The Washington Post - USA (2022-05-26)

A20 EZ RE THE WASHINGTON POST.THURSDAY, MAY 26 , 2022

BY ARIANA EUNJUNG CHA

A large U.S. study looking at
whether vaccination protects
against long covid showed the
shots have only a slight protective
effect: Being vaccinated appeared
to reduce the risk of lung and
blood clot disorders, but did little
to protect against most other
symptoms.
The new paper, published
Wednesday in Nature Medicine,
is part of a series of studies by the
Department of Veterans Affairs
on the impact of the coronavirus,
and was based on 33,940 people
who experienced breakthrough
infections after vaccination.
The data confirms the large
body of research that shows vacci-
nation greatly reduces the risk of
death or serious illness. But there
was more ambiguity regarding
long covid.
Six months after their initial
diagnosis of covid, people in the
study who were vaccinated had
only a slightly reduced risk of
getting long covid — 15 percent
overall. The greatest benefit ap-
peared to be in reducing blood
clotting and lung complications.
But there was no difference be-
tween the vaccinated and unvac-
cinated when it came to longer-
term risks of neurological issues,
gastrointestinal symptoms, kid-
ney failure and other conditions.
“This was disappointing,” said
Ziyad Al-Aly, lead author and
chief of research and develop-
ment service at VA Saint Louis
Health Care System. “I was hop-
ing to see that vaccines offer more
protection, especially given that
vaccines are our only line of de-
fense nowadays.”
“Long covid” refers to the con-
stellation of symptoms that many
people have reported months af-
ter their initial infections. Early
in the pandemic, some patients
who complained of lingering
symptoms were dismissed by
physicians who thought the man-

ifestations might be psychologi-

cal. But the condition has since

become a major concern for the

medical community.

The World Health Organiza-

tion has defined post-covid syn-

drome as symptoms that last for

at least two months and cannot be

explained by alternate diagnoses.

It cited evidence suggesting that

as many as 20 percent of the

half-billion people worldwide es-

timated to be infected with coro-

navirus may experience mid- and

long-term effects.

This week, the Centers for Dis-

ease Control and Prevention re-

leased new estimates of the syn-

drome’s toll in the United States,

suggesting it affects one in five

adults younger than 65 who had

covid, and one in four of those

aged 65 and older. People in both

age groups had twice the risk of

uninfected people of developing

respiratory symptoms and lung

problems, including pulmonary

embolism, the CDC found. Those

in the older age group were at

greater risk of developing kidney

failure, Type 2 diabetes, neurolog-

ical conditions and mental health

issues.

The Veterans Affairs study, be-

lieved to be the largest peer-re-

viewed analysis in the United

States on long covid based on

medical records, looked at pa-

tients who either had two doses of

the Moderna or Pfizer—BioNTech

vaccines, or one dose of the John-

son & Johnson vaccine. It did not

assess the impact of booster

shots. While the study population

contained a wide range of ages

and racial and ethnic back-

grounds, it did skew older, Whiter

and more male than the United

States as a whole.

The VA study also had no way

to tell how different variants may

change the risk of long covid.

These breakthrough infections,

for example, took place at a time

when alpha, delta and prior vari-

ants were at high levels in the

United States. It does not cover

the period when the omicron

variant and its subvariants began

circulating in late 2021.

The findings add to the debate

surrounding similar analyses

trickling out from the United

Kingdom, Israel and other coun-

tries that have shown conflicting

results in terms of whether vac-

cines protect against long covid.

One British study published in

the medical journal Lancet, for

example, based on self-reported

data from an app, showed a 50

percent reduction in risk among

those who were vaccinated. On

the other hand, a paper by Uni-

versity of Oxford researchers

based on electronic records from

the United States found that vac-

cination did not appear to reduce

the risk of long covid for most

symptoms.

The question of vaccines and

long covid has been a critical one

for doctors. Some patients have

claimed a vaccine has cured

them, while others have avoided

the shots for fear of triggering

symptoms.

Igor Koralnik, chief of neuro-

infectious diseases at Northwest-

ern Medicine, said recent re-

search suggests neither is true. In

a paper published in the Annals of

Clinical and Translational Neu-

rology on Tuesday, Koralnik and

his colleagues found that 77 per-

cent of the 52 long-covid patients

they are following had been vacci-

nated against the coronavirus,

but the shots did not appear to

have a positive or negative impact

on cognitive function or fatigue.

“There is a neutral effect of

vaccination. It didn’t cure long

covid. It didn’t make long covid

worse,” Koralnik said.

At the Dartmouth Hitchcock

Medical Center’s Post-Acute

COVID Syndrome Clinic, Christi-

na Martin, an advance practice

nurse, said that since November,

her staff has noticed a “worrying

trend” of vaccinated people hav-

ing breakthrough infections and

developing long covid.

When the clinic was founded a

year ago, she said, they anticipat-

ed seeing fewer new patients by

this time as more people became

vaccinated. Unfortunately,

they’ve seen the opposite, with

patient numbers going up.

“We now feel that long covid is

here to stay. ... This will have

profound implications on our

health-care system and resourc-

es,” Martin said.

David Putrino, a long-covid re-

searcher who serves as director of

rehabilitation innovation at the

Mount Sinai Health System in

New York, shares those concerns.

He worries that public health

leaders are not taking the current

surge seriously enough because

they are discounting the risks of

long covid.

Putrino said that demand for

appointments at his medical cen-

ter’s long covid clinic continues to

increase and he does not antici-

pate a slowdown any time soon.

The clinic has seen about 2,

patients since opening in May,

2020.

“We failed in our health mes-

saging that death is not the only

serious outcome of a covid-19 in-

fection,” Putrino said. “... I’m very

concerned that what this is going

to do is lead us into a continua-

tion of this mass-disabling event

we are seeing with long covid.”

Vaccines may not prevent many symptoms of long covid

Study: Six months later,

little difference between

those who got shot or not

CAROLYN VAN HOUTEN/THE WASHINGTON POST

Eve Efron of Fairfax, Va., has been struggling with long covid for nearly a year, including significant fatigue, brain fog, anxiety and

depression. As many as 20 percent of the half-billion people infected with coronavirus may experience mid- and long-term effects.

BY KAREN DEYOUNG

Saying he was “not particular-
ly optimistic, to put it mildly,” of
success in the year-long negotia-
tions over reviving the nuclear
deal with Iran, the Biden admin-
istration’s envoy to the talks
insisted Wednesday that ongoing
diplomacy remains the best op-
tion for U.S. national security.
“The military option cannot
resolve this issue” and prevent
Iran from developing a nuclear
weapon, Robert Malley told the
Senate Foreign Relations Com-
mittee. “There is no military
response ... we’ve heard this
repeatedly,” including from Isra-
el, he said. “The only option here
is the diplomatic one.”

The hearing was the first ex-

tended public presentation by

the administration since the

stalemated talks were suspended

in March. While several Demo-

crats urged the administration to

continue negotiations, several

others joined most Republicans

in questioning the value of con-

tinuing the talks.

The administration said in

February that if agreement had

not been reached “within the

next few weeks,” Iranian nuclear

advances would “make it impos-

sible” to return to the 2015 Joint

Comprehensive Plan of Action,

or JCPOA, as the Barack Obama-

era deal is known.

“It’s late May,” committee

Chairman Robert Menendez

(D-N.J.) noted. “If Iran were to

break out tomorrow,” with

enough highly enriched uranium

to make a bomb, “what is the

United States prepared to do?” he

asked. “We want to hear U.S.

plans to enforce sanctions al-

ready in place ... plans in detail

for what the administration is

prepared to do to stop the grow-

ing oil trade between Iran and

China ... to bring home Ameri-

cans wrongfully detained in

Iran.”

The United States “must back

up President Biden’s statement

that ‘Iran will never get a nuclear

weapon on my watch,’” Menen-

dez said.

Malley acknowledged that, in

addition to expanding its nuclear

program, Iran has increased its

other destabilizing activities in

the region, including support for

proxy militias, development of

its ballistic missile program and

attacks against U.S. and other

forces in the Middle East. But, he

said, “it is much safer to negoti-

ate” those issues “when we know

the nuclear program is under

control.”

Since April last year, the Unit-

ed States has negotiated indirect-

ly with Iran through the three

European parties — Britain, Ger-

many and France — to the origi-

nal agreement, which sharply

limited Iran’s ability to produce

and retain the enriched uranium

needed for a nuclear weapon, in

exchange for lifting U.S.

“ nuclear-related” sanctions

against it. Signers Russia and

China have also participated in

the negotiations, held in Vienna,

to return from the agreement

from which the Trump adminis-

tration withdrew in 2018.

After the withdrawal, Trump

embarked on a “maximum pres-

sure” campaign against Iran, re-

imposing sanctions that had

been lifted and adding about

1,600 more, while Iran increased

the quantity and quality of its

enriched uranium production far

beyond the JCPOA limits.

Under the terms of a new

agreement, Iran would return to

the 2015 restrictions on the size

and scope of its nuclear program,

and the United States would lift

“nuclear-related” sanctions

against it, while other sanctions

would remain.

But negotiations were sus-

pended in March, according to

U.S. and European officials,

when Iran demanded that the

United States also lift its 2019

designation of the Islamic Revo-

lutionary Guard Corps, a branch

of the Iranian military, as a

foreign terrorist organization.

The Biden administration has

not announced a decision in

response to the Iranian demand.

But Israeli Prime Minister Nafta-

li Bennett, in a series of state-

ments on Twitter on Tuesday,

said that Biden had confirmed to

him in a telephone call late last

month that he would “keep ... the

IRGC” on the list, “which is

where it belongs.”

Biden envoy tries to breathe life into Iran deal

He argues for diplomacy

even as prospects fade in

stalemated nuclear talks

In a tweet, Bennett thanked

Biden “for this principled deci-

sion, and for being a true friend

of Israel.”

Since the talks were suspend-

ed, the European Union negotia-

tors, who serve as coordinator for

the negotiations, have traveled

back and forth between Tehran

and Washington trying to fash-

ion a way out of the stalemate.

Chief E.U. negotiator Enrique

Mora and the emir of Qatar,

Tamim bin Hamad al-Thani, both

issued mildly positive statements

after visits to the Iranian capital

this month.

In a lengthy prepared state-

ment, Malley acknowledged that

there are “strongly held compet-

ing views” in Congress about the

deal. Last month, a bipartisan

supermajority of the Senate

passed a nonbinding resolution

insisting there be no delisting of

the IRGC, and that any nuclear

deal also address Iranian support

for terrorism in the region.

Repeating familiar adminis-

tration talking points, Malley

said that the negotiations were

always limited to Iran’s nuclear

program, with the hope that an

agreement would lead to further

discussions about Iran’s other

activities, including terrorism,

support for proxy forces in the

region and development of bal-

listic missiles.

“To the extent that there is a

disagreement in this room,” he

told lawmakers, “it boils down to

this: are we better off reviving

the nuclear deal and, in parallel,

using all other tools at our dis-

posal — diplomatic, economic

and otherwise — to address

Iran’s destabilizing policies? Or

are we better off getting rid of the

deal and banking on a policy of

pressure alone to get Iran to

accept more onerous nuclear

constraints and curb its aggres-

sive practices.”

“We have gone through several

years of a real-life experiment in

the very policy approach critics

of the JCPOA advocated: a so-

called maximum pressure policy,

designed to strangle revenue for

the Iranian regime, in hopes of

getting Iran to accept far greater

nuclear restrictions and engage

in far less aggressive behavior,”

Malley said.

“Many of us strongly disagreed

with this policy at the time, but

we could of course not prove that

it would fail. That was then. This

is now. Then we predicted, now

we know.”

In response to questions, he

repeated the administration’s

pledge to submit any new deal to

congressional review, while de-

clining appeals to make it a

treaty that would be subject to

Senate approval.

Malley’s testimony was fol-

lowed by that of Mark Dubowitz

of the Foundation for Defense of

Democracies, a leading critic of

U.S. reentry into the nuclear

deal. In his prepared remarks,

Dubowitz said that reinstated

sunset clauses in the original

agreement — to be retained in a

revived deal — would lift many of

the nuclear restrictions it impos-

es on Iran within a handful of

years, and the removal of nucle-

ar-related sanctions would pro-

vide Iran with $275 billion in

sanctions relief during the first

year, and $800 billion in five

years.

Malley called those figures

“wildly exaggerated compared to

what our intelligence believes.”

He said that removal of current

sanctions on Iranian oil exports

would bring Iran “about $5 bil-

lion a month at current prices.”

China is the largest current pur-

chaser of Iranian oil, in violation

of U.S. sanctions.

LUJAIN JO/ASSOCIATED PRESS

“The only option here is the diplomatic one,” said U.S. special

envoy for Iran Robert Malley, shown here in March.

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