According to a large analysis released over the weekend in the peer-reviewed journal Nature, 19 survivors have a nearly 60% elevated chance of death up to six months after infection compared to non-infected individuals.
Over a six-month period, this equates to almost eight additional deaths per 1,000 patients.
“When we are accounting for COVID-19 deaths, the actual total of deaths is much higher,” the Jerusalem Post quoted Ziyad Al-Aly, head of the Clinical Epidemiology Center at Washington University in St. Louis and Chief of Research and Education Service at Veterans Affairs St. Louis Health Care System. He was the study’s principal investigator.
According to Al-Aly, the majority of deaths caused by long-term COVID-19 complications are not reported as COVID-19 deaths. As a result, he said that “what we are seeing now is only the tip of the iceberg.”
Al-Aly and his study team relied on evidence from the US Department of Veterans Affairs electronic health databases to reach their conclusion. More than 87,000 COVID-19 patients were included in the study: 74,435 Veterans Health Administration (VHA) users of COVID-19 who survived at least the first 30 days after diagnosis and were not treated, and almost 5 million VHA users who did not have COVID-19. It also contained 13,654 COVID-19 hospitalised patients and 13,997 flu hospitalised patients.
The veterans were mainly males (about 88 percent), but more than 8,800 women with confirmed cases were also studied.
Both patients survived at least 30 days after being admitted to the hospital, and the study contained six months of follow-up results.
According to the study, even patients who were not diagnosed with acute illness may have long-term health consequences. Ailments can include infectious illnesses, nervous system diseases, mental wellbeing diagnoses, metabolic disorders, cardiovascular and gastrointestinal conditions, and general malaise.
“Even people with mild disease, some people who got COVID and seemed fine with just a fever and a cough, months down the road they have a stroke or a blood clot – some manifestation related to COVID,” Al-Aly said. “The risk is small, but it is not trivial.”
Israel’s Prof. Cyrille Cohen called the report “concerning” and stressed that “in this study we are not talking about severe cases. These are people who were not supposed to die at all.”
Of course, the risk of death and the associated health challenges were increased with the severity of the disease and showed that hospitalized patients who required treatment in an intensive care unit were at the highest risk for health complications and death.
Among patients who were hospitalized with COVID-19 and who survived beyond the first 30 days of illness, there were 29 excess deaths per 1,000 patients over the following six months – a 50% increased risk of death compared to hospitalized flu survivors, the study showed.
“It is really remarkable that such a virus can produce this huge number of long-term consequences,” Al-Aly told the Post.
He said that it is unclear if the same percentages would directly translate outside the United States, to other countries like Israel, since there are differences in the characteristics of every population. Nonetheless, he said, it is a powerful indication of the long-term burden that the disease will cause.
Al-Aly said that for now the only solution to stop these effects is not to contract COVID-19.
“The best way to prevent long-COVID is to prevent COVID. The best way to prevent COVID is vaccination,” he said.
Cohen agreed. He said that when people are considering not vaccinating “because I am young and not at risk of severe disease or death, I think the issue of long-COVID with the percentages we are seeing now is something that people should take into account.”
He did concede, though, that there is still no evidence on the vaccines’ long-term impact, and he referred to a study that a limited number of people who received the Pfizer vaccine in Israel reported potentially fatal heart inflammation.
The Post analysed the interim study, which revealed that within the first three months of Israel’s vaccine programme, 62 cases of myocarditis or pre-myocarditis were reported, the majority of which were reported by people under the age of 30.
The coronavirus vaccine has been administered to over 5.3 million Israelis.
Prof. Nadav Davidovitch, director of the School of Public Health at Ben Gurion University of the Negev, told The Jerusalem Post that the research was too preliminary to make a causal link between vaccine and myocarditis incidents, and that it was “not even clear if these rates were higher compared to previous years.”
“It seems the risk is quite minor and the risk of getting sick from COVID-19 is much higher than from the vaccine’s adverse events,” he said.
Al-Aly said the important thing is for health systems to prepare for what could be an influx of sick patients even as countries vaccinate and active COVID-19 cases decline.
“We need to figure out how to build the healthcare system to deal with this load,” he said.
He said the world was “caught unprepared for COVID” and in some cases “dropped the ball on COVID. Let us not drop the ball on long-COVID.”