What We Know About Breakthrough Infections And Long COVID

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Weeks after getting sick from COVID-19, Kathleen Hipps is still experiencing symptoms, even though she was fully vaccinated.

Kathleen Hipps

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Kathleen Hipps

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Sometimes the numbness is so bad she can’t push her baby’s stroller. Her periods are really heavy too. And work tires her out so fast now 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 percent 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 that vaccinated people who get infected may be at risk for long COVID too, Nath says.

«I think that’s a good question,» he says.

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 percent 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.

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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 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.»

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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,» del Rio says.

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.

  • breakthrough infection
  • covid long haulers
  • COVID-19 vaccine
  • coronavirus pandemic
  • COVID-19

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