IF further proof was needed that infection with SARS-CoV-2 has long-term sequelae for the human body, research led by Monash University has provided it, highlighting the need for GPs and other frontline physicians to be aware of their patients’ COVID-19 history.
The research, led by epidemiologist and PhD candidate Stacey Rowe, and coauthored by Victorian Chief Health Officer Professor Brett Sutton and renowned infectious disease epidemiologist Professor Allen Cheng, among others, is published by the MJA.
“Essentially what we wanted to do was look to see what sort of hospitalisations might have been associated with having COVID-19 – did it cause other than respiratory complications, for example,” Ms Rowe told InSight+.
Rowe and colleagues analysed population-wide surveillance and administrative data for all laboratory-confirmed COVID-19 cases notified to the Victorian Department of Health from 23 January 2020 to 31 May 2021 – prior to the vaccination rollout and the appearance of the Omicron variant – and linked hospital admissions data (admission dates to 30 September 2021).
“A total of 20 594 COVID-19 cases were notified, and 2992 people (14.5%) were hospitalised with COVID-19,” Rowe and colleagues reported in the MJA.
“The incidence of hospitalisation within 89 days of onset of COVID-19 was higher than during the baseline period for several conditions, including myocarditis and pericarditis (IRR, 14.8; 95% CI, 3.2–68.3), thrombocytopenia (IRR, 7.4; 95% CI, 4.4–12.5), pulmonary embolism (IRR, 6.4; 95% CI, 3.6–11.4), acute myocardial infarction (IRR, 3.9; 95% CI, 2.6–5.8), and cerebral infarction (IRR, 2.3; 95% CI, 1.4–3.9).”
In other words, says Ms Rowe, “there are considerable risks associated with SARS-CoV-2 infection” beyond the initial COVID-19 illness.
“You are 15 times more likely to acquire myocarditis requiring hospitalizations following COVID-19 compared with beforehand,” she said.
“Things like heart attacks, or acute myocardial infarction occur quite proximally to getting COVID infection, but other conditions such as the clotting conditions – pulmonary embolism, for example — that risk was highest later in the course of COVID illness, highest around 14 to 60 days following COVID illness.”
Other results were also telling.
“The incidence of hospitalisation with cerebral infarction was twice as high after COVID-19 onset as during the baseline period,” Rowe and colleagues wrote. “Other investigators (here, here and here) have estimated the risk of stroke to be 2–13 times as high for people with COVID-19.”
Professor Cheng, speaking with InSight+, said with testing and tracing of positive COVID-19 cases now not mandatory in Australia, it was harder to know just who has had COVID.
“What this study does suggest is that [the possibility of a previous COVID illness] should be on the radar, because there is a window of elevated risk,” he said.
“If someone presents with, say, chest pain, within a couple of months of having COVID, we really need to be attentive to that, because it’s probably a bit more likely that pain does represent a myocardial infarction than at other times.
“You can’t say that every heart attack that happens after COVID is due to COVID. But there is a period of elevated risk, and it seems to be close to when you got COVID.”
Rowe and colleagues recommend vaccination and “other mitigation strategies”.
“Our findings indicate the need for ongoing COVID-19 mitigation measures, including vaccination, and support the early diagnosis and management of complications in people with histories of SARS-CoV-2 infection,” they wrote.
“The pathophysiological mechanisms underlying symptom persistence and the development of major complications still need to be elucidated, the prevalence of the post-COVID-19 condition (by vaccination status) established, and the risks of complications following vaccination quantified.”
Professor Cheng told InSight+:
“What [this study] does show is you’re better off not getting COVID and whatever way that you do that is probably a good thing.
“Vaccination is the simplest way to protect yourself from getting COVID, but it’s not perfect. Not going out when there’s a lot of COVID out there, wearing masks, improving ventilation and all those other things, are also important.”
At one point in the MJA article the authors wrote:
“Some COVID-19 complications clinically resemble those reported after vaccination against SARS-CoV-2, which is important when evaluating putatively post-vaccination adverse events. Further, we found that the incidence of hospitalisation with severe cardiac and thrombo-embolic events after SARS-CoV-2 infection was higher than the reported risk of these events after vaccination.”
Ms Rowe told InSight+:
“What we found with this study, and what other studies have found internationally is the risk of myocarditis is higher following SARS-CoV-2 infection, than it is following vaccination.
“While people [who feel they have been injured by the vaccine] might grab on to that, there are lots of studies now demonstrating that the risk is higher following infection, than it is following vaccination.”
Professor Cheng agreed.
“It’s important to acknowledge that people do get side-effects after vaccination – myocarditis happens, often after the second dose, usually within a day or so,” he said. “That’s very unambiguously due to vaccination.
“But the question from a public health point of view is, do the benefits outweigh the risks. COVID itself can cause myocarditis at a higher rate [than vaccination]. And that means you’re still better off getting vaccinated.”
Ms Rowe said the study showed that COVID-19 was not a simple respiratory disease.
“These findings really demonstrate COVID-19 is a multi-organ disease, it’s not a respiratory infection. If more research can be channelled into understanding those pathophysiological mechanisms, then we can then start thinking about how best we can prevent these.”
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