AstraZeneca Covid-19 vaccine
(Image: AAP/James Ross)

Across 2021, pandemic rhetoric has focused on risks. Our vaccine rollout “wasn’t a race” because of the low risk of catching the virus in Australia. As outbreaks prompted lockdowns in Sydney, Darwin, Brisbane and Perth, Prime Minister Scott Morrison announced — without the backing of national cabinet or the Australian Medical Association — AstraZeneca would be made available to anyone under 40.

It’s all about risk, with government resources comparing the risk of blood clots per 100,000 AstraZeneca vaccines to COVID-19 deaths and hospitalisations prevented.

But AstraZeneca isn’t the only vaccine that comes with risk. New evidence has emerged about some of the potential harmful side effects of mRNA vaccines like Pfizer and Moderna. Going unvaccinated obviously is risky too — not just because of the risk of catching what could be a mild version of the virus, but because of all the long-term health effects that come with it.

Long COVID-19 risks

Long COVID-19 is nothing to sneeze at, with the full list of lingering symptoms associated with the virus still not fully known.

COVID is a multi-organ disease with a huge range of symptoms and effects. Different studies label long COVID-19 different things but symptoms generally range from four weeks to 260 days after infection. The most common long-term symptoms are fatigue, chest pains, cough, muscle weakness, sleep difficulties, depression and anxiety. While many could occur irrespective of the virus and as a result of the stress of lockdowns, scientists worry this could develop into chronic fatigue syndrome. In Italy, 44% of patients experienced a “decline in quality of life” following infection.

One study found 14% of COVID survivors developed at least one new condition, including chronic respiratory failure, heart rhythm problems, amnesia, diabetes, anxiety and fatigue that required medical care three weeks after the initial infection, compared with 9% of the general population. In another US study, 6.7% of those studied died 60 days after being discharged from the hospital with the virus and 15.1% required readmission.

Worrying, too, are the effects on organs, with evidence of long-term damage to the lungs. One study found almost 20% of patients developed cardiac injury, and another found in mostly healthy patients two-thirds of people were found to have impairment in at least one organ system four-and-a-half months after recovery, and a quarter had multiple organ systems affected. The virus could even lead to people developing diabetes.

An Australian study released last week found that even in NSW’s low number of first-wave infections, 5% of those diagnosed were still experiencing symptoms three months later, with most symptoms being cough and fatigue.

AstraZeneca risks

As has been widely reported, the AstraZeneca vaccine carries with it a risk of developing a blood clot — although it’s very rare, affecting an estimated 1.4 people between the ages of 60 and 69 for every 100,000 first doses. This increases to 3.1 for those under 50. The overall case fatality rate in Australia is 3%.

Side effects are more common with AstraZeneca too, with diarrhoea, fatigue, headache, chills or nausea affecting 33.7% of people after the first dose.

There have also been 38 cases of suspected Guillain-Barre Syndrome — a rare immune disorder that causes nerve inflammation — in Australia, although a link between the vaccine and the disorder hasn’t been made in Australia or abroad.

mRNA vaccine risks

There’s growing evidence of myocarditis, an inflammation of the heart muscle and pericarditis, inflammation of the membrane around the heart, developing after receiving the Moderna or Pfizer vaccine, leading to the US Food and Drug Administration to add a warning to the vaccines last week.

The Therapeutic Goods Administration is monitoring this reaction, although around the world almost all cases were considered mild and resolved within a few days. A causal link has also not been established.

mRNA vaccines can also cause anaphylaxis, a severe allergic reaction, in 2.47 people in every 10,000 people.

In short, every vaccine, every treatment, and every option — including hoping you’re not unlucky enough to catch the virus — carries risk. While rare, understanding the risk and staying up-to-date on medical advice is key.

As Lieutenant General John Frewen, appointed three weeks ago to refresh the vaccine rollout, said: “AstraZeneca remains a very effective and very appropriate vaccine, the Australian Technical Advisory Group on Immunisation advice was always … you should make a risk-based decision.”