Rebecca Araujo

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A study in the New England Journal of Medicine investigated the risk of postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC)—or “long COVID”—in the pre-delta, delta, and omicron eras of the COVID-19 pandemic. They found a reduced but still substantial illness burden in the omicron era.
The researchers used data from the Department of Veterans Affairs, analyzing outcomes of 441,583 veterans with SARS-CoV-2 infections between March 1, 2020, and January 31, 2022. This cohort was compared with 4,784,504 noninfected controls. The team estimated the cumulative incidence of PASC at 1 year after SARS-CoV-2 infection, stratified by variant (pre-delta, delta, and omicron). They also compared incidence between unvaccinated and vaccinated individuals.
Among participants who were unvaccinated, the cumulative incidence of PASC during the first year following infection was 10.42 events per 100 persons (95% CI, 10.22-10.64) in the pre-delta era, 9.51 events per 100 persons (95% CI, 9.26-9.75) in the delta era, and 7.76 events per 100 persons (95% CI, 7.57-7.98) in the omicron era. The difference between the omicron and pre-delta eras was −2.66 events per 100 persons (95% CI, −2.93 to −2.36), and the difference between the omicron and delta eras was −1.75 events per 100 persons (95% CI, −2.08 to −1.42).
Vaccinated participants experienced lower rates of PASC at 1 year. Cumulative incidence in the vaccinated subgroup was 5.34 events per 100 persons (95% CI, 5.10-5.58) during the delta era and 3.50 events per 100 persons (95% CI, 3.31-3.71) during the omicron era. The difference between the omicron and delta eras was −1.83 events per 100 persons (95% CI, −2.14 to −1.52).
Compared with the unvaccinated group, the difference in incidence of PASC in those who were vaccinated was −4.18 events per 100 persons (95% CI, −4.47 to −3.88) in the delta era and −4.26 events per 100 persons (95% CI, −4.49 to −4.05) in the omicron era. The authors attributed 28.11% (95% CI, 25.57-30.50) of the decrease in PASC incidence to era-related effects, such as changes in the virus, and 71.89% (95% CI, 69.50-74.43) of the decrease was attributable to vaccines.
“The cumulative incidence of PASC during the first year after SARS-CoV-2 infection decreased over the course of the pandemic,” wrote the authors in conclusion, “but the risk of PASC remained substantial even among vaccinated persons who had SARS-CoV-2 infection in the omicron era.”
Source: <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403211" target="_blank" rel="noopener">New England Journal of Medicine</a>

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