Aftermath

“Our ignorance about Long COVID is profound… We are facing a post-viral condition of potentially 

“Our ignorance about Long COVID is profound… We are facing a post-viral condition of potentially 

historic proportions and are almost completely in the dark about the underlying mechanism.” 

Harlan Krumholz, M.D., S.M., Professor of Medicine (Yale University)

Trying to reach ‘herd immunity’ as if suddenly there’s going to be this magic day when...

the virus is completely gone—that’s probably a fantasy. But getting the virus to a 

tolerable level where we don’t have to alter our way of life is probably very achievable.

David Wesley Dowdy, M.D., M.Sc., Ph.D., Sc.M., Professor Epidemiology at Johns Hopkins University

There are so many features of life that will remain altered forever by reason of the COVID-19 pandemic. We need unfettered transparency and constant global communication, one that defies wars and international hostilities. Will that happen? Are there more games to be played at the expense of human life? We know that an overpopulated world commands nature to react. What will we face next? When? How will we know?

We also know that, notwithstanding local pockets of herd immunity, COVID-19 is anything but under control. Look at India and Brazil as extreme examples, but even the more developed world is hardly “all clear.” People take exceptional chances too soon. Skeptics and science scofflaws continue to stop full containment even in the otherwise most enlightened nations. Globalization, from commerce to travel, from military assault to humanitarian efforts, will never quite be the same. Where there are larger unprotected gatherings of people, in countries where vaccine access is quite problematical, not only are infected messengers of suffering and death created every minute, but the disease itself eventually turns randomized mutation into mathematically certain variants that may be more infectious, toxic and vaccine resistant.

This all does not mean that COVID-19 cannot be meaningfully contained, eventually. But it augurs badly for the near-term timeline, and we need to face that fact that this malignancy will be with us for a while. Booster shots? For how long? When? Is herd immunity, seemingly no longer achievable even within the United States, a necessity to end COVID-19 forever? AIDS is still with us, but the treatment cocktails seem quite effective. Is that our future with COVID-19? Are treatments with monoclonal antibodies the answer? 

Can we live with a virus and still fall short of “herd immunity”? “[R]espected immunologists say the concept of herd immunity is widely misunderstood — and in fact the conditions for its attainment in the U.S. may be close or already have been reached… That’s because the level of vaccination in much of the country already has been sufficient to drive the levels of infection steadily lower and foster a consistent reduction in new cases.

“Indeed, the daily average of new cases per capita, compiled by the Washington Post, has fallen over the last seven days in all but five states. In two of the five, Wyoming and Maine, the figure rose by only 1% and in a third, New Mexico, it was flat.

“What’s causing confusion, experts say, is that laypersons tend to equate herd immunity with the complete eradication of the virus… ‘That’s not what infectious disease doctors mean by ‘herd immunity,’ ’ says Dr. Monica Gandhi, a professor of medicine at UC San Francisco. ‘Unfortunately, we’ve only eradicated a single virus in the history of mankind, and that is smallpox.’

“Gandhi adds, ‘We live very comfortably with other viruses for which we’ve achieved herd immunity, it’s just that the public doesn’t know it.’.. For example, few Americans devote much attention to measles, a highly infectious disease, because childhood inoculations are so effective. That’s also true of polio, which lost its capacity to terrorize the public soon after mass inoculations with the Salk vaccine were launched in the mid-1950s.” Michael Hiltzik writing for the May 11th Los Angeles Times.

But part of the “big question” remains: what about those lingering, sometimes horrific aftereffects experienced by many of those who have survived a COVID infection, which may actually have been otherwise mild? Are these the latest is what we call “preexisting” conditions that are such a hot topic when it comes to universal healthcare? “Scientists are referring to long COVID as post-acute sequelae of SARS-CoV-2 infection (PASC), where ‘sequelae’ refers to a condition that is the result of a previous illness or injury. SARS-CoV-2 is the name of the virus that causes COVID.

“The symptoms of PASC include fatigue, shortness of breath, ‘brain fog,’ sleep disorders, fevers, gastrointestinal issues and psychological symptoms such as anxiety and depression in patients several months after their initial COVID infection… These symptoms can be mild, but in some people they can be ‘incapacitating’ with the potential for a ‘profound’ impact on public health, according to Dr. Francis Collins, director of the NIH.” Newsweek, February 25th. Frankly, we still do not remotely understand the full ramifications of this aspect of the disease.

“The SARS-CoV-2 pandemic’s acute effects on people’s lives has appropriately held the nation’s attention, but the long-term effects that many people suffer is garnering increasing attention… [T]his syndrome represents a debilitating constellation of symptoms that persist long after a period when people should have recovered from the initial stages of the illness… Surveys conducted by remarkable patient groups have found great heterogeneity among individuals in their types and cadence of their symptoms. Long COVID occurs in people who were initially very ill and in those who were initially without symptoms. One study from the UK reported that a median of 5 months after hospital discharge for COVID-19, only 29% felt fully recovered and 1 in 5 had a new disability – almost 40% had a severe or very severe mental and physical health impairment.

“With millions of people hospitalized and many more millions infected with SARS-CoV-2, the implications for Long COVID are profound. We have large numbers of people facing the prospect of a chronic condition without diagnostics or therapeutics. We are facing a post-viral condition of potentially historic proportions and are almost completely in the dark about the underlying mechanism. Both individual reports and the studies to date paint a picture of lives changed overnight, as people struggle to make it through the days and face a health care system that can offer no substantive assistance. The fact that the pandemic had disproportionate impact on minority communities also heightens the importance of a focus on these communities as we seek to mitigate the effects of Long COVID. And for all people, this syndrome can leave long-lasting financial toxicity, which is so damaging at a time that they may not be able to work – and are in danger of losing insurance coverage.” Dr. Harlan Krumholz writing for the Yale University School of Health, May 5th.

We’re even still tallying the real mortality rate of COVID-19 here in the United States. As we hit 600,000 deaths, studies are telling us that misreported deaths and secondary causes – like not seeking treatment for a potentially fatal event or disease for lack of access to doctors or hospital facilities or simply fear of being exposed to the virus – that push the US numbers closer to one million deaths. The long-term ramifications of this pandemic will continue to be discovered for years to come. We will survive. The disease will be contained at survivable level. But we are changed forever by its impact.

I’m Peter Dekom, and we have discovered that a super-viral disease has so many ways to decimate our lives, from the obvious medical results to the psychological, political and financial damage we never anticipated.