward's first dose of the Pfizer vaccine in late December, 'it was like, click, everything is fine'

Dr Eric Topol, a professor of molecular medicine at the Scripps Research Institute in San Diego, says he is starting a study to measure physiological information like heart rate, respiratory rate, temperature and markers of immune-system response in people with long Covid before they receive a vaccine and for weeks afterwards.

It is plausible that “you have your immune system revved up when you’re fighting a reservoir” of virus or RNA remnants, he says, “and that could be an explanation of why you’re in overdrive with your heart rate”. He wants to see if these biological indicators improve after vaccination.

“We’d really like objective metrics that show that you not just feel better,” Topol says. “You could feel better from the placebo effect, but it’s unlikely your heart rate’s going to go from 100 to 60 because of a placebo effect. And if we keep seeing that pattern, that would be, like, Eureka!”

He adds, “I think there’s probably something there, but I just don’t know what is the magnitude, how many people are going to benefit.”

There are many other questions: Are there specific characteristics – like age, gender, type or duration of symptoms – that might make some long-Covid patients more likely to feel better? Would a vaccine be less effective for people with more complex conditions: people whose symptoms are driven by multiple biological pathways (perhaps both an RNA remnant and autoimmune activation) or whose symptoms have changed or fluctuated over time? Are certain types of vaccines more likely to produce benefit?

Bridget Hayward, a 51-year-old operating-room nurse in Virginia, says that after contracting Covid, a year ago, her body ached from her hands to her hips, and she became so brain-fogged that instead of asking for a scalpel she would say, "Give me that sharp thing we cut with."

Almost daily, she would briefly pass out while bending down to fix a patient’s intravenous line or plug in the cord of a hospital bed. “It was horrifying,” she says. “It was awful thinking it may never get better, like, ‘Is this my new normal? Am I now damaged this way?’”

After several months her worst symptoms improved, but she still tired easily, felt hot even in cool weather, and found it too taxing to do some ordinary tasks, she says.

One day after her first dose of the Pfizer vaccine, in late December, “It was, like, click, everything is fine”. Her body temperature has normalised, and “it felt like a darkness lifted”.

Although “it’s not 100 per cent every day,” she says she has so much energy now that “I’m not just getting from A to B; I’m, like, leaping up.”

One recent day she did several long-overdue errands. “This may not sound like much, but it is a 180-turnaround from three months ago,” she says. “I’m back!”

Kim Leighton, who is 64, has had a similar experience. She was hospitalised in March 2020 and had long-Covid symptoms that included mini blackouts, shortness of breath, getting lost in her own neighbourhood, depression and fatigue. "It really has been hell," she says.

When she started feeling better, in late January, she did not even think to connect it to the vaccine but later realised her stark improvement had started four days after receiving her first Moderna shot. She is delighted that she can now take walks in downtown Portland, Oregon, and has the desire to reconnect with friends.

“Every day, I feel like I’m feeling stronger,” Leighton says. “All the stuff I had to let go of, I’m trying to get it back.”

Dodd, like several others, says she is not taking her improvement for granted. “I’m still sort of wary of what’s around the corner; this disease is so unpredictable.” But, she adds, “even if, God forbid, I have a relapse, to have this time now when I feel better, it’s really amazing”. – New York Times