COVID-19 can kill even months after recovery – new study

Most deaths caused by long-term COVID-19 complications are not recorded as COVID-19 deaths, meaning the commonly used death toll is "only the tip of the iceberg."

SHAARE ZEDEK hospital team members in the coronavirus ward. (photo credit: NATI SHOHAT/FLASH90)
SHAARE ZEDEK hospital team members in the coronavirus ward.
(photo credit: NATI SHOHAT/FLASH90)
COVID-19 survivors have an almost 60% increased risk of death up to six months after infection compared with noninfected people, according to a massive study published over the weekend in the peer-reviewed journal Nature.
That is the equivalent of about eight extra deaths per 1,000 patients over six months.
“When we are accounting for COVID-19 deaths, the actual total of deaths is much higher,” Ziyad Al-Aly, director of the Clinical Epidemiology Center at Washington University in St. Louis and the head of Research and Education Service at Veterans Affairs St. Louis Health Care System, told The Jerusalem Post. He was the lead researcher on the study.
Most deaths caused by long-term COVID-19 complications are not recorded as COVID-19 deaths, Al-Aly said. As such, “what we are seeing now is only the tip of the iceberg,” he added.
To reach their conclusion, Al-Aly and his research team leveraged data from the electronic health databases of the US Department of Veterans Affairs. The study involved more than 87,000 COVID-19 patients: 74,435 users of the Veterans Health Administration who survived at least the first 30 days with COVID-19 after diagnosis and were not hospitalized; and close to five million VHA users who did not have COVID-19. In addition, it included 13,654 hospitalized patients with COVID-19 and 13,997 who were hospitalized with the flu.
The veterans were mostly men (about 88%), but there were still more than 8,800 women with confirmed cases who were analyzed.
All patients survived at least 30 days after hospital admission, and the analysis included six months of follow-up data.
Even those patients who were not hospitalized with severe disease could have health implications months later, the report showed. Ailments could include respiratory conditions, diseases of the nervous system, mental-health diagnoses, metabolic disorders, cardiovascular and gastrointestinal conditions, and poor general well-being.
“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.”
The report was concerning, Prof. Cyrille Cohen, head of Bar-Ilan University’s immunotherapy laboratory, said, adding that “in this study, we are not talking about severe cases. These are people who were not supposed to die at all.”    
The risk of death and the associated health challenges increased with the severity of the disease, and hospitalized patients who required treatment in an intensive-care unit were at the highest risk for health complications and death, the study showed.
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, or a 50% increased risk of death compared with 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.
It is unclear if the same percentages would directly translate outside the US to other countries, such as Israel, since there are differences in the characteristics of every population, he said. Nonetheless, it is a powerful indication of the long-term burden that the disease will cause, he added.
For now, the only solution to stop these effects is to avoid contracting COVID-19, Al-Aly said.
“The best way to prevent long-COVID is to prevent COVID,” he said. “The best way to prevent COVID is vaccination.”
Cohen agreed. When people are considering not vaccinating “because [they think] 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.”
Responding to a Health Ministry report that some Israelis who took the Pfizer vaccine have experienced potentially deadly heart inflammation, Cohen admitted that that there is still little data regarding the long-term effects of the vaccines.
The interim analysis report, which was reviewed by the Post, showed that during the first three months of Israel’s vaccination campaign, some 62 cases of myocarditis or pre-myocarditis were reported, mostly by people under the age of 30.   
More than 5.3 million Israelis have received at least one dose of the coronavirus vaccine.
The study was too preliminary to draw a direct connection between vaccination and the myocarditis cases, Prof. Nadav Davidovitch, director Ben-Gurion University of the Negev’s School of Public Health, told the Post, adding that it was “not even clear if these rates were higher compared with 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.
The world was “caught unprepared for COVID” and in some cases “dropped the ball on COVID,” Al-Aly said. “Let us not drop the ball on long-COVID.”