How Long COVID

 

We already know that the novel coronavirus, COVID-19 (aka SARS-CoV-2), is probably going to be with us for a long time. We are not even close to herd immunity on a global level – and without a global approach, the disease can continue to mutate and threaten without much hope of ending. Even within the United States, where vaccines are freely accessible and clearly effective to those over 12 years of age, vaccine resistance (accompanied by “mask” and social distancing resistance) – most of it based on disinformation and politization of a medical reality – pretty much assures the disease will continue to defeat the best medical intentions, private and governmental. People travel, and travel spreads the disease.

American levels of polarization have just added “vaccinated” vs “unvaccinated” as two categories of risk and exposure. With vaccines still not available for young school-aged children, and with some states (now facing judicial opposition) insisting the there can be no mandate by employers or school districts for vaccinations or masks, the Delta strain of the virus is exploding in those jurisdictions. Delta is unlikely to be the last super-toxic variant of COVID-19, and we can only hope our vaccinations keep up with that roiling threat of new varieties. None of our current treatment options for those infected – notably Regeneron (a monoclonal antibody) and remdesivir (a broad-spectrum antiviral) – offer a cure for the disease. We seem to be sitting in wait at least for the same kind of containment we have achieved over HIV infections, but that took decades.

Increasing numbers of children are now getting COVID infected with some deaths recorded, but their greatest threat is as carriers of the disease back into their homes, where unvaccinated adults are likely to become infected with the “heavy viral load” Delta virus, which currently accounts for most U.S. infections. Those vaccinated can still face a “breakthrough” infection, but death or severity requiring hospitalization is no longer a material threat to them. Thus, the explosion of new cases is largely a “pandemic of the unvaccinated.” And that has a profound impact not just on our overall health but on the ability of our economy to recover.

What we cannot fully appreciate, but are beginning to understand, are the lingering or recurring aftereffects that plague recovered COVID patients well beyond the main impact of the disease. Sometimes months or even a year (or more?) later. Jason Maley, a Harvard Medical School instructor in medicine and director of BIDMC’s Critical Illness and COVID-19 Survivorship Program (in the  April 13th Harvard Gazette) explains: “Long COVID or what’s now — through the National Institutes of Health — being referred to as ‘post-acute sequelae of COVID-19’ [PASC,] is persistent symptoms or new symptoms that develop, generally speaking, at least four to eight weeks after the initial infection with COVID-19. It can include the continuation of symptoms that happened when a person was first sick, like shortness of breath, or fatigue, or it can be new symptoms where a patient feels like they’ve improved and they’re recovering and then a month after being infected, they have worsening chest discomfort and brain fog and difficulty thinking, and all sorts of symptoms from head to toe that can either persist or develop somewhat newly after they’re infected.” Loss of a sense of taste or smell can also occur.

Those having suffered and recovered from a bout with COVID-19 face a new pre-existing condition that has often expensive and prolonged symptoms. The disease has not been with us long enough to measure many of its potential longer-term effects, but what we know already is disturbing. Melissa Healy, writing for the August 27th Los Angeles Times, updates what we know so far about the challenge of long-haul COVID: “COVID-19 patients in Wuhan were among the pandemic’s first victims, and a comprehensive new study finds that a year after shaking the coronavirus, survivors were more likely than their uninfected peers to suffer from mobility problems, pain or discomfort, anxiety and depression.

“A detailed accounting of 1,276 people hospitalized for COVID-19 in the pandemic’s opening months reveals that a full year later, almost half continued to report at least one lingering health problem that is now considered a symptom of ‘long COVID.’ … One out of five said they had continued fatigue and/or muscle weakness, and 17% said they were still experiencing sleep difficulties. Just over one in four said they were suffering anxiety or depression in the wake of their bout with the SARS-CoV-2 virus… For the growing number of patients who identify themselves as COVID ‘long haulers,’ the new accounting offers cause for optimism — and concern. The period from six to 12 months after infection brought improvement for many. But most patients struggling with symptoms at the six-month mark were not yet well six months later.

“The findings, catalogued by a team of Chinese researchers, were published late Thursday [8/26] in the medical journal Lancet… ‘This is not good news,’ said David Putrino, a rehabilitation specialist who works with COVID long haulers at Mount Sinai Hospital in New York. ‘If you run the numbers here, about one-third of the group that had persistent symptoms are getting better after 12 months, while two-thirds are not.’… Putrino also called the findings a ‘wake-up call’ to public health officials that even when the pandemic is over — a distant enough prospect in the midst of a fourth wave of infections — its downstream consequences will not be…

“There will be a lot of them. More than 87,000 COVID-19 patients are being hospitalized each day in the United States, and 2.7 million have receiving hospital care in the past year alone… The half who contend with persistent symptoms will show up in doctors’ offices with clusters of vague and perplexing complaints including brain fog, heart palpitations, pain and exhaustion. And despite emerging evidence that time and specialized treatment can help many to improve, few will have the wherewithal to spend months in intensive rehabilitation for their symptoms, Putrino said…

“When the [Wuhan] study’s COVID-19 patients were examined at six months, 68% said they had at least one of 15 symptoms considered hallmarks of long COVID… At one year, 49% were still afflicted by at least one of those symptoms… The proportion of patients with ongoing muscle weakness and fatigue dropped from 52% to 20% during that time. Patients experiencing loss of smell dropped from 11% to 4%, and those afflicted with sleep problems fell from 27% to 17%. The 22% who reported hair loss at six months dwindled to 11% a full year out…. At the same time, the numbers of patients reporting breathing difficulties saw a slight increase, rising from 26% at six months to 30% after a year. Likewise, patients who reported new depression or anxiety increased from 23% to 26% during that period… An editorial published alongside the new study noted that only 0.4% of COVID long haulers are receiving rehabilitative treatment for their symptoms.” 

In short, those unvaccinated who simply will not accept their responsibility in continuing and spreading the disease to others or who continue to believe that the disease is not as virulent as it is, also face the potential of a very long-term set of health threats should they contract COVID-19. Aside collateral and permanent damage to critical organs, they now may also face a very long-term litany of debilitating aftereffects that could materially impact their quality of life… and their ability to earn a living. With the FDA finally fully approving Pfizer’s mRNA vaccine, the excuses for remaining unvaccinated have all but disappeared.

I’m Peter Dekom, and the entire nation faces a serious long-term challenge made so much worse by our politized and polarized body of vaccine resisters, most of whom are basing their decisions on inadequate or distorted “information.”