What We Know About Breakthrough Infections And Long COVID

Sep 13, 2021
Originally published on September 13, 2021 10:19 am

Like millions of others, Kathleen Hipps thought she was safe from COVID-19 after she got two shots of the Moderna vaccine last spring. So she figured she just had a summer cold when she got the sniffles in July. But then she opened some Vick's VapoRub.

"Anyone who's ever smelled Vick's VapoRub knows how pungent of a smell it is. And I couldn't smell it. And that's how I knew I had COVID," says Hipps, 40, a Los Angeles lawyer who has two young sons.

And sure enough, Hipps tested positive. "I got very sick. I was very tired, very congested — could barely get out of bed. I couldn't work at all. I had to find colleagues to cover my work for me. And I just spent the next week basically in bed, completely isolated from my family," she says.

Hipps never ran a fever, though, and did not have bad head or body aches. She started feeling better after about a week, tested negative and went back to working from home and caring for her family. She thought she was fully recovered.

"And I was in my mom's new car and all of a sudden I felt burning. And I thought there was something wrong with her car," she says.

Wherever she moved her foot, she could still feel the burning sensation. And then her other foot started burning too. It felt like she was walking on hot coals, she says.

"I've learned that this is neuropathy, and this a common symptom of long COVID," Hipps says.

Some patients' symptoms last for weeks or months

Long COVID is a poorly defined, poorly understood condition that occurs when COVID-19 patients' symptoms won't go away for weeks or months, or new ones emerge just when they think they're all better.

More than six weeks after it started, Hipps still experiences the burning sensation every day, as well as tingling and numbness in her hands.

Sometimes the numbness is so bad she can't push her baby's stroller. Her periods are really heavy. And work tires her out so fast now that she has to take lots of breaks.

"I'm really scared. I mean I'm really scared that there are things that are going on with me that I'm going to have to deal with for the rest of my life," Hipps says.

Now it's really important to stress that the COVID-19 vaccines are still highly effective at protecting people from getting really sick or dying, and are still quite good at keeping most people from even catching the virus or getting mildly ill.

But breakthrough infections can happen, especially with the delta variant. And it's becoming increasingly clear that unvaccinated people can develop long COVID symptoms, even from mild cases.

"We've seen that with the infection itself in the unvaccinated individuals about 30% of those individuals continue to have these long-haul COVID symptoms," says Dr. Avindra Nath, who is studying long COVID at the National Institutes of Health.

So the concern is whether vaccinated people who get infected may be at risk for long COVID too, Nath says.

"I think that's a good question," he says.

Studies look for answers about long COVID

A small Israeli study recently provided the first evidence that breakthrough infections could lead to long COVID symptoms, although the numbers are small. Out of about 1,500 vaccinated health care workers, 39 got infected, and seven reported symptoms that lasted more than six weeks.

And a large British study subsequently found about 5% of people who got infected — even though they were fully vaccinated — experienced persistent symptoms, although the study also found that the odds of having symptoms for 28 days or more were halved by having two vaccine doses.

"I think it's a reasonable concern. But it's too early. I think we need to follow these patients. It's quite recent that they've been recognized. So at the moment we don't have that answer," Nath says, adding that if there is a risk, he suspects it's probably very low.

But the experts don't all agree

Some infectious disease experts remain highly skeptical that long COVID from breakthrough infections is a big problem.

"Pathophysiologically, it's quite unlikely to get long COVID from a breakthrough infection," says Dr. Monica Gandhi, an infectious disease researcher at the University of California, San Francisco.

That's because the immune response generated by the vaccine would prevent the virus from taking hold in the body or triggering a harmful overreaction by the immune system, Gandhi says.

"I think it is absolutely not impossible, but pathophysiologically it is less likely," she says.

Other researchers are convinced the problem is real.

"Categorically I can say that we have already been seeing a handful of cases of long COVID from breakthrough infection," says David Putrino, who studies long COVID at Mount Sinai.

"We need to behave as though there is the same chance as always of developing long COVID from a mild-to-asymptomatic infection because once you have it you can't unring that bell and you're looking at months to years of illness," Putrino says. Putrino is working with Akiko Iwasaki, an immunologist at Yale University, to try to understand how breakthrough infections can lead to persistent symptoms.

Iwasaki says some people may experience long COVID because the virus is still hiding in the body. In others, it may be that their immune systems overreact to the virus — a so-called autoimmune response.

"We know that the vaccine induces a robust immune response to quickly clear the virus during breakthrough infections," Iwasaki says. "And that suggests to me that autoimmunity may be the culprit there."

Even if breakthrough infections can lead to long COVID, others say there are also plenty of other reasons vaccinated people should continue to keep being careful to avoid catching the virus.

"At the end of the day, my biggest concern honestly is not that I'm going to get long COVID," says Dr. Carlos del Rio, an infectious disease researcher at Emory University. "It's that I'm going to bring COVID and give it to someone else. I mean, I have a young granddaughter. If I get infected, I could give it to her. I'm more concerned that people who are vaccinated can get infected and transmit to others."

For her part, Hipps hopes her symptoms don't plague her for months or even years.

"It's scary because there's obviously a lot of things we don't know about this virus and I'm scared about these long-term implications on my body."

Still, she is glad she got the vaccine. She knows it probably kept her out of the hospital and kept her alive.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

NOEL KING, HOST:

People who are fully vaccinated can and do get COVID in breakthrough cases. But can they get long COVID, a punishing form of the virus where symptoms last for four weeks or even longer?

NPR health correspondent Rob Stein has been looking into it.

ROB STEIN, BYLINE: Like millions of other Americans, Kathleen Hipps thought she was safe after she got two Moderna shots last spring. So she figured she just had a summer cold when she got the sniffles in July. But then she spotted a bottle of Vicks VapoRub.

KATHLEEN HIPPS: And I thought, oh, you know, this would - might be kind of good for my cold. So I opened it up. And anyone who's ever smelled Vicks VapoRub knows how pungent of a smell it is. And I couldn't smell it. And that's when I knew I had COVID.

STEIN: And sure enough, Hipps, a 40-year-old lawyer in Los Angeles with two young sons, tested positive.

HIPPS: I got very sick. I was very tired, very congested, could barely get out of bed. I couldn't work at all. I had to find colleagues to cover my work for me. And I just spent the next week basically in bed, completely isolated from my family.

STEIN: She never ran a fever, though, or got bad head- or body aches. And she started feeling better after about a week, tested negative and went back to working from home and caring for her family.

HIPPS: I thought I was completely recovered. And I was in my mom's new car. And all of a sudden, I felt burning. And I thought there was something wrong with her car. And I moved my foot around. And everywhere I was moving my foot, I could still feel this burning.

STEIN: And then her other foot started burning, too, like she was walking on hot coals.

HIPPS: And I've kept having this burning sensation in my feet. And I've learned that this is neuropathy. And this is a common symptom of long COVID.

STEIN: Long COVID - when COVID-19 patients' symptoms just won't go away or new ones emerge just when they think they're all better. Hipps still gets that burning every day - tingling and numbness in her hands, too - sometimes so bad she can't push her baby stroller and so bad she's afraid to drive. Her periods are really heavy, too. And her work tires her out so fast now she has to take lots of breaks.

HIPPS: I'm really scared. I mean, I'm really scared that there are things that are going on with me that I'm going to have to deal with for the rest of my life.

STEIN: Now, the vaccines are still incredibly good at protecting people from getting really sick or dying and are still quite good at keeping most people from even catching the virus or even getting mildly ill. But breakthrough infections can happen, especially with the delta variant. And it's becoming increasingly clear that unvaccinated people can develop long COVID symptoms, too, even from mild cases. So doctors have started to wonder if that could happen to vaccinated patients like Hipps, too.

Dr. Ravindra Nath is studying long COVID at the National Institutes of Health.

AVINDRA NATH: We've seen that with the infection itself in the unvaccinated individuals, about 30% of those individuals continue to have these long-haul COVID symptoms. And so the concern is that even if you are vaccinated, if you got the infection, you got the virus - could it do the exact same thing to these individuals, too? So I think it's a good question.

STEIN: A small Israeli study recently provided the first evidence that breakthrough infections could lead to long COVID symptoms. And more recently, a big British study found that 5% of people who got infected even though they were fully vaccinated experienced persistent symptoms.

NATH: I think it's a reasonable concern. But it's too early. I think we need to follow these patients. It's quite recent that they have been recognized. So at the moment, we really don't have that answer.

STEIN: Other infectious disease experts remain highly skeptical that long COVID from breakthrough infections are a big problem.

Here's Monica Gandhi at the University of California San Francisco.

MONICA GANDHI: Pathophysiologically, it's quite unlikely to get long COVID from a breakthrough infection.

STEIN: Because, Gandhi says, the immune response generated by the vaccine would prevent that from happening.

GANDHI: I think that it absolutely is not impossible, but I think pathophysiologically it is less likely.

STEIN: And she noted that the big British study found vaccination cut the risk for long COVID in half. But other researchers are convinced the problem is significant.

DAVID PUTRINO: Categorically, I can say that we have already been seeing a handful of cases of long COVID from breakthrough infection.

STEIN: David Putrino studies long COVID at Mount Sinai.

PUTRINO: We need to behave as though there is the same chance as always of developing long COVID from a mild-to-asymptomatic infection because, you know, once you have it, you can't unring that bell, and you're looking at months to years of illness.

STEIN: Putrino is working with Akiko Iwasaki, an immunologist at Yale, to try to understand how it could happen. Iwasaki says, long COVID may be caused in some people from the virus hiding in the body. In others, it may be their immune systems overreact to the virus - a so-called autoimmune response.

AKIKO IWASAKI: We know that the vaccine induces a robust immune response to quickly clear the virus during breakthrough infections. And even with that, we're seeing some people develop long COVID. And that suggests to me that autoimmunity may be the culprit there.

STEIN: But even if breakthrough infections can lead to long COVID, others say there are plenty of other reasons vaccinated people should continue being careful to avoid catching the virus.

Dr. Carlos Del Rio is an infectious disease doctor at Emory.

CARLOS DEL RIO: At the end of the day, my biggest concern is - honestly, it's not that I'm going to get long COVID. It's I'm going to bring COVID and give it to somebody else, right? I have a young granddaughter. I can give it to her. I'm more concerned that the people who are vaccinated can get infected and transmit to others.

STEIN: For her part, Kathleen Hipps hopes her symptoms don't plague her for months or even years.

HIPPS: It's scary because, you know, there's obviously a lot of things we don't know about this virus. And I'm scared about these long-term implications on my body.

STEIN: But Hipps is still really glad she got the vaccine. She knows it might have kept her out of the hospital and kept her alive.

Rob Stein, NPR News.

(SOUNDBITE OF HELIOS' "VAINGLORY") Transcript provided by NPR, Copyright NPR.

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