People Can Develop Long Flu Similar to Long COVID-19
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COVID-19 isn’t the only viral infection that causes lingering health problems — the seasonal flu is also linked to an increased risk of certain conditions well after the acute phase, according to a new study of veterans who were hospitalized with either COVID-19 or the flu.
The research, published on December 14 in The Lancet Infectious Diseases, found that in the 18 months after infection, people hospitalized for either COVID-19 or seasonal flu had an increased risk of death, hospital readmission, and health problems in the heart, lungs, brain, kidneys, and other organs.
“The study illustrates the high toll of death and loss of health following hospitalization with either COVID-19 or seasonal influenza,” said coauthor Ziyad Al-Aly, MD, a clinical epidemiologist at Washington University in St. Louis and the chief of research and development at VA St. Louis Health Care System in a press release.
“Many people think they’re over COVID-19 or the flu after being discharged from the hospital. That may be true for some people. But our research shows that both viruses can cause long-haul illness,” said Dr. Al-Aly.
The Presence of Long COVID Prompted Investigators to Examine Long Flu
Since the COVID-19 pandemic began, extensive research has emerged detailing the virus’s ability to attack multiple organ systems and potentially resulting in long COVID.
“A major lesson we learned from SARS-CoV-2 is that an infection that initially was thought to only cause brief illness also can lead to chronic disease,” said Al-Aly, noting that before the pandemic, it wouldn’t have even occurred to him to examine the possibility of a “long flu.”
“We wanted to know whether and to what degree people with flu also experience long-term health effects,” Al-Aly said.
Long-Term Health Risks Are Higher for COVID-19 in Nearly Every System in the Body
Using records from the U.S. Department of Veterans Affairs, researchers compared the long-term health outcomes of about 11,000 people hospitalized with influenza from 2015 to 2019 with those of about 81,000 people hospitalized with COVID-19 from 2020 to 2022.
This included how many people went on to develop any of 94 different health risks, risk of death, and risk of hospital readmission 18 months post-infection.
“The risks were higher in COVID for all organ systems except the pulmonary system [lungs], which was higher in flu. This tells us the flu is truly more of a respiratory virus, like we’ve all thought for the past 100 years,” said Al-Aly.
By comparison, COVID-19 is more aggressive and indiscriminate in that it can attack the lungs, but it can also strike any organ system and is more likely to cause fatal or severe conditions involving the heart, brain, kidneys, and other organs, he said.
Relative to people who’d had the flu, people with COVID-19 were at increased risk of 64 of the identified complications, including fatigue, mental-health problems, and lung, gut, and heart issues.
The flu was associated with a 6 percent elevated risk of health conditions in 6 of the 94 conditions, mostly in the respiratory system.
People With COVID Had a Greater Risk of Death and Hospital Readmission in the 18 Months After Infection Compared With People Who Had the Flu
People who had COVID-19 had a 50 percent higher risk of death than those with the flu, which translated to about 8 more deaths per 100 people in the COVID-19 group compared with the flu group, confirming findings shown in previous research.
The COVID-19 group also experienced an increased risk of hospital readmission as well as admission to an intensive care unit (ICU). For every 100 people in each group, there were 20 more hospital admissions and nine more ICU admissions in COVID-19 than flu.
The findings were consistent as dominant variants shifted from pre-delta to delta and later omicron, and found in both vaccinated and unvaccinated individuals, according to the authors.
The authors did acknowledge limitations of the study — a major one being that it focused only on people hospitalized for COVID and flu and didn’t include a control group of people without either infection. In addition, the VA data was heavily skewed toward older male patients, so there are remaining questions as to how these health burdens affect people of other ages and sexes.
COVID-19 Remains A Much More Serious Threat to Human Health Compared With the Flu
“The findings show that COVID-19 remains a much more serious threat to human health than the flu,” said Al-Aly
“One thing that really stuck out is that in almost every area that was measured, it was worse almost always with the people who had COVID-19 than it was with people who had the flu,” says David Wohl, MD, a professor of medicine in infectious diseases at the UNC School of Medicine in Chapel Hill, North Carolina.
“These findings really push back firmly and conclusively against statements like ‘COVID is just like the flu.’ It is not like the flu,” says Dr. Wohl, who was not involved in the study.
“The idea that COVID-19 or flu are just acute illnesses overlooks their larger long-term effects on human health,” Al-Aly said. A big “aha” moment was the realization that long-term health losses were more serious than the initial symptoms patients experienced in the first 30 days after infection, he noted.
“Long COVID is much more of a health problem than COVID, and long flu is much more of a health problem than the flu,” said Al-Aly.
‘We Need to Wake Up’ to the Seriousness of Viral Infections
Pre-pandemic, the medical community tended to dismiss most viral infections as somewhat inconsequential, and people would typically recover after being sick for a few days, said Al-Aly.
“But we’re discovering that is not everyone’s experience. Some people are ending up with serious long-term health issues. We need to wake up to this reality and stop trivializing viral infections and understand that they are major drivers of chronic diseases,” he said.
Other recent studies support Al-Aly’s comments that even routine viral infections can cause symptoms and health issues that linger. In a study published in December 2022 in JAMA Network Open, for instance, a study of 1,000 adults, most of whom weren’t hospitalized, about half of people sick with something other than COVID-19 reported ongoing issues three months later.
A study published in September 2021 in PLoS Medicine that included both hospitalized and nonhospitalized patients also found that about 40 percent of people with the flu experienced at least one symptom commonly associated with long COVID in the six months after their illnesses.
Trying to Untangle Long Effects of Infections
“I do think that we’re learning that some viruses do cause reactions, like long COVID, and maybe there is a post-viral syndrome with influenza that’s also being picked up here. However, it’s very difficult to tease out what could be due to having COVID or the flu specifically versus being sick enough to be in the hospital,” says Wohl.
For example, if you were following people who had a heart attack and were hospitalized, some things may happen to them over the next 18 months that may not be related to their heart attack, but just being debilitated, he says.
“So, I think here it’s hard to tease out what’s long COVID versus COVID knocked you down, and you just never really got back up, and you had a cascade of other things happen to you. That can happen, especially to older people, especially if they were in the hospital,” he says.
Findings Highlight the Importance of Prevention and Treatment
These findings really emphasize why prevention is so important and necessary, says Wohl. “Only around 60 percent of folks in these two groups were vaccinated. This is a high-risk group — why isn’t that number 99 percent? A lot of these illnesses could have been prevented by getting a COVID vaccine and a flu vaccine,” he says.
People should also be aware that there’s treatment for people who do get sick, says Wohl. “Taking treatment once you do get diagnosed is really important. Paxlovid is used to treat COVID-19 and reduce the risk of these kinds of outcomes,” he says.
In November 2022, the Centers for Disease Control and Prevention (CDC) reported a real-world study showing that adults who took Paxlovid within five days of a COVID-19 diagnosis had a 51 percent lower hospitalization rate within 30 days compared with those who didn’t take the drug.
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