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Omicron and Long COVID: What Is the Risk?

  • Authors: News Author: Carolyn Crist; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 7/29/2022
  • Valid for credit through: 7/29/2023
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

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Target Audience and Goal Statement

This activity is intended for primary care physicians, infectious disease specialists, nurses, pharmacists, physician assistants, and other members of the healthcare team who care for persons with COVID-19.

The goal of this activity is for learners to be better able to assess the risk for long COVID associated with the Omicron variant.

Upon completion of this activity, participants will:

  • Analyze the effect of vaccination against COVID-19 for mortality and long COVID
  • Compare rates of long COVID during the Omicron and Delta COVID-19 surges
  • Outline implications for the healthcare team


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News Author

  • Carolyn Crist

    Freelance writer, Medscape


    Carolyn Crist has no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine


    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Editor/Nurse Planner

  • Leigh Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Leigh Schmidt, MSN, RN, CMSRN, CNE, CHCP, has no relevant financial relationships.

Compliance Reviewer

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Yaisanet Oyola, MD, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

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Omicron and Long COVID: What Is the Risk?

Authors: News Author: Carolyn Crist; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 7/29/2022

Valid for credit through: 7/29/2023


Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to the approved COVID-19 vaccines are provided in this activity in an effort to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.

Clinical Context

Everyone has their own particular concerns regarding COVID-19. Although hospitalization and even death related to severe COVID-19 are usually at the top of the list, long COVID remains a substantial concern as well. Research into the pathogenesis and epidemiology of long COVID continues to evolve; however, it is clear that long COVID takes a considerable toll on health-related quality of life (HRQoL).

One of the major questions regarding long COVID is the efficacy of vaccination against prolonged symptoms among adults who acquire COVID-19. A study by Al-Aly and colleagues, which was published in the May 25 issue of Nature Medicine,[1] used large cohorts of adults in the Veterans Affairs health system to answer this question.

Compared with contemporary controls without COVID-19, vaccinated adults who had COVID-19 experienced HRs of 1.75 (95% CI: 1.59, 1.93) for death and 1.5 (95% CI: 1.46, 1.54) for long COVID; however, when vaccinated adults with breakthrough COVID-19 were compared with unvaccinated adults with COVID-19, persons with breakthrough infections experienced reduced HR for death (0.66 [95% CI: 0.58, 0.74]) and long COVID (0.85 [95% CI: 0.82, 0.89]).

It appears that the Omicron variant is associated with a lower rate of severe disease compared with the Delta variant. How do these 2 important variants compare in their risk for long COVID? The current study by Antonelli and colleagues addresses this question.

Study Synopsis and Perspective

The Omicron variant of SARS-CoV-2 poses about half the risk for long COVID as the Delta variant, according to a new study published in The Lancet.[2]

At the same time, about 5% of people who contract Omicron still experience symptoms such as brain fog, fatigue, headaches, heart problems, and other health issues at least a month after getting infected. The study is considered one of the first large-scale reports about the long-term risks for Omicron.

"The basic question that we're trying to answer is: 'Is long COVID as common... in the Delta period [as it is] in the Omicron period?" Claire Steves, one of the study authors and a genetic epidemiologist at King's College London, United Kingdom, told NPR.[2]

"What's the risk of going on to get long COVID, given the different variants?" she said.

Steves and colleagues have been tracking thousands of people who tested positive for COVID-19 to determine the risks for long COVID with different variants. They compared more than 56,000 people in the United Kingdom who caught Omicron between December 2021 and March 2022 with more than 41,000 people in the United Kingdom who caught Delta between June 2021 and November 2021.

The patients tracked their symptoms using the COVID Symptom Study app. Persons who caught Omicron were about half as likely as persons who caught Delta to still experience health problems a month later. The chance of developing long COVID from Omicron was 4.5% compared with 10.8% from Delta.

The reduced risk is "great news," Steves said, especially because Omicron is so contagious that many people have been infected quickly. If the risk of contracting long COVID were the same as the Delta variant or higher, the number of people with long COVID would have exploded, she said, but the lower risk does not mean people should not worry about long COVID, she warned.

"The caveat is that the Omicron variant has spread very rapidly through our populations, and therefore a very much larger number of people have been affected," Steves said. "So, the overall absolute number of people who are set to go on to get long COVID, sadly, is set to rise."

The study did not address why Omicron carries a lower risk for long COVID, although Steves said it makes sense because the variant also tends to have a lower risk of making people severely ill.

Long COVID experts told NPR that future studies should confirm the data in medical clinics, and the findings should inform public health measures.

"We're saying, you know: 'You can take off your masks in airplanes. You don't need to be vaccinated anymore to enter a restaurant.' All of these policy decisions are going to increase the likelihood that people get infected with COVID, while there's still a 5% chance of severe chronic illness," David Putrino, PhD, who treats patients with long COVID at Mount Sinai in New York, New York, told NPR.

"That's short-sighted and going to create a lot of long-term disability that did not need to exist," he said.

Study Highlights

  • Investigators drew study data from the COVID Symptom Study, an ongoing project using an app for individuals living in the United Kingdom to report on the symptoms of COVID-19.
  • Participants eligible for the current study had a positive test for COVID-19 and reported symptoms at least weekly in the app for ≥ 28 days after infection. Individuals with a history of prior COVID-19 were not evaluated in the current research.
  • There were data for 56,003 adults with a positive test for COVID-19 between December 20, 2021 and March 9, 2022; > 70% of cases of COVID-19 were due to Omicron during this period. Researchers compared these participants with 41,361 adults with COVID-19--positive tests between June 1, 2021 and November 27, 2021. The Delta variant was responsible for > 70% of cases of COVID-19 during this period.
  • The main study outcome was persistent symptoms at day 28 after a positive test. This result was adjusted to account for sex, age, socioeconomic status, vaccination status, body mass index, and comorbid illnesses.
  • 57% of the total cohort was female, and the average age of participants was 53 years; 19% of the cohort had significant comorbid illnesses.
  • There were insufficient data to assess the study outcome among children and unvaccinated adults.
  • The Omicron surge was more profound among adults with higher socioeconomic status vs the Delta surge.
  • Rates of long COVID were 4.5% in the Omicron cohort and 10.8% in the Delta cohort.
  • Long COVID was significantly less common with Omicron vs Delta across all vaccine doses (ORs 0.24-0.5), although the difference was most pronounced among adults whose last COVID-19 vaccine was ≥ 3 months before a positive COVID-19 test.
  • Participants’ age did not substantially change the study’s main findings.

Clinical Implications

  • In a previous study by Al-Aly and colleagues, COVID-19 among vaccinated adults was associated with higher risks for mortality and long-term symptoms compared among adults without COVID-19; however, vaccination was associated with a 34% lower risk for mortality and 15% lower risk for long COVID in comparing adults with COVID-19.
  • In the current population-based study by Antonelli and colleagues, rates of long COVID were 4.5% in the Omicron cohort and 10.8% in the Delta cohort. Long COVID was significantly less common with Omicron vs Delta across all vaccine doses, and participants’ age did not substantially change the study’s main findings.
  • Implications for the healthcare team: Although omicron likely represents a lower risk for long-term illness, it was still associated with symptoms at 28 days in 1 in 20 adults. Members of the healthcare team should use these findings to inform public health measures and provide evidence-based care.


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