Doctor Lapp on COVID-19 Vaccines and COVID-19 Long-Haulers

Email a Friend

By Charles W. Lapp, MD

[Updated August 23, 2021]

Note: Dr. Lapp is the founder and Medical Director of the Hunter-Hopkins Center in Charlotte, North Carolina, a medical practice specializing in ME/CFS and FM.

Vaccines Against COVID-19 & ME/CFS

Three vaccines for COVID-19 are now available to the American public, one from Moderna, one from from Pfizer, and a third from Johnson and Johnson. All three vaccines were approved on emergency use basis for people 16 and older.

In May, the FDA approved the Pfizer vaccine for 12- to 15-year olds and on August 23, 2021 granted the Pfizer vaccine full approval for people 16 and older.

Both Moderna and Pfizer vaccines utilize a new type of immunization using mRNA to deposit recombinant antigen into the bloodstream. Because a live or attenuated virus is not involved, it is thought that such vaccines would not trigger flares or relapses in people with ME/CFS (PWCs), who may develop relapses from ‘live virus’ vaccines like influenza, MMR, and Hepatitis B.

Both the Moderna and Pfizer vaccines require two doses, and may cause local pain and swelling, fever, headache and flu-like symptoms for a day or two. Two immunizations are required – at least 3-4 weeks apart – for full immunity in over 90% of cases, but the second dose generally causes more adverse effects than the first.

The Johnson & Johnson vaccine is a single dose that utilizes an attenuated adenovirus to convey antigen into the system and is therefore more likely to trigger flares and relapses in PWCs. It has been up to 85% effective in reducing COVID-19 infection, and 100% effective in preventing hospitalization and death due to SARS-CoV-2.

It is not clear if people with ME/CFS (PWCs) are at higher risk for contracting COVID-19. Clearly their immune systems are low functioning due to reduced antibody production, increased cytokine activity, autoantibodies, reduced NK function, etc.

Others would say that PWCs are not immunodeficient, and they are less susceptible to viral infection than the general public. Our recommendation is to take either the Moderna or Pfizer vaccine when it is available to you.

Individuals who have had COVID-19 may wish to be vaccinated in order to boost their immunity, but only one jab is recommended because those who already have antibodies to COVID-19 develop more severe reactions to a repeat vaccination.

Some providers have suggested taking Tylenol, NSAIDs, or steroids before a vaccination to reduce the side effects. However, recent evidence suggest that these may reduce the effectiveness of the vaccine or affect antibody production. It is okay, however, to take Tylenol, Advil, Aleve, aspirin or similar analgesics for any side effects that occur after the immunization.

COVID Long-Haulers and ME/CFS

Recent studies and surveys have established that at least 10% and perhaps 50% or more persons who were infected with COVID-19 still suffer symptoms 6 months after the onset of their illness. The majority are unable to work. They have come to call themselves COVID Long-Haulers. Many meet criteria for ME/CFS, which is not surprising since ME/CFS is most commonly triggered by infection.

If at least 10% of persons infected with SARS-CoV-2 develop Long Covid, then we can expect another 2.5 million or more ME/CFS-like cases in the United States in the near future in addition to the already 1.5 million already affected by ME/CFS. This will place an incredible burden on both providers and our economy.

Persons with Long Covid frequently complain of fatigue or exertion intolerance, post-exertional malaise, and cognitive dysfunction in addition to orthostatic intolerance such as POTS, body and joint pain, difficulty sleeping, coughing, shortness of breath, chest pain, headaches, loss of smell and taste, and profound psychologic distress including anxiety, depression, and PTSD.

Those who were most seriously affected might suffer cardiac, pulmonary, renal, or coagulation problems.

To document illness, individuals suspected of COVID-19 should have a nasal swab for SAR-CoV-2 antigens during the early acute phase of the illness, and/or blood work for SARS-CoV-2 antibodies later in the illness.

Clinics for the management of Long Covid have sprung up at Mt. Sinai Hospital in New York, Yale Medical Center, George Washington University, and other notable medical centers. They certainly provide an excellent and needed resource for Long Haulers.

However, there is a concern that such centers will not recognize the symptoms of ME/CFS in these individuals and exacerbate symptoms by not preventing post-exertional malaise, or not identify clinical entities like Postural Orthostatic Tachycardia Syndrome, which can easily be dismissed as a symptom of Long Covid and not addressed clinically.

Those Long Haulers who develop classical symptoms of exertion intolerance, post-exertional malaise, sleep disruption, cognitive problems and/or orthostatic intolerance should seek out an ME/CFS specialist.

Key Points

Persons with ME/CFS/FM should tolerate the Moderna and Pfizer vaccines, perhaps not J&J
Avoid Tylenol, NSAIDs, and steroids prior to the vaccination.
Prevention (masking, handwashing, social distancing and immunization) is key to preventing Long Covid
10-50% of people who contract COVID-19 will develop a prolonged ME/CFS-like illness
COVID-19 infection should be documented with nasal swab or blood tests
Long Haulers should seek specialists with an understanding of ME/CFS
Long Haulers may wish to boost immunity with a single dose of vaccine

References
1. Komaroff AL and Bateman L, 18 Jan 2021, “Will COVID-19 lead to myalgic encephalomyelitis / chronic fatigue syndrome?’ Frontiers in Medicine, 7: article 606824
2. Topol E, Verghese A, Fauci A, 2020, “We’re all in this together and we’re gonna get through it,” Medscape. Available online at https://www.medscape.com/viewarticle/933619#vp_2
3. Jason LA and Mirin AA, 2021, “Updating NAM ME/CFS prevalence and economic impact figures to account for population growth and inflation,” Fatigue: Biomedicine, Health & Behavior, doi: 10.1080/21641846.2021.1878716
4. Komaroff AL, 2019, “Advances in understanding the pathophysiology of chronic fatigue syndrome,” JAMA 322: 499-500.
5. Association of State and Territorial Health Officials, 13 Jan 2021, “Pfizer and Moderna vaccine comparisons.” Available online at https://www.astho.org/COVID-19/Pfizer-Moderna-Vaccine-Comparison/
6. Zimlich R, Miller A, 4 Feb 2021, “An overview of the Johnson & Johnson COVID-19 vaccine,” available online at https://www.verywellhealth.com/johnson-and-johnson-covid-19-vaccine-5093160
7. Krammer F, Srivistava K, et al’, 1 Feb 2021, “Robust spike antibody response and increased reactogenicity in seropositive individuals after a single doe of SARS-CoV-2 mRNA vaccine,” MedRxiv, doi: https://doi.org/10.1101/2021.01.29.21250653. Preprint available online at https://www.medrxiv.org/content/10.1101/2021.01.29.21250653v1.full.pdf