Friday Q&A: on Risks After COVID; Booster Shots; New Vaccine Formulas; & COVID During Pregnancy

You ask the best questions!

It’s Friday Q&A time! This week’s Q&A is all about COVID. My newsletter and podcast episode about the “here and now” of COVID are here.

Click here to submit your questions (about anything) for future Q&A posts!

The first question is free for everyone. The remaining questions (about boosters, new vaccine formulas, and getting COVID while pregnant) are for paid subscribers.

Don’t forget to check out my recent Q&As on:

• Help with Infertility; When to Freeze Eggs; Anxiety about So Many Pills; & Finding a Therapist

• Diet Coke; Stomach Woes; Strength Training for Beginners; & Finding the Right Doctor for Menopause

• Treating Heartburn; Selecting the Best Doctor; Insomnia; & How to Triage Your Medical “To-Dos”

  

  Photo by Fusion Medical Animation on Unsplash

Let’s dive in!

QUESTION #1

Is it true that having a mild or even asymptomatic COVID infection increases the risk of death from cardiac events by 3-4x within the first year post-infection? I have read this on social media posts by some scientists and MDs, which has increased my anxiety quite a lot.

-KL

Dear KL, 

I hear you! Here’s the deal: Just like any respiratory illness can aggravate pre-existing health conditions, so can COVID. The statistic you cited, however, is not accurate. It seems to be coming from a not-so-well-done study in JAMA Health that generated panic-inducing headlines. The study compared two non-comparable groups of people, e.g. people with a “post COVID condition” to people who supposedly hadn’t had COVID—and then it studied how the health of these two groups played out over time. Right off the bat, you can easily see why people who ended up in the hospital with a post-COVID condition are not the same as other random people (they had more health problems to begin with!) In other words, the confounders here are too great to make sense of the data. 

Do I have patients with serious post-COVID outcomes? Absolutely. Can COVID exacerbate cardiovascular disease? Yes, yes! But COVID is only one factor in an ocean of risk factors for poor health outcomes. This is not to diminish the potential impact of COVID; it’s to recognize the importance of context when caring for patients—and when reading scary headlines.

For more (cheeky yet spot-on) analysis on this study, here is a great write-up by cardiologist Anish Koka, MD.

The upshot? 

• It’s not clear if COVID causes an increased risk of death from cardiovascular events—or if cardiovascular events simply continue to be common just like COVID is. Correlation is not causation.

• Accurate data on how COVID infection affects subsequent health are hard to come by, because nearly everyone has had COVID by now. 

• Any viral infection (COVID or otherwise) can exacerbate underlying health conditions.

• My advice: 

  • Get vaccinated if you haven’t already, and trust the vaccine doses you’ve already had continue to work extremely well where it counts the most—protecting against serious COVID outcomes.

  • Rest assured that getting COVID in the vaccine era is less dangerous than in the pre-vaccine era, particularly for high-risk individuals. 

  • The best way to protect your heart and all of your organs from any long-term consequences of COVID is to exercise regularly, eat healthy, limit alcohol and caffeine, manage stress and your underlying health, and see your primary care doctor for a check-up!

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QUESTION #2

Our son is 18 and had his primary series and first booster back in December 2021. We are not planning to give him the bivalent because we feel he is well protected against severe disease (he also had Covid in April 2022). Since his last vaccine was over a year ago, if he gets Covid again, would he be more likely to have “long Covid” symptoms after (understanding based on your latest letter that long Covid is not that common in teens). Concerned also since this would be the scary reinfection the media talks about.

- Pearl S.