It’s hard to predict exactly what COVID-19 has in store for us, but at the dismal rate Americans are getting the new bivalent vaccine boosters, it’s not good. A recent modeling study by the Commonwealth Fund of the likely impacts of various vaccine booster scenarios should be a wake-up call. It found that if by the end of the year we could improve the uptake in the U.S. of the COVID bivalent vaccine booster to around 54% from the current 5%, the impacts would be huge.
Specifically, as shown in Scenario 1 in the table below, by March 31, 2023, around 75,000 lives would be saved, about three-quarters of a million hospitalizations averted, and some $44 billion in direct medical costs saved.
The entire table is available at: https://www.commonwealthfund.org/blog/2022/fall-covid-19-booster-campaign-could-save-thousands-lives-billions-dollars.
These numbers are impressive, to be sure, but there’s a critical corollary buried in them. Because of the phenomenon known as “long COVID,” the number of infections averted, which the study predicts would be around 20 million, is especially important. Let me explain why.
Most people who get COVID-19 recover within a few weeks. But some — even those who had mild infections — can have symptoms that persist long afterward. The symptoms in these “COVID long haulers” may be extremely varied. The most common are fatigue, fever, cough, and difficulty breathing or shortness of breath. Other, less common problems include neurological symptoms such as “brain fog” (difficulty with cognition), headache, stroke, sleep problems, loss of smell and taste, depression, or anxiety; joint or muscle pain; cardiovascular symptoms such as chest pain and palpitations; digestive symptoms; new-onset diabetes; and manifestations of blood clots in various organs.
Estimates vary (in part because different researchers and healthcare organizations use different definitions), but it appears that long COVID occurs in approximately five percent of people who have been infected; that somewhere between seven and 23 million Americans currently are suffering from long COVID; and a million are sufficiently debilitated that they are unable to work. The risk of getting long COVID is greater if the acute illness was severe, especially if it resulted in hospitalization or intensive care.
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Long COVID appears to be more common in adults than in children and teens. However, anyone who gets COVID-19 can have long-term effects, including people with no symptoms or only mild illness during the acute infection.
“The best way not to have long COVID is not to have COVID at all,” observes Leora Horwitz, MD, a professor of population health and medicine at New York University’s Grossman School of Medicine. And as illustrated in the scenarios shown above, vaccination lowers the likelihood of infection, as well as of hospitalization and death.
So, what does all this imply, in terms of judgements about public health and individuals’ risk-tolerance? It should certainly persuade individuals to be fully vaccinated and boosted and to wear masks in high-risk situations such as crowded indoor spaces, airports, airplanes, schools, and medical facilities. Whether federal, state, and local governments should resume mandates is another question. Given the Commonwealth Fund’s analysis, it is hard not to conclude that they make sense, in order to avoid Americans’ suffering, disruption of commerce, and intense stress on our healthcare system.
Henry I. Miller is a physician and molecular biologist. He was the founding director of the FDA’s Office of Biotechnology, a Consulting Professor at Stanford University’s Institute for International Studies, and a fellow at the Hoover Institution.