Coronavirus news & views

The Virus Came From Wuhan Lab DOE Now Says…..Sort Of

 “Where’s the beef?” Clara Peller in a 1984 Wendy’s commercial

So, the world has been abuzz since the Department of Energy recently reported that it decided, albeit with low confidence, that the SARS-CoV-2 virus might have leaked by accident from the virology lab in Wuhan. Across cable television and the internet, including sources such as Fox, Breitbart, Joe Rogan, gossip lines, et al., are full of “I knew it all along,” and “I told you so’s.” Never have so many virology experts suddenly been spawned on Facebook. And most of them could not tell you whether a coronavirus is an RNA or DNA virus, let alone the difference between RNA and DNA.

But let’s slow down a bit. Have you even wondered why the Department of Energy is releasing an assessment about a virus? And did you wonder what data they based their assessment on? I did and I explain it here. What I learned tells a much more complete, and less compelling story than what most of the priests of the press, Junior virologists, and other rumor mongers have reported. What has been reported has been woefully inadequate and vastly misleading.

The DOE report was based on intelligence data that remains classified, and is not a science report. Apparently intel spooks weigh science information much differently than scientists do, and often put less credibility in published science because the information usually does not come from “trusted” sources that an spook has history with (their version of "peer review" I guess). The US intelligence community is distributed between 18 agencies, including Energy, State, Treasury, and others including, of course, the CIA, FBI, and DOD. Eight of these entities have been involved in reviewing the COVID-origins issue.

In 2121, the Energy Department, which oversees 17 national laboratories, several of which study SARS-CoV-2 and its origins, reported it was undecided on how the virus emerged. What caused DOE to recently change their assessment is not known. They are not releasing the classified data. Therefore, their information appears not to be scientific data, which is usually published. Four other unnamed agencies, along with a national intelligence panel, still judge that the virus was likely the result of a natural transmission from an animal to humans, and two other agencies are undecided. Only the FBI agrees with DOE in thinking that the virus leaked from the lab. Notably, the CIA also remains undecided. In other words, the DOE’s opinion is a minority opinion of low confidence in the intel community. It is hardly worth all the breathless excitement it elicited from Tucker Carlson and other bloviators who now dishonestly insinuate that it has now been proven the virus came from the lab. That is far from decided.  

The intel community’s definition of low confidence intelligence is “that the information’s credibility and/or plausibility is uncertain, that the information is too fragmented or poorly corroborated to make solid analytical inferences, or that reliability of the sources is questionable.”  Someone should send that to Tucker.

The origin of the virus has been actively investigated over the last couple of years and your sometimes humble correspondent has reported previously on those investigations in these pages (it is worth reading for background). These blog posts have favored the natural origin of the virus, because that is what the preponderance of data have suggested. There have been no published data supporting a lab leak hypothesis. None. Also, recent science reports in top-flight science journals continue to conclude that the virus had a natural origin. A paper just published in 2023 in Cell reported that SARS-CoV-2 is the ninth known coronavirus to have jumped from an animal into humans. Two earlier reports in Science, and also summarized in these pages last March, agreed that the virus originated in the Wuhan wet market not just once, but twice. These studies included genetic evidence and epidemiological tracing showing that the early cases of COVID all centered around the Wuhan wet market and not around the lab eight miles away.

Furthermore, back in 2020, I also wrote a summary of how the earliest events of the pandemic unfolded. Here is a synopsis of the first few days: On December 31, 2019, Chinese officials informed the WHO about a cluster of 41 patients with a mysterious pneumonia in the city of Wuhan associated with a new coronavirus. Then, in the middle of that night a Chinese CDC team from Beijing arrived and collected 585 “environment” samples from a garbage truck, drains and sewers in the wet market. Thirty-three of the samples tested positive for the new coronavirus. Fourteen of the positive samples were from the area of the market where wildlife was traded. At the same time, Wuhan officials quietly began disinfecting the market, and it was closed.

It is interesting that the immediate focus was on the market and not the lab.

Keep in mind that we have very many examples of viruses, including several other coronaviruses similar to SARS-CoV-2, spontaneously passing from animals to cause disease in humans. This includes the first example of SARS-CoV-1 that came from a food market in China in 2002, and then MERS, which passed from a camel to humans. It was natural for medical scientists to first think that SARS-CoV-2 arose similarly. So far, the evidence is not convincing that it did not. The fact that we have not yet convincingly identified an animal source for the virus is not surprising. It took 30 years to establish the source of the HIV virus, and we still do not know the source of the Ebola virus.

So far, despite the very weak statement from the DOE, the preponderance of data still favors a natural origin of the virus, not a lab origin. But, that still is far from definitive. That “preponderance” of evidence, can change in a hurry with new data. Therefore, it remains worth further investigation. But until the Chinese government allows outside scientists to review lab data books and interview scientists from the Wuhan labs, the investigation will proceed with one hand tied behind its back. It remains remotely possible that an animal carrying the ancestral coronavirus will be caught confirming that it did come from an animal. Yet, even if we did find an animal source for the virus, it may not tell us about the path it took to get into humans. We might never know that to the delight of the conspiracy nuts and fabulists out there who have never weaned off the teat of fantasy.

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Pandemic History: Long COVID

"We learn from history that we learn nothing from history."
--George Bernard Shaw

Let’s hope GBS is wrong about what we learn from the recent pandemic. As it recedes in our rear view mirrors, scientists are looking to all the data and information collected to retrospectively see what we learned about this new virus and disease. This is especially true for that totally unexpected disease phenomenon called “long-COVID.” As we became aware that some COVID survivors continued to suffer from a strange constellation of symptoms, referred to as long COVID, I wrote in these pages about what that affliction entailed, and what we were seeing and discovering about it. You can find several other blog posts on that topic by looking under “long COVID” in the "Categories" listed to the side of this post.

Long COVID was particularly difficult to study since, by definition, it lasts months, maybe even years in some people. That means that discerning how it manifests itself, and how to effectively treat it would take months to flesh out. We have gleaned a bit about that and also have identified areas we need to look at more closely in order to fully understand this part of the disease.

A Scottish study of about 100,000 participants began while the pandemic fulminated, and the results of that study are just being released. The study helps clarify how to diagnose long COVID, which earlier had vexed physicians who had no idea what they were looking at. Long COVID presented doctors with a hodge-podge of seemingly unrelated symptoms—was it a single disease? Different disease manifestations? Psychosomatic? What it then was was a head scratcher. The Scottish study helps confirm that it is a real COVID-associated problem, and the most common symptoms include breathlessness, palpitations, chest pain and “brain fog” or reduced mental acuity. We also learn from the study that the risks of acquiring long COVID is greater in women, older people and economically disadvantaged people. Also, people already dealing with other physical and mental health problems, such as respiratory problems or, surprisingly, depression, are more prone to long COVID. Why is that? The study also found that 1 in 20 people had not recovered up to 18 months after coming down with COVID. It also reported that people with asymptomatic infections were unlikely to suffer long-term effects, which helped confirm what we expected, that it probably is not the virus that causes long COVID, but the culprit is some people’s immune response to the virus. Who are those people susceptible to long COVID, and what is different about their immune response? It also seems that vaccination protects a bit against long COVID, but not as much as previously thought. But, this observation complicates things. The vaccine is designed to stimulate an anti-virus immune response without the risk attendant to an infection. Why doesn't this immune response cause long COVID symptoms like the immune response to the actual infection? Basically, how it all works still is not well known, but that bit of new information scientists are gleaming from the data moves us gradually closer to finding out.

Looking at other data collected since the pandemic reared its ugly head, the WHO estimates that about 10-20% of COVID survivors have lasting symptoms that reduce their quality of life to varying degrees.

The Washington Post reports that somewhere between 7-23 million Americans currently suffer from long COVID. One million of these are unable to work. People are not dying from long COVID, but they often are considerably impaired and that makes them heavy consumers of expensive medical care, and often unable to work at full capacity, which adds to the personal and social costs of the chronic complication.

Anthony Fauci, in an interview with The Guardian, cautions that even though COVID deaths and hospitalizations are declining, it is premature to declare victory over COVID since we continue to deal with the insidious chronic sequelae of the disease. Furthermore, all indications suggest that COVID will be a recurring problem for the world and as it regularly sweeps across the globe, it will continue to create new cases of long COVID. This means that we still need to remain vigilant to avoid the virus when possible, and to make sure that vaccinations are effective and available to the population. Other therapies continue to be explored, but, unlike, antibiotics that fight bacteria, safe anti-viral drugs are very hard to develop because they often come with too extreme side effects.

Continued research into the virus and disease by medical scientists, and further examination of the pandemic history by epidemiologists hopefully will lead to a better understanding of the causes of long COVID, how to more definitively diagnose it, and ultimately how to effectively treat, or even prevent it. Toward these ends, Fauci’s National Institute of Allergy and Infectious Diseases recently launched a $1.15 billion initiative to achieve these goals. The CDC also recently began its own major study of the problem.

Stay tuned for changes in how we deal with the virus and with long COVID as we learn more about it. That is how science works.

COVID More Deadly Than Flu For Kids

In the US, nearly six times more kids and teens died from COVID in one year than did from the flu, according to a new analysis of pediatric mortality data. According to CDC data, childhood flu deaths have ranged from 39 to 199 per year since 2004. Meanwhile, in 2021 alone, more than 600 children died from Covid-19, according to an analysis done by researchers at the Harvard University Medical School and at Brigham and Women’s Hospital in Boston.  The analysis used data from the CDC to compare COVID deaths during the pandemic to flu deaths over the last decade (see figure below).

Of the known respiratory viruses, only CoV-2 has ever killed more than 100 US kids in a single month since the middle of the 20^th century. Much of that is because we have long had vaccines for other viruses that cause human respiratory disease, but have yet to widely vaccinate children against COVID-19. Hopefully, new vaccines will also render COVID less deadly for kids like vaccines have done for several other respiratory diseases.

Throughout the pandemic, some have argued that COVID poses little health risk to kids aside from a few days of sniffles. Though kids often experience less-severe symptoms than adults, COVID is still a very real risk. An estimated half a million kids now deal with long COVID, a number that experts say is likely an undercount because its myriad symptoms make it tricky to diagnose.

Masks Redux

"You’ve got to be very careful if you don’t know where you are going, because you might not get there."

—Yogi Berra

As cases of COVID-19 ascend in areas of the US, some schools are reverting to requiring masks. Of course this is accompanied by renewed claims that they are ineffective. In fact, Florida governor Ron DeSantis issued an executive order barring local school districts from requiring their students to wear masks, claiming that there was no evidence that masks prevent infection in schools. That claim has been levied over and over by many politicians, talking heads, pundits, and assorted Facebook “experts.” But, they are flat wrong. There are multiple lines of evidence from a variety of disciplines—including materials science, infectious diseases, pediatrics and epidemiology—showing that masks can help protect children and teachers from getting COVID in schools. Some of that evidence has already been presented in these pages, and I now add to that body of evidence, more  data recently summarized in Scientific American.

1. For starters, laboratory experiments show that masks block the respiratory droplets and aerosols that transmit SARS-CoV-2, the virus that causes COVID. In one test, an engineering team at the University of Wisconsin–Madison used a machine in a classroom setting to pump out particles the same size as those that carry the virus from an infected person. The researchers placed several CPR dummies with or without masks around the room and measured the degree to which the aerosols penetrated the masks. They reported that a surgical mask reduced the chances of penetration by 382 times when compared to the maskless mannequins.
2. Then, in the real world, not a laboratory setting, several epidemiological studies also concluded that masks in schools work. Researchers at the ABC Science Collaborative in North Carolina collected data from more than a million K–12 students and staff members from schools across that state, which mandated masking in schools from August 2020 until July 2021. The scientists reported little in-school transmission when the mask mandates were in place during the fall, winter or summer months. During this time, in-school transmission remained low as COVID cases fluctuated outside the schools. With mask mandates, rates of within-school spread were as low as one percent.
3. Masks, combined with other prevention efforts, also reduce the risk that students might bring home the virus to parents or other relatives. An online survey of 2.1 million Americans by researchers at Johns Hopkins University showed a 38 percent increased risk of COVID-related illness in households with a child attending school in person. That risk went down, however, as the number of school-based mitigation measures, including mask mandates went up.
4. Studies done in wider communities beyond schools give the strongest real-world evidence that masks stop COVID’s spread. An international team of researchers conducted a randomized controlled trial involving nearly 350,000 people across 600 villages in rural Bangladesh. Half of the villages got free cloth or surgical masks and a promotional campaign encouraging their use. The other half did not. The researchers found that the mask intervention significantly curbed coronavirus transmission.

Bottom line:  The effectiveness of masks in schools is supported by many different studies and analyses that show similar results. There are more than a dozen studies beyond those cited here, that all point to the same conclusion:

Masks work.

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What Happened To The Flu And Other Respiratory Diseases?

A NYC based travel blogger who travels a lot used to get a respiratory infection whenever she flew. That stopped when the airline mask mandates went into effect. The mandates, of course, were designed to hinder the spread of the CoV-2 virus that causes COVID, but it makes sense that if masks and other physical (that is, non-medical) mandates worked to mitigate COVID, then we would see a decrease in other contagious respiratory diseases after the mandates were, well…mandated.

We did.

The mandates worked, despite persistent claims of some to the contrary. This particular blog subject was stimulated by a radio talk show where a couple of nonscientist talking heads announced that there was no scientific proof that the masks or other mandates prevented disease. I previously posted in these pages evidence that masks, in particular, do indeed work to retard the spread of disease (see here, here, here, and here). In this post, I present further data on how the mandates significantly reduced the incidence of other infectious respiratory diseases around the world. If the measures can reduce flu, then you can bet that they also reduced COVID-19.

Note, however, that this is not necessarily an endorsement for returning to the measures. Your humble scribe didn’t much like his glasses fogging up, or having to make two trips from the car to the store because he forgot his mask. But, let’s argue the issue based on its merits and not from false premises based on incorrect claims.

After South Korea implemented various hygiene and social distancing measures in response to COVID, they saw the 2019-20 flu season end an astounding 12 weeks earlier than the previous year. Epidemiological surveillance data bolstered by clinical diagnostic testing showed that infection from several different pathogenic respiratory viruses (including adenovirus, bocavirus, metapneumovirus, rhinovirus, flu, parainfluenza, and respiratory syncytial virus) dropped to nearly 0% just five weeks into 2020!

In the United States, the incidence of infection by influenza, respiratory adenovirus, rhinovirus, enterovirus, RSV, non-COVID coronaviruses, metapneumovirus, and parainfluenza viruses all decreased in March 2020, soon after implementation of mandates. Similar results were seen in Japan.

More dramatically, since pandemic mitigation measures were put in place, there has been a 99% global reduction of infections from both influenza types A and B compared to prior years. In particular, one of two flu B substrains has not been isolated in the world since August 2021 suggesting that this variant is now extinct. The overall genetic diversity of influenza viruses has also dramatically diminished indicating that other flu sub-types (or clades) have disappeared around the world since the pandemic mandates were put in place.

And this reduction of respiratory infectious disease does not only hold for those caused by viruses. Another study looked at surveillance data from 26 countries across 6 continents for several bacterial diseases caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, which are typically transmitted via respiratory droplets. Numbers of weekly cases in 2020 were compared with corresponding data for 2018 and 2019. Data for disease due to Streptococcus agalactiae, a non-respiratory pathogen, were also collected from nine laboratories for comparison. All countries experienced a significant and sustained reduction in respiratory bacterial diseases in early 2020 (Jan 1 to May 31), coinciding with the introduction of non-medical COVID containment measures in each country. By contrast, the incidence of disease due to S agalactiae (which is not transmitted by the respiratory route) did not differ significantly from the 2 previous years.

Clearly, the mandates significantly reduced the incidence of respiratory infections by non-COVID viruses and bacteria. They worked. So, why did we still have COVID infections after the mandates went into place? The mandates reduced, not eliminated these diseases, so infections still happened. Since we did not have historical COVID infection data from previous years to compare with, the effects of the current mandates on the incidence of COVID are not as clear cut as they are with other diseases for which we do have historical data for comparison. But, as I wrote before (see above), it is clear that places in the US and around the world that used masks and other protective measures saw reduced incidence of COVID compared to similar places that did not.

Bottom line: The studies mentioned here regarding non-COVID infectious diseases fully support data previously posted in these pages that the mandates, including masks, are effective non-medical tools for controlling infectious respiratory diseases.

Don’t let anyone tell you differently.

A Single Gene Doubles Risk Of COVID Death

“Nothing shocks me. I’m a scientist.” —Indiana Jones

British scientists recently identified an allele, or a version of a gene, that portends lung failure and death in COVID-19 patients. Research recently published in the journal Nature Genetics, found that a poorly studied gene expressed in lungs, designated LZTFL1, has a variant form that does not differ in its coding sequence. That is, the different alleles of the gene express the same protein sequence. They do differ, however, in their non-coding sequences that regulate expression of the gene. When expressed, the gene product prevents cells lining airways and the lungs from responding properly to the CoV-2 virus. The lining of the lung essentially transforms into less specialized cells which affects their normal function.

Previous work had identified a stretch of DNA on human chromosome 3 that doubled the risk of death from COVID. Using an artificial intelligence algorithm to analyze millions of genetic sequences from hundreds of cell types from all parts of the body, the Oxford University Howard Hughes research team honed in on the lung-specific genetic off-on switch. This is another example of what I previously labeled "BioX," the new frontier of bioscience, or post-molecular biology science.

Importantly, the variant allele that augurs a worse lung response to infection does not affect the immune system. Therefore, the it is probable that vaccination remains the best way to protect these at-risk patients. Finding this new allele could also lead to novel therapies to target the pathway affected by this genetic variant to provide targeted treatment for at-risk populations.

The troublesome variant is mostly found in people of South Asian ancestry—some 60% of whom carry the allele—which partly explains the severe devastation from COVID seen in the Indian subcontinent. In contrast, 15% of those with European ancestry and 2% of Afro-Caribbean people carry the risky allele.

It will be interesting to see if this lung-specific gene also affects the course of other respiratory infectious diseases.

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Lingering Post-COVID Vascular Risks

George Burns once opined that “the secret of a good sermon is to have a good beginning and a good ending; and to have the two as close together as possible.” The same might be said for blogs. If so, this is a pretty good blog post.

We have known for some time that patients with COVID-19 are at risk for dangerous blood clots (also called deep vein thrombosis, or DVT), pulmonary embolism, and bleeding. Findings reported this month in the British Medical Journal reveal that this risk continues several months after COVID recovery.

The study compared more than one million people in Sweden who had COVID-19 to a control group of more than 4 million people who did not. The overall risks for each problem were low, but still elevated for up to six months following COVID. According to the report, DVT occurred in 0.04% of patients who had had COVID and in just 0.01% of control patients during the same time. Pulmonary embolism occurred in 0.17% of post-COVID patients and in 0.004% of control patients. And bleeding events occurred in 0.10% of patients who had recovered from COVID, while only 0.04% of control patients had such a problem.

While the risks of blood clots and bleeding were highest in patients whose COVID had been more severe, those who had had mild COVID still showed an elevated risk.

Bottom line: You are not out of the woods after you recover from COVID. Significant problems can arise a few months later.

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Still More Evidence For An Animal Origin Of The Virus

Conspiracy buffs won’t like this, but compelling new evidence presented in three papers, which include photographic and DNA data, has pretty much nailed down the origin of the SARS-CoV-2 virus. It began in a wet market animal not in the lab eight miles away as the conspiracists have conjectured. This new data comes from an international team of scientists which concluded that the coronavirus twice jumped from  caged wild animals into people at the Huanan Seafood Wholesale Market in Wuhan. These data correlate nicely with previous geo-epidemiological data showing the market, not the lab, to be the infection nidus with later infections radiating out from there.

Despite the Chinese’s government denial that live animals were sold in the Wuhan market, the new studies provide photographic evidence of wild animals sitting in stacked cages in the market in late 2019, in or near stalls where scientists found SARS-CoV-2 virus on a number of surfaces, including on cages, carts and machines that process animals after they are slaughtered at the market. This, along with a new genetic analysis pinpoints a specific stall at the market where the virus passed from an animal into people. These data also estimate the time when not just one but two zoonotic spillovers occurred, once in late November or early December and then again few weeks later. This coincides almost exactly with the timing of the outbreak of disease at and around the market.

The two initial infection events involved slightly different versions of the SARS-CoV-2 virus. The fact that they were related is evidence that the virus had spread and mutated in animals in the market before it infected humans.

A leader of two of the studies was U of Arizona professor, Michael Worobey, a viral pandemic sleuth who has been at the forefront of the search for the origins of the bug responsible for the current pandemic. His lead in the research is significant since, back in May, 2021, Worobey, along with 17 other scientists, called for investigation into the lab-leak theory. His latest research overturned that conjecture. This new evidence adds to previous evidence for an animal/market origin of the virus presented earlier in these pages here and here.

Final thought. It is sobering to think how these two simple infection events that occurred in November and December of 2019 in a Chinese market triggered something that has now caused six million deaths and untold misery around the world. And it is not finished with us.

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Another Unexpected Pandemic Consequence: Undiagnosed Cancer

In these pages, your humble bloggeur (that would be me) has written about several unusual consequences of the COVID-19 pandemic. Most of these were on the ironically funny side, such as farmed fish being too large for restaurant plates, rattlesnakes climbing in plane landing gears, and the ketchup packet shortage. But, not all of these odd aftermaths of the pandemic are humorous. The topic of this post is very unfunny.

It seems that as healthcare providers were swamped with COVID cases, or were at reduced capacity because staff became ill, or because service slowed in order to prevent CoV-2 spread, many people have missed routine medical care for non-COVID problems. It is feared that this will create a crisis in coming years involving increased diagnosis of cancers that were caught later than usual. As we deal with the fourth wave of COVID-19 caused by the Omicron variant, we are learning that the pandemic dramatically disrupted routine health screenings for cancer and other chronic diseases. Some now predict that the next crisis that could overwhelm the US health system will be a surge in advanced chronic diseases like cancer that went undiagnosed and untreated for too long.

Screenings for several major cancers and new cancer diagnoses fell significantly during 2020, according to a study published in December 2021 in the journal Cancer. This was not because there was less cancer in the world. It was because fewer patients were seeing their doctors.

A co-author of the Cancer study, and who is a professor at the University of Maryland School of Medicine, said that we have never before seen screening rates drop so dramatically in such a short time.

In one case, a Hispanic man in his 40s first noticed rectal bleeding in early 2020 that his doctor said was probably due to hemorrhoids. The man was unable to get a timely colonoscopy to rule out cancer because the local hospitals were overwhelmed with COVID-19 patients, and he also feared catching COVID if he went to a hospital swamped with COVID patients. Eighteen months later, he finally got a colonoscopy, which revealed advanced rectal cancer. Those 18 months likely were the difference between being cured by a simple polyp removal vs dealing with a cancer that had metastasized throughout his body.

At this point, nobody knows how many cases like this are out there. We will find out.  

This patient, as thousands of others like him, had the misfortune to notice symptoms that needed followup amid the biggest disruption of medical care in US history. In 2020, while hospitals curtailed services in order to prepare for the COVID surge, the number of colonoscopies plummeted 93 percent. By the end of the year, there had been 133,231 fewer colonoscopies performed compared to 2019. There also were 62,793 fewer chest CT scans, 49,334 fewer fecal blood tests, and prostate biopsies dropped 25%.

This drop in screenings has created a huge backlog that will take months to clear. A gastroenterologist at a small community hospital in the Middle-of-No-Where, Kansas was recruited by a larger hospital in Kansas City to do nothing but colonoscopies from 7 in the morning to “whenever at night.” They had a backlog of 1000 patients—a certain percentage of whom have cancer already growing in their colons while waiting to be told they had colon cancer. And that backlog begets a fresh one of new patients who also need to be scoped because they just noticed something like rectal bleeding, but will have to wait for those who have already been waiting.

This backlog creates a subtle form of medical rationing. It forces doctors to make hard choices about which patients to prioritize. "Lucky" are the serious patients who are moved to the head of the line. Not so lucky are those whose colonoscopies or mammograms or biopsies are then further delayed.

I would rather deal with rattlesnakes in my plane's landing gear or forgo mustard on my brat (which would be pushing the limit) than delay a needed medical test or procedure. It seems that your humble bloggeur (me again) has been caught in the backlog. I am scheduled to have an enlarged parathyroid gland removed next week, but COVID can still derail that. I won’t be certain that the surgery will happen until the day before I am to be operated on and that depends, in part, on everyone, including me, being COVID-free, and the OR not being diverted for use as a COVID ICU. If it proceeds as scheduled, I will have waited several months since the initial diagnosis for the surgery. An additional routine diagnostic test I need in order to determine how the fractious organ might have affected my bone health was scheduled six months out. Six months for a routine scan?

The Long Haul, Part 4: The Cost of Long COVID In Terms Of Individual Health And Quality Of Life

Surviving COVID-19 is one thing, recovering is another.

My frustration with those who would minimize the impact of COVID-19 is reaching an apex. I constantly have to deal with their baseless rationalizations that “it is just a cold,” or “it only kills 0.01% of people” (actually the number is 2% around the world), etc. And I constantly reply to these iconoclasts that COVID has become, by far, the leading killer in the US. I also explain over and over that treating simple mortality percentage as the only relevant statistic to consider is falderal. For example, the Spanish flu also killed “only” 2% of those infected, but in just 24 weeks, that virus killed more people around the world than were killed in WWI AND WWII together! The percent figure is meaningless without considering the percent of what. Why do they continue to ignore the devisor and, hence, the total number of deaths?

A small percentage of a very large number is, in fact, another large number.

Those who wish to downplay the significance of the pandemic only focus on this mortality percent, but mortality is NEVER the whole story for any pandemic. A serious person will also consider the morbidity caused by the disease. In fact, the major CDC publication on health in the US is called the Morbidity and Mortality Weekly Report. Notice that it considers both morbidity and mortality, and further notice that morbidity is listed first in the title. I have made three prior posts in this series on Long COVID, about the significant lasting morbidity of COVID-19. You can see these posts here, here, and here. In those posts, I shared data showing that some ~10-30% of COVID survivors suffer serious health problems that last months.

In those posts, I mentioned the cases of a young, healthy MD, and of a young, healthy journalist, both of whom struggled with long COVID, and how it affected their careers and cost them thousands of dollars in out-of-pocket expenses for the dozens of tests and doctors they needed. In an article in Maclean’s magazine, a reporter interviewed many Canadian long COVID patients and heard how their lives have been turned upside down. They reported that they are unable to live like they used to and care for their families, do anything mildly strenuous, or even cook their meals. They spend long stretches of time in bed. Many of those interviewed had not returned to work several weeks after recovering from the acute disease.

Anecdotes like these have been repeated millions of times around a world that, according to the Johns Hopkins University COVID tracker, has seen more than 330 million cases of COVID (and this is a significant undercount since many countries do not record these data well). Research has corroborated these anecdotes.

+++

Common long-term symptoms include debilitating fatigue; respiratory problems; and “brain fog.”  Other common symptoms include compromised function of the heart, and kidneys, which sometimes require transplantation. Wide-spread clotting problems can cause significant illness and even limb amputation. There also are frequent neurological and neuropsychiatric symptoms as highlighted in Part 3 of this series. Surprising manifestations continue to emerge, such as new-onset diabetes.

Lung scarring often occurs in patients who experienced COVID-caused acute respiratory distress syndrome (ARDS), a common problem seen in acute COVID patients who required ICU care. ARDS is a serious respiratory problem that can be caused by different respiratory viruses and other things. About a third of patients with ARDS arising from any cause were unemployed 5-years later because of their lung damage. It is fully expected that patients with COVID-related ARDS will be found to fare similarly.

There also is the dysfunctional immune response common in many moderate to severe COVID cases that can cause long-term multi-organ damage, particularly in the liver and kidneys. It can also disrupt coagulation control of the blood, sometimes leading to amputations, mostly in patients in their 30s and 40s. It was reported that amputations due to vascular problems have doubled since the CoV-2 virus arrived. Compromised coagulation control in COVID patients can also precipitate adverse cardiovascular events such as heart failure, or hemiplegia due to strokes. Data from the COVID Infection Survey on long-COVID suggest that the risk of major adverse cardiovascular events and long-term illness is about ten times higher in COVID patients (even after mild COVID) compared to non-COVID matched controls. A Dutch study found that 31% of COVID ICU patients suffered thrombotic complications. These problems can unexpectedly pop up in people who had completely recovered from COVID.

A global survey tallied 205 different symptoms across 10 different organ systems that can persist after COVID infection has cleared. Typically, these manifold long COVID symptoms do not appear in isolation, but in multi-symptom clusters. A long hauler typically has several of these problems at a time.

While it is estimated that overall, 10-30% of COVID patients become long haulers, reports on the number of people suffering long COVID vary widely. Depending on the report, anywhere from 30-90% of COVID survivors suffer long term health problems. And even at the lower end of that range, 30% of over 330 million people world-wide who have been infected is a very large number. It represents an enormous personal toll in terms of lost health and diminished quality of life. Some of these reports are summarized below.

• Half of 70,000 hospitalized UK COVID-19 patients experienced long-term complications, according to a study published in July. Complications occurred regardless of age group: For instance, 25% of adults aged 19-29 developed complications, as did 33% of those aged 30-39. Complications affecting the kidneys and respiratory system, liver injury, anemia, and arrhythmia were the most common.
• Many COVID-19 survivors require extensive and prolonged rehabilitation. An European study found about one-third of 1,837 non-hospitalized COVID patients (i.e., those with mild disease) needed a caregiver three months after their symptoms started.
• In April the CDC reported in its Morbidity and Mortality Weekly Report that 69 percent of nonhospitalized adult COVID patients in Georgia required
• one or more outpatient visits 28 to 180 days after their diagnosis.
• A study published last February in the Journal of the American Medical Association found that roughly one-third of 177 people who had mild COVID disease not requiring hospitalization reported persistent symptoms and a decline in quality of life up to nine months after illness.
• 70% of people hospitalized for COVID-19 in the UK had not fully recovered five months after hospital discharge. They averaged nine long COVID symptoms requiring continued medical care.
• A study in South Korea found that 90% of patients who recovered from acute COVID experienced long-term side effects.
• According to a report in the journal, Lancet, 75% of people hospitalized with COVID-19 in Wuhan early in the pandemic, reported continued problems with fatigue, weakness, sleep problems, anxiety and depression six months after being diagnosed with the disease. More than half also had persistent lung abnormalities.

Data like these have been commonly reported around the world, pointing to a more chronic and expensive health problem than seen with the flu or common cold, which often is caused by different coronaviruses. A July 2021 article in Scientific American talked about how all of this indicates that long COVID will cause a “tsunami of disability” that will affect individual lives as well as create enormous strain on the health system. Consider the numbers: More than 60 million Americans (this is an underestimate since many COVID cases are not reported) have been infected with the CoV-2 virus. Therefore, if only 30% of these suffer long COVID, we are talking about 20 million long haulers and counting.

The related health care and disability costs of all of this are also still being calculated. How many “long haulers” will not be able to return to work for months, or at all? How many will need short-term disability payments, and how many will become permanently dependent on disability programs? As increasing numbers of younger people become infected, will we see a generation of chronically ill? This then moves us to consider the economic and financial cost of long COVID, which will be the topic of the next installation in this series.

Stay tuned.

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