Cardiovascular specialist Alan C. Kwan, MD, is an investigator with the Smidt Heart Institute at Cedars-Sinai. (no I dont). doi: 10.1007/s12026-021-09185-5. Nat Cardiovasc Res 1, 11191120 (2022). Lorsque vous utilisez nos sites et applications, nous utilisons des, authentifier les utilisateurs, appliquer des mesures de scurit, empcher les spams et les abus; et. 2022 Aug;32(4):307-311. doi: 10.1007/s10286-022-00880-3. 2021 Apr;69(2):205-211. doi: 10.1007/s12026-021-09185-5. System. 32, 307311 (2022). Unauthorized use of these marks is strictly prohibited. Nat. Our hospital played a substantial role in both care for patients and vaccination efforts in Los Angeles during the initial phases of the COVID-19 pandemic. TODAYrecently interviewed Susan Cheng, MD, MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute, about recent study findings showing that heart attack deaths among young people, ABCNews.com recently interviewed infectious disease specialist Soniya Gandhi, MD, MPH, associate chief medical officer at Cedars-Sinai, to discuss the recent increase in norovirus cases and how to avoid getting sick. Syndrome POTS in rare cases can be associated with COVID vaccine, as It's not clear yet whether patients are developing POTS after COVID-19 for some reason above and beyond why any other infections trigger POTS, or whether it's just that we're seeing a lot. Before There does appear to be a small signal associating COVID-19 vaccines with POTS occurring after vaccine exposure within 90 days, Kwan told Dador. Sue. I tell you this not to deter you from getting the vaccine, but to advise you to work closely with your doctors before deciding. Ive had POTS for years. Furthermore, developing a screening pathway with genetic testing to identify at-risk individuals with a genetic predisposition toward post-vaccination adverse events is necessary, and would lead to a reduction in serious post-vaccination adverse events and promote public trust and vaccination compliance. "In our contemporary practice, we are seeing patients who have previously been infected with COVID-19 present with symptoms consistent with POTS," said Jonathan Hsu, MD, cardiologist at UC San Diego Health. Cardiologist came in and looked me over. This site complies with the HONcode standard for trustworthy health information: verify here. A study just published in December 2022 found that upon examining patients who developed long COVID-19, 39 percent of women met the criteria to be diagnosed with POTS, while only 7 percent of men . When I heard people describe what they were feeling, they sounded very much like my patients with POTS, says Tae Chung, a Johns Hopkins physiatrist with a joint appointment in the Johns Hopkins Department of Neurology and Neurosurgery, and director of the Johns Hopkins Postural Orthostatic Tachycardia Syndrome (POTS) Program. POTS patients- vaccine or no vaccine? | Page 2 | Mayo Clinic Connect Careers. sharing sensitive information, make sure youre on a federal For the vaccine part of the study, the investigators examined electronic medical records from 284,592 vaccinated individuals (mean age 52 years; 57% women). "What is the relation between COVID-19 vaccination and new POTS-related diagnoses?". He put me on 50 mg 2 times per day of Metoprolol and .1mg of fludrocortisone. Sanada Y, Azuma J, Hirano Y, Hasegawa Y, Yamamoto T. Cureus. Furthermore, the authors showed that the odds of new POTS-associated diagnoses following natural SARS-CoV-2 infection were more than five times higher compared to the post-vaccination period12. I apologize for the long post. The risks of POTS after COVID-19 vaccination and SARS-CoV-2 infection & S.C. The study by Kwan et al. I became very ill and no success in controlling the symptoms until the cardiologist at Mayo diagnosed me with POTS and instructed me on the changes I needed to make to get the symptoms to subside. COVID Long Haulers Illuminate Overlooked Medical Condition official website and that any information you provide is encrypted As such, some of the affected individuals may have recovered later. Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA, Dysautonomia Clinic, Williamsville, NY, USA, Department of Cardiology, Karolinska University Hospital, and Department of Medicine, Karolinska Institute, Stockholm, Sweden, You can also search for this author in My daughter had dizziness with first and second, in a delayed reaction that was probably inflammatory, but was okay with the third. 40, 8190 (2017). In the USA, the pre-pandemic prevalence of POTS has been estimated to be in the range of 500,0003,000,000 people, affecting predominantly women of reproductive age and roughly 1 in 100 teenagers3. Since the COVID-19 pandemic, there has been an increase in POTS diagnosis among patients. The Moderna and Pfizer BioNTech vaccines prevented COVID-19 infection in cancer patients, particularly in those whose treatment concluded more than six months before vaccination, say researchers at Stanford, Harvard and the VA. December 2, 2021 - By Krista Conger. Third, it reaffirms that POTS occurs at a high rate after SARS-CoV-2 infection and is likely one of the major phenotypes of PASC. A larger number of people, 9% to 61%, may have POTS-like. Stories about patients with persistent symptoms following infection with the coronavirus started surfacing in the news during the summer of 2020. Postural Orthostatic Tachycardia Syndrome (POTS) | Johns Hopkins Medicine JAMA. volume1,pages 11191120 (2022)Cite this article. Emergence of Post COVID-19 Vaccine Autoimmune Diseases | IDR Find out about the different types of COVID-19 vaccines, how they work, the possible side effects, and the benefits for you and your . Fedorowski, A. et al. My GP put me on Oomneprazole(sp?). After 20 hours I was not able to go from lying, sitting, standing. 2023 Jan 26;15(1):e34236. COVID-19 infection, vaccine linked to POTS heart disorder, study suggests By continuing to browse this site you agree to our use of cookies. Please enable it to take advantage of the complete set of features! Alan C. Kwan, Joseph E. Ebinger, Susan Cheng, Jlia Arany, Victor Bazan, Roger Villuendas, Tetsuya Akaishi, Tamotsu Onodera, Tadashi Ishii, Shigeru Shibata, Kazuo Kobayashi, Hiromi Rakugi, Anna Irene Vedel Srensen, Lampros Spiliopoulos, Anders Hviid, Hannah E. Davis, Lisa McCorkell, Eric J. Topol, Benjamin A. Satterfield, Deepak L. Bhatt & Bernard J. Gersh, Mateusz Soliski, Agnieszka Pawlak, Jan J. ebrowski, Nature Cardiovascular Research J. Intern. Initially, the team compared novel POTS-related diagnoses odds to the odds for myocarditis (benchmark event) and CPC (common primary care) diagnoses (referent events). The virus clearly seems to be affecting the autonomic nervous system, says Chung, and we are seeing it manifest in two scenarios.. Instead of getting eyerolls and no help they listened and tested. Postural orthostatic tachycardia syndrome (POTS) has been observed following SARS-CoV-2 infection. Although POTS was previously recognized as a condition that can develop after SARS-CoV-2 infection2, data on its potential development after vaccination have been scarce. Johns Hopkins researchers continue study into brain stimulation reinforced with repetitive learning strategies to increase motor function after stroke. They said I have a UTI and discharged me with an antibiotic. Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients. Accumulating all POTS-associated diagnoses in one group gave slightly lower odds. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). We are able to more definitively say that we think that this is a real observation, he said. The https:// ensures that you are connecting to the Called 911. Third, the generalizability of this report is limited to a specific population. A comparison of estimators from self-controlled case series, case-crossover design, and sequence symmetry analysis for pharmacoepidemiological studies. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Johns Hopkins Postural Orthostatic Tachycardia Syndrome (POTS) Program. The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical. Studies have reported POTS as a potential post-acute coronavirus disease 2019 sequela (PASC). This suggests that those with symptomatic COVID-19 infection were more likely to develop POTS in general, and that the risk of post-infection POTS is much higher than post-vaccination POTS in this cohort12. Comparing a 90-day period before exposure and a 90-day period after exposure, in fact, the probability of receiving a POTS-associated diagnosis was more than fivefold higher after a bout of COVID-19 than after vaccination (OR 5.35; 95% CI 5.05-5.68), according to researchers led by Alan Kwan, MD (Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA). doi: 10.7759/cureus.34236. A coordinator will follow up to see if Mayo Clinic is right for you. Probably had it for years but no dx. A case of transient POTS following COVID-19 vaccine. POTS, a debilitating heart condition, is linked to Covid and, to a POTS can cause a rapid increase in heartbeat, fainting, dizziness and fatigue. Si vous souhaitez personnaliser vos choix, cliquez sur Grer les paramtres de confidentialit. 1a). During these months I have had a Colonoscopy, Endoscopy, CT scans bloodwork, urinalysis, etc..Motegrity did not help nor did Nortriptyline. COVID-19 vaccine injured doctors are finally starting to speak upand Dev. Europace 19, 12111219 (2017). Among the post-SARS-CoV-2 vaccination cohort of 284,592 individuals, the average age was 52.0years, 57.0% were women, and 63% were Whites. For most of the conditions investigated, post-COVID-19 rates were greater than those observed post-SARS-CoV-2 vaccinations. volume1,pages 11321133 (2022)Cite this article. In the meantime, to ensure continued support, we are displaying the site without styles dvelopper et amliorer nos produits et services. Officials decided to keep the current rules in place until that date to give health care facilities and local public health agencies time to prepare for the change and adjust safety policies. 9, 43 (2020). Moderna said people without insurance will be able to get its COVID vaccine at no cost after the U.S. government . Second, it clearly demonstrates that POTS and POTS-associated comorbidities occur more frequently after COVID vaccination than before, and much more frequently than myocarditis, which, despite increasing at a higher rate after vaccination, remains a rare post-vaccination complication. Sorry, I misunderstood your concern. The range of symptoms reported looked much like the usual ones in VAERS. Epub 2022 Jul 26. However, they found that people diagnosed with COVID-19 are five times more likely to develop POTS after being infected than after getting vaccinated. Among SARS-CoV-2-infected individuals, the novel diagnoses odds and the corresponding occurrence rates showed increasing trends, especially for POTS, hypertension, and diabetes. Thus, there exists a biological probability of comparable systemic immune responses to COVID-19 vaccinations in comparison to those induced due to SARS-CoV-2 exposure. POTS is clinically diagnosed on the basis of orthostatic dizziness, pre-syncope, palpitations, and a table tilt test or 10.0-minute standing test demonstrating elevated heart rate when changing from a supine position to a standing position. But the condition isn't well understood, and many patients are dismissed as having anxiety, delaying diagnosis. POTS was more likely to be diagnosed than a collection of common primary care diagnoses (OR 1.10; 95% CI 1.03-1.17), although there was a stronger association between vaccination and myocarditis (OR 2.57; 95% CI 1.02-6.77). Consequently, POTS and POTS-associated conditions may be among the most common adverse events after COVID-19 vaccination. Slider with three articles shown per slide. You are using a browser version with limited support for CSS. I have now lost 18 pounds since January. Rev. Prominent symptoms include a rapid increase in the heartbeat of more than 30 beats per minute, or a heart rate that exceeds 120 beats per minute, within 10 minutes of standing. Chen, G. et al. The odds of developing POTS-related diagnoses after vaccination compared with before vaccination was 1.33 (1.251.41), and the odds ratio of post-vaccine POTS-related versus non-POTS-related diagnoses was 1.10 (1.031.17). Some researchers believe that coronavirus can be a trigger for POTS, as an increased number of people who recovered from COVID-19 are now experiencing POTS-like symptoms, such as brain fog, tachycardia (increased heart rate) and severe chronic fatigue. In 17 of the cases, a COVID-19 vaccine caused myocarditis, a form of heart inflammation, pericarditis, a related condition, or both. The authors declare no competing interests. POTS is a common condition affecting an estimated one to three million Americans. COVID-19 Vaccine FAQs | Cleveland Clinic Prospective evaluation of autonomic dysfunction in post-acute sequela of COVID-19. The study has some limitations. Kokorelis C, Malone L, Byrne K, Morrow A, Rowe PC. Thank you for visiting nature.com. SARS-CoV-2 vaccinations elicit immune responses to the SARS-CoV-2 S (spike) glycoprotein. shows that anti-SARS-CoV-2 vaccination can increase the incidence of POTS, although at a much lower frequency than the viral infection itself, and indicates the need to study the link between this dysfunction of the autonomic nervous system and the SARS-CoV-2 spike protein. Elvira Forte, Associate Editor, Nature Cardiovascular Research. 'Given that COVID-19 vaccination elicits an immunological response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein, there is biological plausibility for a similar, even if attenuated, systemic response to vaccine when compared to that seen from viral exposure.'Researchers 'evaluated the relation between COVID-19 vaccination and new POTS-related diagnoses . The likelihood of getting diagnosed with postural orthostatic tachycardia syndrome (POTS) increases after both COVID-19 and vaccination against SARS-CoV-2 infection, although COVID-19 itself poses a greater risk, observational data suggest. Since April 2021, some people have developed myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining outside the heart) after receiving the Pfizer-BioNTech or Moderna coronavirus vaccines in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). Similar findings were observed after repeating the analysis and considering the second vaccination as the index vaccination. I appreciate reading this. Additionally, POTS odds (1.3, n=4,526) were higher than. Bisaccia, G. et al. Vaccination Still Best Option for Protection, Asked about potential mechanisms to explain the findings, Kwan said POTS is typically thought of as an issue with the autonomic nervous system, which maybe damaged by COVID-19. The primary outcomes were the diagnosis-specific odds of a new diagnosis occurring post-exposure vs. pre-exposure and the odds of acquiring a post-exposure new POTS diagnosis vs. a new CPC diagnosis. Postural orthostatic tachycardia syndrome (POTS) is an impaction of the autonomic nervous system initiating orthostatic tachycardia. (2023) Efficacy of first dose of covid-19 vaccine versus no vaccination on symptoms of patients with long covid: target trial emulation based on ComPaRe e-cohort. We found that most POTS-related diagnoses increased after COVID-19 vaccination to a greater degree than non-POTS-related diagnoses (Fig. Cardiovasc. People could self-report pre-existing conditions when getting the vaccine or making a VAERS report, but it is not required in VAERS. Clin Auton Res. As COVID-19 vaccines will continue to be necessary for the foreseeable future, pharmacovigilance regarding off-target effects will improve our ability to engage patients in a balanced discussion on the relative benefits versus the risks of vaccination. Blitshteyn, S. Eur. The study, published online Monday in Nature Cardiovascular Research, expands on sporadic reports of POTS occurring after COVID-19 vaccination by addressing the issue in a large cohort, Kwan told TCTMD. Blitshteyn, S. & Whitelaw, S. Immunol. Takeuchi, Y., Shinozaki, T. & Matsuyama, Y. Evaluating and Caring for Patients with Post-COVID Conditions: Interim Guidance. A life-changing condition called POTS, which can cause fainting, irregular heartbeats and dizziness, particularly among young women, appears to be on the rise as a result of the coronavirus pandemic. Key Takeaways. Came back the next day and said I might have POTS. The authors declare that they have no conflict of interest. I did have stones. Kwan said his team was inspired to delve into POTS as a possible side effect based on anecdotal reports coming out of the specialized clinic at Cedars-Sinai that had been set up to manage the condition before the pandemic. TCTMD is produced by the Cardiovascular Research Foundation (CRF). Methodol. Hi Ali - I looked and I looked - and I failed. I have only had 1 brief flare up. Once diagnosed, many patients face . Most (62%) received the shot from Pfizer/BioNTech, 31% the one from Moderna, 7% the Janssen vaccine from Johnson & Johnson, and less than 0.1% a mix of other shots. Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients Immunol Res. Overall, the study findings showed a probable association between POTS incidence and SARS-CoV-2 vaccinations, with a 5.4-fold greater incidence of POTS post-COVID-19 than that post-SARS-CoV-2 vaccination. b, Post-infection odds by diagnosis in all patients. Article government site. Interested in more discussions like this? 8, 156 (2021). CV Risk Factors or Preexisting CVD: Whats Worse for COVID-19? PubMedGoogle Scholar. I looked and I looked and I failed. Large Cohort Study Finds Possible Association Between Postural Orthostatic Tachycardia Syndrome and COVID-19 Vaccination but Far Stronger Link With SARS-CoV-2 Infection. Researchers analyzed data on nearly 300,000 patients from the Cedars-Sinai Health System in Los Angeles County from 2020 to 2022 who had either received at least one dose of a Covid vaccine. The risks of POTS after COVID-19 vaccination and SARS-CoV-2 infection: its worth a shot. Enter the email you used to register to reset your password. Thank you in advance! Similarly, mechanistic studies investigating POTS following SARS-CoV-2 infection and COVID-19 vaccination are needed to determine causation and delineate the underlying immune-mediated mechanism, possibly involving the spike protein and/or formation of autoantibodies to G-protein-coupled receptors and other targets in the cardiovascular system and beyond13. Disclaimer. Dr.Kerryn Phelps is the former President of the Australian Medical Association (AMA). on this website is designed to support, not to replace the relationship Kwan and colleagues observed, from a large health organization clinical database, a potential increase in the incidence of POTS following COVID-19 vaccination. Join our newsletter! I will look further to see if there is a way to tease this out of the VAERS data. Federal government websites often end in .gov or .mil. Thus, we examined the extent to which new diagnoses of POTS are increased following COVID-19 vaccination in our health system, a large quaternary care system in Los Angeles. Si vous ne souhaitez pas que nos partenaires et nousmmes utilisions des cookies et vos donnes personnelles pour ces motifs supplmentaires, cliquez sur Refuser tout. Moderna announced a free COVID vaccine program. But will that be First, the accuracy of POTS and POTS-associated diagnoses is crucial for study validity. Patients with postural orthostatic tachycardia syndrome, a disorder of the autonomic nervous system, can experience a rapid heart beat, fainting and dizziness. Internet Explorer). Further research is required to investigate post-SARS-CoV-2 vaccination POTS etiology and incidence. Despite these limitations, the study by Kwan et al.12 is of major importance to POTS research and patient care for several reasons. For COVID-19-vaccinated individuals, POTS odds were higher 90days post-vaccination compared to those 90days prior to vaccination. Some COVID Long Haulers Are Being Diagnosed With POTS - Verywell Health BMJ Medicine . Clustered bootstrapping yielded similar OR values. Twenty-nine (93.5%), one (3.2%), and one (3.2%) received Pfizer, Moderna, and Oxford vaccines, respectively. ABC 7: Syndrome POTS in Rare Cases Can Be Associated With COVID Vaccine Patients with lymphoid malignancies have impaired humoral immunity caused by the disease itself and its treatment, placing them at risk for severe coronavirus disease-19 (COVID-19) and reduced response to vaccination. Quantitative sudomotor axon reflex test revealed normal response in the forearm ( A, MeSH March 2022 Gallbladder removed, heart rate increasing, still have GI issues. Never got vaccinated. The 90 day mark post vaccine was a nightmare. End of August, went to ER with continuing upper GI problems. We recognized that pharmaco-epidemiology studies had previously used self-controlled designs, wherein patients serve as their own control3. Kwan, the first and corresponding author of the study, told ABC 7 news reporter Denise Dador that in reviewing patient health records, he and his team found that a small percentage of patients who received the COVID-19 vaccine experienced POTS. What is the relation between COVID-19 vaccination and new POTS-related POTS - postural orthostatic tachycardia syndrome | Iowa Hawkeyes fan What is the relation between COVID-19 vaccination and new POTS-related diagnoses?. New POTS diagnoses within 90days of exposure were identified based on the international classification of diseases (ICD)-9,10 codes or phecode grouping and expressed as a rate per 100,000 exposures. 17, e52 (2010). He got his start in journalism at. The .gov means its official. POTS spiked during COVID-19, and patients could wait years to see a Vaccines represent one of the most groundbreaking scientific advances that substantially reduced the mortality and morbidity associated with various infectious pathogens. ; Consider enrolling hospitals designated by the Centers for Medicare & Medicaid Services (CMS) as Disproportionate Share Hospitals (DSH) external icon . My daughter and I both have autoimmune conditions: I have lupus. POTS, a common disorder of the autonomic nervous system, is characterized by an increase in heart rate of at least 30 beats per minute within 10 minutes of standing and symptoms of orthostatic. POTS and COVID-19 Heart damage, myocarditis, and heart failure have been some of the most crippling outcomes of severe COVID-19 infections. COVID-19 and POTS: Is There a Link? | Johns Hopkins Medicine with these terms and conditions. https://doi.org/10.1038/s44161-022-00194-7, DOI: https://doi.org/10.1038/s44161-022-00194-7. The probability says this will help protect you and those around you, Kwan said. Johns Hopkins' medical concierge services offer complimentary assistance with appointments and travel planning. Internet Explorer). Nat Cardiovasc Res 1, 11321133 (2022). Blitshteyn, S. et al. Further studies are also necessary to understand the pathophysiology underlying both POTS occurring after vaccine and POTS occurring after infection. In a recent study published in Nature Cardiovascular Research, researchers assessed the association between POTS (postural orthostatic tachycardia syndrome) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and coronavirus disease 2019 (COVID-19) vaccinations. Ali I was teaching someone else to use the VAERS reports, and I found the information you were seeking. Connect with thousands of patients and caregivers for support and answers. mesurer votre utilisation de nos sites et applications. The investigators found that the risk of developing POTS after vaccination is less than five cases per million doses. The prevalence of POTS was documented in an international survey of 3,762 long-covid patients, leading researchers to conclude that all covid patients who have rapid heartbeat, dizziness, brain . Therefore, deriving precise estimates of risk per exposure is difficult, and follow-up studies are needed to determine the absolute risk of POTS after vaccination. April 2022 kidney stones removed. Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-Cov-2 Infection, Inappropriate sinus tachycardia in post-COVID-19 syndrome, Reports of acute adverse events in mRNA COVID-19 vaccine recipients after the first and second doses in Japan, COVID-19 pandemic and hypertension: an updated report from the Japanese Society of Hypertension project team on COVID-19, Long COVID: major findings, mechanisms and recommendations, Cardiac involvement in the long-term implications of COVID-19, Understanding the role of nACE2 in neurogenic hypertension among COVID-19 patients, Heart rate variability comparison between young males after 46weeks from the end of SARS-CoV-2 infection and controls, Seroconversion dynamic and SARS-CoV-2 seropositivity in unvaccinated population during the first and second outbreaks in Mexico, https://doi.org/10.1038/s44161-022-00177-8. Cardiovasc. If we can understand the relationship between COVID-19 and POTS, it will also help us understand the cause of POTS.. Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-CoV-2 COVID infection. Hello, I have been advised that those of us with POTS can have autoimmune reactions to the COVID vaccines. For new POTS diagnoses post-COVID-19, 12,460 SARS-CoV-2-infected individuals were analyzed, with an average age of 47.0years, of which 50% were women and 54% were Whites. Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-Cov-2 Infection, Inappropriate sinus tachycardia in post-COVID-19 syndrome, Reports of acute adverse events in mRNA COVID-19 vaccine recipients after the first and second doses in Japan, COVID-19 pandemic and hypertension: an updated report from the Japanese Society of Hypertension project team on COVID-19, A nationwide questionnaire study of post-acute symptoms and health problems after SARS-CoV-2 infection in Denmark, Long COVID: major findings, mechanisms and recommendations, Long-term neurologic outcomes of COVID-19, Cardiac involvement in the long-term implications of COVID-19, Heart rate variability comparison between young males after 46weeks from the end of SARS-CoV-2 infection and controls, https://doi.org/10.1038/s44161-022-00177-8. It doesnt quite bring it to the point of being able to tell an individual patient, This is what your specific odds of POTS are after a vaccination, but we believe this essentially brings some validity to the observation that POTS may occur after vaccination, though notably at a significantly lower rate than after [COVID-19 itself].. The main analysis was repeated with the second vaccine dose as the index study exposure and using cluster bootstrapping. Covid-19 vaccination can curb the effect of long COVID on patients

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