As Holidays Approach, COVID-19 Remains a Major Concern

Kevin Kavanagh, MD

Al Roker’s (cohost of the Today Show) recent hospitalization for blood clots in his leg, which embolized to his lungs, is a sobering illustration of the long-term risks imposed by even a mild case of COVID-19, along with the reason why those who survive the acute infection should not be considered recovered. Al Roker recently recovered from a SARS-CoV-2 infection which caused what were termed “mild symptoms.” He was publicly vaccinated on the Today Show in January 2021. This report follows the cardiac death of Julie Powell, age 49, the author of Julie and Julia. Her husband reportedly contracted COVID-19 twice in a month and Julia Powell contracted the disease in mid-September. Ms. Powell was both vaccinated and boosted.

Many individuals are asking, are these reports just chance occurrences? Are these incidents due to the vaccine or to COVID-19? Recent reports point strongly to COVID-19. Clotting was a very rare risk factor for the Johnson & Johnson vaccine, but not a significant factor with mRNA vaccines.

The evidence of these cases being a post COVID-19 sequela is rapidly mounting. A recent large study published in the journal Circulation evaluated 48 million medical records from patients who resided in England and Wales. 1.45 million individuals had COVID-19. Those who had COVID-19 were 22 times more likely to have an arterial thrombosis and 33 times more likely to have an embolism during the first week of their acute illness. During weeks 27 to 49, after the onset of symptoms, there was still a 35% increase in clot formation and an 80% increase in embolism.

An early study, in June 2020, from Baylor College, reported that over half of COVID-19 patients admitted to their ICU developed clinically significant thromboses.

On April 6, 2022, Katsoularis, et al, analyzed data from the Public Health Agency of Sweden on over 1 million Swedish patients who tested positive for SARS-CoV-2. During the first 30 days after acute COVID-19, there was a 5-fold increase in deep vein thrombosis and a 32-fold increase in pulmonary embolism.

On April 22, 2021, Al-Aly et al reported an overall delayed risk of thrombosis in COVID-19 patients that was 39% higher 30 to 180 days after onset of symptoms. This risk increased to 11 times higher if the patient was hospitalized during the acute phase, and 26 times higher if the patient was treated in the ICU. A vivid reminder that if a patient is discharged from a hospital after COVID-19, they should not be considered “recovered” but instead should have continued close monitoring.

Overall, this post COVID-19 sequela is just one of many which contribute to delayed fatalities in COVID-19 patients. These sequelae are responsible for a delayed excess death rate in COVID-19 of 8.4 per 1000 patients.

These events also illustrate why it is so hard to determine the exact fatality rate for COVID-19. At the beginning of the pandemic, there were complaints that people dying of heart attacks (coronary thrombosis, or a clot in the coronary artery) were being counted as COVID-19 deaths. As evidence mounts, this once considered ludicrous practice, was probably correct. In the end, excess death rates will need to be used to obtain a more accurate estimate of the pandemic’s toll.

The above is just another reason to take steps to be as safe as possible during the holidays. Remember, many relatives are elderly and at a very high risk for severe COVID-19 and Long COVID. All who are able should receive the bivalent BA.5 booster. Right before family gatherings, perform a rapid antigen test on all attendees. Ask visiting relatives to follow safe practices (wearing masks and avoiding crowded indoor settings) several days before the holiday events. No single practice will afford adequate protection, but all three will help provide the highest possible protection for a safe holiday.