Concerns over lasting symptoms among COVID-19 long haulers

•Brain fog, neuropsychological effects vary in duration, cause, researchers find
•Gavi inaugurates new partnership to reach ‘zero-dose’ children across marginalised communities

More than two years after the COVID-19 pandemic erupted, scientists have become increasingly aware of a group of patients- so-called ‘long haulers’- who remain plagued by a combination of symptoms long after the infection passes.

In a study published in the Journal of Clinical Neuroscience, specialists from Massachusetts General Hospital (MGH) describe their findings related to their multidisciplinary clinical work in this area.

Commonly, patients with long COVID present with ‘brain fog’, a vague description including lack of sleep, anxiety, depression and a history of headache or migraine combined with trouble with attention and word-finding difficulties as well as executive dysfunction,” says Zeina Chemali, MD, MPH, director, Neuropsychiatry Clinics and Training at MGH, and medical director of the McCance Center for Brain Health. “In the patients, we treated with long COVID who presented with “brain fog” we found that the root cause of this commonly used term is often multifactorial.”

In their study conducted over 15 months from February 2020-May 2021, Chemali and colleagues followed 87 confirmed and 13 presumed cases of non-hospitalised individuals with lasting symptoms beyond six months after COVID-19 infection.

A key feature of the study is that most (75 per cent) of the cohort were white educated women. “Even though we know Black Americans and Latinx individuals got very sick with COVID-19, we did not see them in the long hauler’s clinic,” notes Chemali who emphasizes this finding likely follows from disparity in healthcare with the inability to find time and access to the care needed.

The post-COVID-19 long haulers clinic quickly became the launching base to advance the NIH-funded RECOVER study with principal investigator Ingrid Bassett, MD, an investigator in the hospital’s Division of Infectious Diseases. The study aims to understand how and why COVID-19 affects people differently. “The most important question is what is it in a person’s make-up that influences how they react to COVID-19 in a specific way and exhibit certain symptoms?” Chemali asks.

“Why do some people get very sick, others do not, some become long haulers and why do some people never get COVID-19 at all?” To date, approximately 200 patients have been referred from the MGH COVID-19 long haulers clinic to the RECOVER Study and other trials conducted throughout the Mass General Brigham healthcare system.

Meanwhile, Gavi, the Vaccine Alliance yesterday inaugurated the Zero-Dose Immunisation Programme (ZIP), a new innovative initiative that will provide two consortia of partners with up to US$ 100 million to identify and reach zero-dose children living in displaced communities and fragile and conflict settings. Zero-dose children are those that have not received a single shot of a routine vaccine.

International Rescue Committee (IRC) and World Vision (VW) have been chosen to lead the initiative in the Horn of Africa and the Sahel regions respectively, across 11 countries. As of 2020, there were over four million zero-dose children living across the targeted countries.

ZIP, which falls under Gavi’s new US $ 500 million Equity Accelerator Fund will commence with a three-month inception phase during which zero-dose children will be identified alongside the unique barriers, including gender-related barriers, preventing access to immunisation. Children living in areas outside government reach, as well as mobile populations and refugees who move across borders, will be prioritised in the outreach.

At the end of the inception phase, detailed work plans will be agreed as well as relevant targets, with the overall goal of addressing the identified barriers and reaching as many zero-dose children as possible and increasing full immunisation.

Governments will play a central role in the inception and implementation phases and will be involved in decision-making processes.

Both implementing partners were selected following a competitive process including an objective review by Gavi’s Independent Review Committee (IRC). The partners were chosen for their extensive experience in conflict areas and strong footprint in remote areas. They will work closely with governments and local organisations throughout the project, which is set to conclude in December 2025.

Deputy Chief Executive Officer of Gavi, the Vaccine Alliance, Anuradha Gupta, said: “Lower-income countries have made remarkable progress in immunisation over the last two decades but too many children, particularly those in hard-to-reach areas and fragile and conflict settings, are still missing out on life-saving vaccines. We have an opportunity now to build on the progress so far and reach ‘zero-dose’ children with vaccines as well as other essential health services.

“There is a reason these communities are consistently missed and therefore to achieve our goal we need innovative approaches, dedicated focus and resourcing, and new partnerships to address their unique needs and realities. Today’s ZIP launch is an exciting paradigm shift in new partnerships and how we can reach those left furthest behind.”

International Rescue Committee – working closely with Acasus, Flowminder, IOM, ThinkPlace and various local organisations and CSOs– will focus their efforts in Ethiopia, Somalia, South Sudan and Sudan. World Vision –– working alongside the African Christian Health Association Platform, Food for the Hungry, CORE Group and local partners will take the lead in Chad, Niger, Nigeria, CAR, Cameroon, Mali and Burkina Faso.

“With half of all under-five deaths occurring in zero-dose children, it is time for new and innovative partnerships to close the immunisation gap. The IRC is proud to be joining forces with Gavi on this urgent issue at this vital time. Traditional approaches have left more than 12 million children without routine vaccination services, and we are determined to show that new partnerships with diverse actors can deliver results and save children’s lives,“ said David Miliband, President & CEO of the International Rescue Committee.

“Immunisation has prevented the deaths of millions of children, yet vaccine access remains inequitable and out of reach for so many children living in fragile contexts and conflict zones. World Vision is thrilled to partner with Gavi to reach the most vulnerable, zero-dose children, in the Sahel with access to life-saving childhood vaccines. We are committed to partnership—at every level—as it will be critical to address the systemic challenges and barriers limiting access to vaccines,” said Margaret Schuler, Senior Vice President, International Programs for World Vision US.

Gavi’s Equity Accelerator Fund is dedicated to reducing the zero-dose burden in lower-income countries by investing in targeted initiatives. The remaining US $ 400 million out of the total $ 500 million will go directly to Gavi-supported countries to identify where zero-dose children are and to sustainably reach them with a full range of vaccines.

Building on two decades of remarkable progress in expanding the reach of immunisation – which has seen the number of children dying from vaccine-preventable diseases in lower-income countries drop by 70 per cent – Gavi’s latest five-year strategy seeks to push even further. During the period 2021-25, the Alliance and its partners will dedicate focus to reaching zero-dose children and missed communities, leveraging the power of innovation and new partnerships to reduce the number of zero-dose children globally by 25 per cent in 2021–2025.

The partnership with IRC and World Vision is emblematic of this transformative shift in the way the Alliance operates, for the first time in Gavi’s history bringing on board non-governmental organisations as core implementing partners.

Gavi, the Vaccine Alliance is a public-private partnership that helps vaccinate half the world’s children against some of the world’s deadliest diseases. Since its inception in 2000, Gavi has helped to immunise a whole generation – over 888 million children – and prevented more than 15 million future deaths, helping to halve child mortality in 73 lower-income countries. Gavi also plays a key role in improving global health security by supporting health systems as well as funding global stockpiles for Ebola, cholera, meningitis and yellow fever vaccines. After two decades of progress, Gavi is now focused on protecting the next generation and reaching the unvaccinated children still being left behind, employing innovative finance and the latest technology – from drones to biometrics – to save millions more lives, prevent outbreaks before they can spread and help countries on the road to self-sufficiency.

Gavi is a co-convener of COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, together with the Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization (WHO). In its role Gavi is focused on procurement and delivery for COVAX: coordinating the design, implementation and administration of the COVAX Facility and the Gavi COVAX AMC and working with its Alliance partners UNICEF and WHO, along with governments, on country readiness and delivery.

The Vaccine Alliance brings together developing countries and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Bill & Melinda Gates Foundation and other private sector partners.