Tag Archives: long Covid

Long Covid and the vaccines: do they give us any protection?

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I come bearing a shred of good news about long Covid. Or at least it’ll look good to you if, like me, you worry about the prospect of long Covid. This comes from two doctors, Sarah Ryan and Lawrence Purpura, who’ve worked extensively with it. I’ll skip the details on their experience–just follow the link if you’re interested. It’s shortcut week here at Notes. In fact, the shortcuts are so short that I’m going to quote them interchangeably. They’ll never know–and if they do I’ll take no shortcuts in apologizing.

They say the long Covid cases they’re seeing have been less severe than the ones they used to see. They attribute that first to the omicron variants attacking the upper respiratory system, where they don’t cause as many of the heavy duty symptoms–lung complications, increased heart rate, lightheadedness, and chronic fatigue–and second to the vaccines being somewhat protective against long Covid. 

No, the vaccines don’t protect us completely, but “studies show that even one dose of a COVID vaccine reduces the odds of developing long COVID by seven to 10 times.”

Break out the ice cream so we can celebrate, will you? Or at least an M&M.

Irrelevant photo: Fields after a December frost.

Who’s most at risk? An article in Cell “identified four factors that correlate with greater risk of long Covid—type 2 diabetes, prior infection with Epstein-Barr virus, level of Sars-CoV-2 RNA detected in the blood, and the presence of autoantibodies.”

A different study sees being female as an increased risk. That same study saw people’s risk decrease by 30% if they’d have two doses of vaccine.

How likely are people with Covid to get long Covid? No one has a good answer to that. There’s no one definition of long Covid, which makes it next to impossible–or maybe that’s completely impossible–to compile statistics. 

Still, they estimate that something like 1% to 5% of Covid patients will go on to get moderate to severe long Covid. At twelve weeks, around 25% of them report fatigue, 25% report insomnia, 20% report increased heart rate or dizziness, and 15% report neurocognitive deficits–things like short-term memory problems. Some of those symptoms will be very mild to some disabling.

A different study came up with 1% of people who had Covid but weren’t hospitalized coming down with long Covid, 6% of people who were hospitalized, and 32% of people who ended up in intensive care units.

Many people will have what Ryan and Purpura call “profound recovery” in three to six months; 10% will have symptoms that go on for more than a year. An even smaller percentage will still have symptoms after a year and a half. 

So the news is far from an all-clear, but in a bad-news situation, this is good news.

 

Other long Covid news 

I’ve been stacking up articles on long Covid but never seem to get back to them. But here we are in shortcut week, so let’s do a few quick summaries and then run:

  • Covid’s associated with increased liver stiffness–a possible sign of liver injury–months after infection. Note the hesitancy in there: associated with; a possible sign. Nothing definite, just something worth looking into more.
  • Covid can affect the brain profoundly even months after infection.
  • A different study, from the early stages of the pandemic (I hope that’s significant), linked Covid to impaired reasoning, speed of thinking, and verbal abilities, comparing what they saw to the effects of sleep deprivation. The severity of the symptoms matched the severity of the infection.
  • A small study found Covid can damage the DNA in cardiac tissue. Compared to the 2009 flu, “Covid has led to more severe and long-term cardiovascular disease.”
  • Covid’s associated with increased chances of long-term brain problems, including strokes, cognitive and memory problems, depression, anxiety, and migraines. And if that doesn’t make you anxious, tremors, involuntary muscle contractions, epileptic seizures, brain fog, hearing and vision abnormalities, and balance and coordination problems–basically symptoms like the ones that come with Parkinson’s. Vaccines reduce the chances of having any of this joy land in your life by about 20%. Keep in mind, though, that a group of people who’ve had Covid are more likely to face these problems than a group that hasn’t, but that doesn’t mean all of them will.
  • Covid was associated with an increased chance of stroke and heart attack. If the study’s correct, over the course of a year, for every 1,000 people who had Covid, you’d expect to find five extra strokes, three extra heart attacks, and twelve extra cases of heart failure.  

Those last two studies show a pattern but don’t show cause and effect so let’s not go off the deep end with them. 

 

Is Covid no worse than the flu?

The claim that Covid’s just like the flu translates to “Don’t get hysterical.” So an article from Australia has given us a comparison of the two. 

Between the beginning of 2022 and August 28, Australia had 44 times as many Covid cases as flu cases and 42 times as many Covid deaths. 

That makes the death rate from Covid lower, right? It looks that way to this number-phobe, but it also misses the point. The absolute numbers are higher. If you find yourself in the group of people who died, you’re not going to be consoled by the percentages. 

Okay, strictly speaking, if you find yourself in that group you’ll be dead and unlikely to care anymore, but still, you see my point: Some 1,700 people were hospitalized with the flu between the start of the year and some date in September–pick a number, any number, because here at Notes we don’t really care. Compare that to a single day in July 2022 when 5,429 people were hospitalized with Covid.

 

Life expectancy

I kind of ditched our good news theme there, didn’t I? Sorry. I had some, I spent it all in one place, and now it’s gone. To hell with it, let’s do more bad news. It’s cheaper.

The Covid pandemic lowered life expectancy worldwide. Or at least in the 29 countries included in one study. That leaves out a bunch, but close enough for our purposes.

Predictably, the losses aren’t evenly distributed. Countries with the most effective responses bounced back to pre-pandemic levels relatively quickly. Countries where the response was less effective may have what the study calls “a protracted health crisis.”

It’s another piece in the argument that Covid’s not just the flu in fancy clothes. Flu in the second half of the twentieth century caused smaller, less widespread drops in life expectancy. 

 

The new variant on the block

The new variant that’s emerged in China is BF.7, which is short for something more complicated, which we don’t need to bother with. It’s more infectious than earlier variants, has a shorter incubation time, and is better at infecting people who’ve already had Covid. The symptoms aren’t that different than we’re used to: fever, cough, sore throat, runny nose, and fatigue, but some people end up with vomiting and diarrhoea.

It’s been found in several countries other than China but doesn’t seem to be spreading as quickly in them, although (as I write this, in mid-December) it’s not clear why.

The future of mRNA vaccines

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Covid may end up giving us an unexpected gift–a real one, not some snarky, I’m-saying-the-opposite-of-what-I-mean gift. All the work that went into developing the mRNA vaccines for Covid may soon translate into a flu vaccine that works against all 20 known subtypes of flu. It’s still in the testing stage, but it’s looking promising, and since flu can turn from annoying to lethal without having to file paperwork, this is no small thing.

In animal tests, it reduced symptoms as well as protected the little beasties against death. 

To be clear: protection against death is good. It’s not as good as 600% protection against illness, as we know from the Covid vaccines, which miss that 600% bullseye, but it’s a hell of a lot better than having zero protection against death.

The flu vaccines that are around now are seasonal: they protect against the recent versions but if some new strain that jumps unexpectedly from a bird or animal, adapts to humans, refuses to file paperwork, and turns out to be as potent as the 1918 flu–well, they’re not up to the job.

The 1918 flu? That’s the one those of us over a certain age learned to call the Spanish flu because it didn’t originate in Spain and because it’s important to have someone to blame, however inaccurately.

Thoroughly irrelevant photo: a neighbor’s dahlia

The developers of the new vaccine are currently designing human trials, and with luck the vaccine will be available by 2024.

Yeah, so what else can the technology do?

Since you asked, mRNA technology makes the creation of multivalent (be impressed with that word, please) vaccines relatively easy. 

Multivalent vaccines? They’re the ones like that flu vaccine that fore-arm us against bugs with pandemic potential, even when we’re not forewarned. 

The vaccine we really need these days is a pan-coronavirus vaccine, and one is moving into the human-trial stage. Or it’s fixin’ to get ready to think about moving into the human-trial stage. It’s close. In animal trials, three doses not only protected against severe disease, it also protected against infection and decreased the amount of virus the vaccinated animals shed, so they were less likely to pass it on.

Now we come to the hazy part: The article I read introduced it as a vaccine against coronaviruses in general, but the rest of the article focused on it as a Covid vaccine. I’ll leave you to figure out what that means. I’m short on time and can’t trace this one through the convolutions of the internet. 

The article did say, “The vaccine candidate is a combination of a nanoparticle antigen . . . along with an adjuvant—an ingredient that boosts a vaccine’s effects . . . . The adjuvant formulation, 3M-052-AF, significantly enhanced the immune responses in the animals when combined with the antigen.”

I’d translate that for you but I’m in so far over my head that not even the tips of my fingers reach the air. It does sound impressive, though.

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A Covid nasal vaccine is also in development, and it’s designed to piggyback on the immunity that previously vaccinated people carry. By coming in through the nose, it can work primarily on the mucus lining, which is where Covid likes to throw a housewarming party when it enters a body. If the vaccine works, it will be the emergency number you’ll want to call before the party starts, because you know what kind of neighbors Covid germs are. Loud music, fights, broken glass on the sidewalk. 

I could go on, but you get the picture.

In a trial, the spray protected previously vaccinated mice against both death and disease. It did zilch for unvaccinated mice. In hamster trials, it reduced transmission of the disease. It doesn’t use  live viruses, viral vectors, or adjuvants, and that may make the vaccine safer. 

Why? How much? No idea. Go do your own research.

So far, it hasn’t been tested in humans and the article I read was heavily spiced with the word may, so it’s not time to get too excited about this one. Although that hasn’t stopped me.

What about vitamin D and Covid?

Do vitamin D supplements protect against Covid? According to two studies, no. It makes sense that they would–vitamin D supports the immune system–but in a trial of 6,000 people vitamin D supplements made no difference in the number of either Covid or other respiratory tract infections. A second trial involved 35,000 people and tested vitamin D plus cod liver oil. Again, no noticeable difference emerged.

Both trials have their limits. In one, some people in the control group popped the occasional vitamin D supplement. In the other, most of the participants weren’t low on vitamin D at the start of the trial, so the real trial was with a much small group. And vaccines were rolled out during both trials, throwing the balance off. So don’t count them as conclusive, just suggestive.

The endless, depressing news about long Covid and (new word here) post-Covid

Having had Covid can–emphasis on can; it doesn’t always–leave people with nervous system  damage that messes with anything from their sense of smell to their ability to concentrate. It can increase their chances of having a stroke–not right away but eventually. 

It’s called neuro-Covid. Yes, folks, it’s another new word. Don’t say Covid hasn’t been generous with us.

A study that looked at the cerebrospinal fluid and blood plasma of people with neuro-Covid found an overblown immune response in the group with the most serious symptoms: impairments in the blood barrier that could have been caused by a cytokine storm; antibodies that had turned on the body’s own cells; and an overactivation of the microglia, which are immune cells responsible specifically for the brain. People with serious symptoms also had a smaller brain mass than healthy people, especially in the area responsible for the sense of smell.

“The virus triggers such a strong inflammatory response in the body that it spills over to the central nervous system,” Professor Gregor Hutter of the University Hospital of Basel said. “This can disrupt the cellular integrity of the brain.” 

The researchers are hoping to find a test that could predict long Covid and neuro-Covid before they strike, and to identify targets for drugs to attack–in other words, to identify the excessive immune response at an early stage so they can put the brakes on it. 

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A different study shows that having multiple Covid infections increases the risk of long Covid and of other post-Covid health risks. This was a massive study–5.8 million people in the US Veterans’ Affairs database. Its limitation is that this is a population primarily of older white males, so diverse it ain’t. 

The study showed that, compared to people who hadn’t been reinfected, people with repeat infections are twice as likely to die prematurely and three times more likely to be hospitalized. Heart and lung problems were more than three times more common, and reinfection also contributes to brain conditions, kidney disease, and diabetes.

The risk could increase with each infection.

Are you depressed yet? Sorry. It’s not pretty out there and I would have to open the damn curtains. But since I have . . . 

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Another study came at post-Covid brain problems from a different direction. 

To back up for a minute and state the obvious: The problem with studying brains is that as long as their owners are using them you have to accept some limits on the ways you study them. You only have access to certain information once their owners to die, which most people are reluctant to do, even in the interest of science. So this set of researchers created brain organoids–little clusters of brain cells the size of a pinhead. If the organoids object to being messed with, they have no way of letting us know, so it’s open season and the researchers infected them with Covid.

Sorry, guys. For the greater good and all that.

The researchers found that an unusual number of synapses were eliminated.

So what? Well, synapses are the social media of the brain. They allow the neurons to communicate with each other. In the normal wear and tear that goes on inside a brain, a number of synapses will be eliminated, which may explain why I can’t remember what I did five days ago, not to mention the fingering for an F chord on the guitar: The downsizing committee up there decided I no longer need to know those things and got rid of the relevant synapses in the name of efficiency. I might still want to know that stuff, but it’s austerity up there in my skull and something had to go. I should be grateful my brain didn’t ditch everything I know about commas, because, hey, that’s important.

I’m aware that that last paragraph implies that who- or whatever I am exists separately from my brain, but let’s stay out of that rabbithole while I remind you that austerity is what Britain’s government–or what passes for a government when it’s not tied up with more important business–calls cutting public services. Calling it austerity, though, makes it sound like it’s good for us. Think of it as the kale of the political world.

So what the researchers saw happening in the infected organoids was something like what’ll happen in austerity Britain 2.0, which is Sunakian austerity as opposed to Cameronian austerity. When the promised spending cuts kick in, it won’t just be the F chord that goes, it’ll be the smell of lilacs and where I put my car keys and the oomph I need to get from one end of the official looking letter that just came in the mail to the other so I can figure out if I’m being evicted or asked to serve as the next prime minister.

Did I lose you in that last paragraph? Sorry. I was having such fun–

I’ll summarize in a marginally sane way: In infected organoids, an excessive number of connections were downsized–or as serious people would put it, eliminated. That’s frighteningly like what happens in Alzheimers, Parkinsons, and schizophrenia. 

It’s true that our brains are bigger than organoids, and with luck, more complex. But post-mortems on Covid patients (post-mortems, I remind you, are carried out on people who are no longer using their brains), as well as brain imaging on live patients, show that the gray matter isn’t as thick in people who’ve been infected, which hints at a loss of synapses. 

Keep in mind that we’re still in the land of hints, though, not definitive conclusions, and also that I’m not clear on whether the post-mortems and scans were carried out on people who’d had serious cases of Covid or simply from people who’d been infected.

For the researchers, the next step is to look at whether various drugs will inhibit all that downsizing. 

Some of us living in Britain want to know if some drug can stop the government from downsizing services that have already been downsized so radically that they’re held together by nothing more than thread and newspaper headlines.

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Will you forgive me if I toss in a bit of good news? Paxlovid looks like it decreases the odds of developing long Covid.

Pax-what? It’s an antiviral pill that reduces the chances of hospitalization and death in people who’ve been infected–and reduces the chances of long Covid by 25%.

That’s from a preliminary study–it hasn’t been peer reviewed yet, and its study subjects were (again) mostly older white males in high-risk groups, but the US National Institutes of Health plan to study the drug’s effectiveness on people who already have long Covid to see if it works after the fact.

Bits of good news about Covid

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We’re talking about Covid again, so let’s grab some shreds of good news and pile them up like hamster bedding–only (if I remember my brother’s hamster correctly) not as stale smelling.

 

Shred number one

A study involving older, high-risk adults showed that nasal irrigation reduced the risk of hospitalization and death from Covid and helped people recover faster. 

What does “older” mean if we don’t have a comparison group? C’mon, we all know that in our culture it’s not nice to say someone’s old. They’re trying to be polite. My best guess is, older than the researchers.

Next question: What’s nasal irrigation? An inexpensive and low-tech way of clearing out your sinuses. You squirt a mild sterile saline solution up one nostril, tipping your head so it dribbles helplessly out the other, having found its way via satellite navigation. As the solution falls into the sink, you’ll hear a small voice saying, “You have reached your destination.” 

Irrelevant photo: It must be time for another cat photo. This is Fast Eddie, who doesn’t look like he was assembled correctly but was. Really.

Okay, I asked Lord Google what it involves, and I even tried doing it. It’s mildly off-putting but I’ve done worse things in the name of health. It’s entirely survivable.

But let’s go back to the study: Only 1.3% of the subjects were hospitalized, and none died. Compare that to the control group, where 9.47% were hospitalized and 1.5% died. Group one also got better faster and had fewer symptoms hanging on at the end of two weeks. 

The inspiration behind the study was 1) that saline decreases Covid’s ability to attach to cells–to the ACE2 receptor, in case you’re taking notes and 2) that the larger a person’s viral load is, the sicker they’re likely to be, so if within 24 hours of testing positive (the study’s designers reasonsed) some of the virus was rinsed out, that might reduce Covid’s damage. 

Nasal irrigation is a common practice in Southeast Asia, and interestingly enough death rates from Covid were lower there. That’s not definitive proof, but it’s intriguing enough to make a person design a study around it–if the aforesaid person happens to be in the right line of work, of course. 

Irrigation also helps with colds, postnasal drip,  sinus headaches, and all sorts of fun stuff. It’s said to improve people’s sense of taste and smell and the quality of their sleep. 

I’m starting to sound like a true believer, aren’t I? Sorry. I’ll recover in a minute or two, as soon as I stop this saline solution dribbling out of my left nostril. In the meantime, I can balance things out by admitting that it won’t make you taller or reverse aging.

 

Shred number two

A small study hints that vaccination may be decreasing the number of people who come down with long Covid. The study comes from the long Covid clinic at the Cambridge University Teaching Hospital, which treats people on the severe end of the spectrum. Between August 2021 and June 2022, it saw a 79% drop in referrals compared to August 2020 and July 2021.

That’s not proof that vaccination’s the cause–it’s only correlation–but it does suggest it.

Other studies also show a decrease, although the numbers have been all over the map. One showed a 15% reduction and another 50%. A third showed “eight of the ten most-commonly reported symptoms were reported between 50 and 80% less often.” I’d translate that into a format that parallels the other studies but somebody glued the pieces in place and I can’t. 

The reason the numbers vary so much is that the studies weren’t defining long Covid the same way or following people for the same length of time. 

So does catching Covid multiple times increase your odds of getting long Covid? The assumption has been that with each infection, you roll the dice again, taking the same risk each time. But one author of the study expects that previous infections will have more or less the same impact as vaccination and the risk will turn out to diminish after the first infection.

Probably.

 

Shred number three

The omicron variant may be 20% to 50% less likely to turn into long Covid than the delta variant, depending on a person’s age and how much time has passed since they were last vaccinated. 

But–and isn’t there always a but?–because more people caught the omicron variant than the delta, the absolute number of people in the UK who came down with long Covid as a result was higher. 

Sorry. That second paragraph was as welcome as a thorny old blackberry cane sneaking into the hamster bedding.

 

Shred number four

Allergies might offer some protection against Covid. Do you have hay fever, allergic rhinitis, eczema, dermatitis? Be grateful for your bad luck, because you may be 23% less likely to get infected . Got one of those plus asthma? Be grateful twice: It may have down by 38%. 

That’s not proof, but it’s an interesting possibility.

 

Shred number five

A study estimates that in the first year Covid vaccines were available, they prevented 19.8 million deaths worldwide. Unfortunately, though, because of how unevenly they were distributed, the advantage was heavily skewed toward the richest countries.

You knew it wouldn’t all be good news here, didn’t you? 

During the first Covid wave, before vaccines were available, shutting schools cut daily deaths by 1.23 per million over 24 days and shutting workplaces cut daily deaths by 0.26 per million over 24 days. (Kids were less likely to get sick but they’re generous little creatures and they do like to share their germs.) For a population of 67 million (which just happens to be Britain’s population), that translates to roughly 82 deaths avoided every 24 days by shutting schools and 17 by shutting workplaces.

Lockdowns and restrictions on public transportation didn’t have as significant an impact. The difference is at least partially attributable to vulnerable people not being able to avoid workplaces and schools.  

 

Shred number six

India and China have approved inhalable vaccines, and many medical manufacturers are chasing their own inhalable versions. Injected vaccines concentrate antibodies in our muscles, which is useful, but we catch Covid by inhaling it, so the theory goes that loading the nose and mouth with antibodies could potentially keep us from spreading it. In other words, it really could end the pandemic.

Potentially. I don’t think the data on either of the new vaccines have been made public yet, so keep watching.

 

And now your weekly quota of bad-to-ambiguous news

Tedros Adhanom Ghebreyesus, head of the World Health Organization, said, “Last week, one person died with Covid-19 every 44 seconds. Most of those deaths are avoidable.”

That quote’s from early September .

“You might be tired of hearing me say the pandemic is not over. But I will keep saying it until it is.”

A week later, he said “We have never been in a better position to end the pandemic. We are not there yet, but the end is in sight.”

However, “If we don’t take this opportunity now, we run the risk of more variants, more deaths, more disruption, and more uncertainty.”

WHO is urging countries to continue testing for the virus, to continue sequencing it, and to vaccinate 100% of the most at-risk groups, including health workers and the elderly.

Covid: It ain’t over till it’s over…

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…as the endlessly quotable Yogi Berra may or may not have said.

But forget Berra. The World Health Organization, a.k.a. WHO, isn’t as much fun to quote but it knows how to do footnotes, and that makes it more impressive. In its opinion, the pandemic isn’t over. Between the beginning of 2022 and late August, at least a million people around the world died of Covid. 

Or if you want to start counting at the beginning of the pandemic, that’s 6.45 million. Both numbers undercount the damage, but never mind that. Let’s work with what we’ve got.

”We have the tools that can actually prevent these deaths,” said Maria Van Kerkhove, WHO’s technical lead on Covid. “A lot of people are talking about living with COVID. But we need to live with this responsibly. A million deaths this year is not living with COVID. Having 15,000 deaths per week is not living with COVID-19 responsibly.”

In one recent week, more than 5.3 million new cases were reported worldwide, a number that doesn’t include people who registered positive only on a home test. Or who never tested.

“These are huge numbers, and that’s an underestimate,” said Van Kerkhove. “We do see this virus circulating really intensely around the world.”

Irrelevant photo: an orchid

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That brings me to the question of why I keep banging on about Covid. Apologies if I’ve gotten boring–Notes isn’t supposed to be mindless, but it is supposed to be a fun read. The problem is that scientists keep coming up with new information. What I’m saying here is, Blame the scientists. If they weren’t so damn good at this, it wouldn’t end up in your inbox.

And if that isn’t a good enough reason, it’s because it still matters. Living with Covid doesn’t have to mean pretending it’s no danger.

 

Long Covid 

Let’s talk about long Covid. Again. Sorry to keep coming back to it, but not long ago someone challenged me on the extent of the problem (my thanks; it was an interesting discussion) and since long Covid’s hard to define and at least as hard to measure, I didn’t have great statistics to offer. But I have started to see some lately, so let’s play with numbers. They all involve money, since it can be counted, and when you’re dealing with something as hazy as long Covid that’s useful. Besides, as we all know, money matters more than life itself.

So let’s talk money: A report from the US estimates that 4 million people are out of work with long Covid, which could mean $170 billion in lost wages. In a year. The report’s author,  Katie Bach, said, “If this looks like other post-viral illnesses, some people will recover, but there will be this big stock of people who don’t, and it will just continue to grow over time.”

She called it “a shocking number.” 

In mid-2021, the Federal Reserve Bank of Minneapolis estimated that 26% of people with long Covid were out of work or had cut their working hours. An international survey found that 22% of people with long Covid weren’t working and 45% had cut their hours, and a U.K. survey found 16% had reduced their hours and 20% were on paid sick leave. That was between April and May 2021.

Australia’s treasury reports that the country’s lost 3 million working days to long Covid. Or to put that another way, 31,000 people have missed work every day because of it. 

 

So how many people have long Covid? I’m not sure anybody has a reliable count, but the U.S. Centers for Disease Control estimate that 19% of people who’ve had Covid get long Covid symptoms. Unfortunately, the number’s less helpful number than it sounds like, because long Covid’s symptoms range from relatively mild to completely hair-raising and the duration ranges from weeks to the possibility of a life sentence.  

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Are we having fun yet?

Evidence is growing that people who’ve had Covid face an increased risk of neurological and psychiatric problems as much as two years after their infection. That’s not the final word on the subject, but it comes from a study that followed 1.28 million cases over two years. It does seem to be a strong hint. 

The good news? Depression and anxiety are generally gone after two months and are no more common after Covid than after other respiratory infections. And kids are at the lowest risk for kids for later complications. 

End of good news.

Adults 64 and under showed an increased risk of brain fog–640 cases per 10,000 people vs 550 cases per. Over 65s? The number went up to 1,540 per compared to 1,230. For dementia (we’re still talking about the over 65s here) it was 450 instead of 330. Psychiatric disorders? That’s 85 instead of 60. 

Is there anything can we do about it? Hell yes. I’m going to petition the courts to lower my age.

Does the risk end after two years? We haven’t had enough time for anyone to find that out. 

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A theory that’s loose on social media holds microclots responsible for long Covid, and some evidence does back that up, but (as one article says) hematologists worry that enthusiasm for the theory has gotten ahead of the data.

Danny Altmann, an immunologist at Imperial College London, said, “We’ve now got little scattered of bits of evidence. We’re all scuttling to try and put it together in some kind of consensus. We’re so far away from that. It’s very unsatisfying.”

But that’s not stopping a few medical groups from offering treatment to remove the clots, and some people with long Covid are desperate enough to try anything, which I can understand. But at least some treatments to get rid of clots risk messing with the blood’s ability to clot, and that (she said, indulging in a mild understatement) would not be a good thing.

 

How Covid’s changing

Its incubation period—the time between when a person gets infected and when they’re shedding enough of the virus to infect other people—is getting shorter, and the shorter that time that period is, the harder it is for vaccines to keep the virus from spreading.  

Yeah, that was news to me too. Measles and rubella have a two-week incubation period, which allows time for a vaccinated person’s immune memory cells to crank out antibodies and keep the person from passing the bug to other people. So vaccines for those diseases stop the spread. In contrast, a Covid vaccine, although it protects the wearer, doesn’t protect the wearer’s friends. Or enemies. 

On the bright  side, the shorter incubation time means people who test positive might not have to isolate themselves for as long.

Every cloud has a silver lining, but the problem with that is that silver linings are too heavy to float. Watch out for falling silver linings.

 

Expired tests

You may (or may not) remember that a while back I wrote about the expiration dates on Covid tests. After they pass those dates, I led you to believe (if and only if you read it, of course), they start to call in sick and miss work. Well, I need to update that. The U.S. Food and Drug Administration set the expiration dates in the early days of the pandemic, on the basis of the limited information that was available at the time, but manufacturers are testing aging tests them and some turn out to be good beyond their expiration dates.

How do you know if yours still good?

“To check whether your test kit is still good beyond the printed expiration date, you can search on the FDA’s “At-Home OTC COVID-19 Diagnostic Tests” website.

“Type in the brand name on the FDA site, and a link will appear showing a list of updated expiration dates.

“You may have to check the lot number on your package. For instance, say you’re trying to look up an iHealth COVID-19 test kit with lot number 222CO20208. Scroll down the document to find your lot number, and you’ll find that the original expiration date of Aug. 7 has been extended to Feb. 7, 2023.”

Apologies.

 

An update on Hafiza Qasimi

In early August, I wrote about Hafiza Qasimi, a woman artist fleeing Afghanistan after the Taliban destroyed her paintings and left her unable to work. The campaign to raise the 10,000 euros she needed to apply for a German visa has reached its goal. This allows her to demonstrate that she can support herself for her first year in the country. (The amount will be raised to 11,208 in January.)

In the meantime, Qasimi has reached Tehran. I have no idea how she did that. In Afghanistan, women aren’t allowed to either travel or leave the country unless they’re with their husband or a male a relative. But she managed it, she’s safe, and she’s been offered a three-month residency at a German art gallery is she can get that visa.

The group supporting her is trying to raise more than the 10,000 euro minimum so that she can afford health insurance and other basics. They’re also working with her on a grant application that would allow her to study at art school.

“This,” they say, “will provide her with the space she needs, as a free woman, to renew and develop her artistic work. We are full of confidence and look forward with Hafiza to the future.”

Her brother, who lives in Germany, will be flying to Tehran to see her for the first time in eight years.

If you want to contribute to the fundraising campaign, any amount will be welcome. And if you don’t (or would love to but can’t), that’s okay. Do what you can where you can and wish her joy in her freedom.

It’s variant day at the Covid Cafe

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Welcome to the Covid Cafe, my friends. We have two variants on the menu today.

 

BA.5

Our first variant, BA.5, has gotten better than previous versions at evading both the vaccines and the immunity people acquired from earlier infections. But where previous omicron variants tended to stay in the upper respiratory tract, making it somewhat milder, BA.5 has picked up some mutations from the delta variant–that’s the most damaging variant to date–and it’s very pleased with them, thanks, and with itself for being so clever. 

They may be the reason it’s better at infecting cells than those respiratory-type omicron variants, and why it may be more serious. 

Seeing it circle back in this way doesn’t make me want to go out and celebrate. On the positive side, though, the current vaccines do still protect against its worst effects. But sensible people are recommending masks, ventilation, and distance–all those things governments and a lot of our fellow citizens have gotten bored with. 

 

Irrelevant photo: thistle with bee

BA.2.75

Are we having fun yet? 

Our second variant is BA.2.75. It seems to spread quickly and to evade immunity. How hard it hits people is yet to be determined. It’s also called Centaurus. I have no idea why and my brain isn’t willing to expend any bandwidth on it, but since it’s also possible that the thing has peaked, it has a second name: scariant. 

Come fall, updated vaccines are expected to target the omicron mutations. I’m in line already, and rolling my sleeve up.

 

However

Efforts to create a pan-coronavirus vaccine have slowed down for lack of funding, lack of any sense of pressure, and lack of even marginal good sense. The current vaccines are still keeping death and destruction to a minimum, and hey, that’s good enough. Let’s just stagger on.  I could toss in a quote or two here, but hell, you get the point. Follow the link if you like. It’s find-your-own-quote day here at the cafe.

In addition, testing candidate vaccines won’t be as easy it was at the beginning of the pandemic because Covid isn’t raging through populations the way it was. Pre-existing immunities make their effectiveness harder to measure.

 

Other mutations

A team that’s been analyzing millions of omicron samples in order to study its mutations reports that omicron alone has 130 sublineages. A member of the team, Kamlendra Singh, thinks vaccines might become less effective over time.  

“The ultimate solution,” he said, “will likely be the development of small molecule, antiviral drugs that target parts of the virus that do not mutate. While there is no vaccine for HIV, there are very effective antiviral drugs that help those infected live a healthy life, so hopefully the same can be true with COVID-19.” 

Singh helped develop CoroQuil-Zn, a supplement that infected people can take to help reduce their viral load. It’s currently being used in India, southeast Asia, and Great Britain and is waiting for FDA approval in the United States.

A virologist writing in the Conversation agrees, at least in part, saying that vaccines targeting recent variants will inevitably fall behind as the virus mutates. “Vaccines that generate antibodies against a broad range of SARS-CoV-2 variants and a cocktail of broad-ranging treatments, including monoclonal antibodies and antiviral drugs, will be critical in the fight against COVID-19.”

 

Long Covid news

Long Covid’s too stale for the cafe, but it’s not growing mold yet, so let’s have a nibble out here in the alley. 

The BMJ (formerly known as the British Medical Journal) has summarized 15 studies showing that the vaccinated are less likely than the unvaxxed to end up with long Covid. That’s most true of people over 60 and least true of people between 19 and 35. 

Long covid can range from annoying to life changing (in a bad way, in case that’s not already clear; it won’t make you grow wings or develop superpowers). It also ranges from transient to no-end-in-sight. In the UK, 2% of the population has reported having it and in the US, that’s 7.5%. 

Or by another count, 2 million people in the UK have it. That may or may not work out 2%. Don’t worry about it.  

Why is the percentage in the UK so different from the one in the US and why don’t I care if the UK numbers match? Because no one’s tracking long Covid systematically. It can get pretty weird out there.  

With that out of the way, let’s talk about the important stuff: “hy did the British Medical Journal change its name? I don’t know, but since my father did the same thing, I shouldn’t roll my eyes about it.

Which is unlikely to stop me. Especially since my father didn’t change his name to an abbreviation,but to the last name I use although I have no deep-rooted claim to it.

On the positive side, that bit of history means I know for a fact the Josh Hawley isn’t a relative–even a distant one.

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In the absence of systematic tracking, a UK study compared a big whackin’ number of people’s medical records to see what they could learn about long Covid. 

Among other things, they were able to add 42 symptoms to the existing list. (Yeah, progress comes in some annoying colors.) The new ones include hair loss, reduced sex drive, erectile problems, swelling limbs, and bowel incontinence.

I did tell you it could be serious, didn’t I? You should listen to me. 

They also organized the symptoms into three categories: 80% of the people with long Covid symptoms had a broad spectrum of problems, from fatigue to pain; 15% had mental health and cognitive problems, from depression to brain fog; and 5% had respiratory problems.

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A small study treated long Covid patients with cognitive symptoms by using hyperbaric oxygen therapy, and the results were enough to give a person hope. The group that got the real treatment had “significant improvement in their global cognitive function and more cognitive improvement related to their specific damaged brain regions responsible for attention and executive function,” along with improvement in their energy, sleep, and psychiatric symptoms.

The patients who got the placebo treatment didn’t, although they did get a simpler sentence with no fancy language or quotation marks.

The treatment, unfortunately, isn’t something you can set up in your garage. It involves five treatments a week for two months in a machine that looks like a mid-size submarine. 

 

Protective actions you never thought of

Covid is less likely to kill or hospitalize people who fast at least one day a month than it is to do either of those things to those of us who think eating should be a daily practice. This may be because fasting reduces inflammation or it may be attributable to a couple of other reasons that you can look up yourself by following the link.

The bad news? The study involved people who’d been fasting intermittently for decades. It offers no information on people who took it up twenty minutes before becoming infected.

 

A bit more about vaccines

I’ve found enough shreds of good news that I can spare you one more piece: Vaccination, although it doesn’t prevent Covid, does seem to reduce the odds of infection. Not by as much as we’d all like, but I don’t know about you, I’ll take any percentage I can get.

You want details, though, right? Fine: In the second wave of the pandemic, vaccinated National Health Service employees who worked face to face with patients were 10% less likely to get infected than unvaccinated ones. And I’ll remind the assorted anti-vaxxers who pop up here periodically that the primary value of the vaccines lies in preventing death and serious illness, which (do you really need to be reminded?) is not a bad thing. They haven’t turned out to create sterilizing immunity, and that’s a damn shame but doesn’t mean the people who recommend them should be burned at the stake. 

No one’s offered to do exactly that to me yet, but the conversations do have a way of turning hostile. Or starting out that way. A recent comment opened with, “Stop lying, Ellen.”

And I appreciated the suggestion, since hadn’t thought of that myself. I also appreciated the generous and high-minded approach to discussion. Let it be a model for us all.

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But forget about me. Ben Neuman, a professor in the Department of Biology and chief virologist at the Texas A&M Global Health Research Complex, has another reason to get vaccinated: “to avoid the brain damage that often comes with COVID. During a natural infection, the immune response around your brain will starve cells of oxygen, and the effect is that you will lose a lot of gray matter—something like a stroke. Unlike a stroke, where usually only one part of the brain is affected, COVID seems to affect the entire brain, so you don’t necessarily lose one thing, like the ability to control nerves on one side of the face, you lose a bit from everywhere. COVID-associated brain damage only happens with infection, not with the vaccine, and having a strong set of white blood cells trained by the vaccine is likely to be helpful in preventing brain damage.” 

 

Okay, but what about monkeypox?

Let’s forget about whether monkeypox is a pandemic or an epidemic or just a damned nuisance. Those–especially damned nuisance–have technical definitions that, for a bunch of free-range blog readers, aren’t the most useful standards. The more pressing question is, How much of a problem is this likely to be?

After what sounds like a lot of internal argument, the World Health Organization declared it a global health emergency. The disagreement, as far as I understand it, comes from this: Diseases that spread on the air (think Covid or flu) are bigger worries. They’re easy to catch. Monkeypox is spreading through touch. That doesn’t make it fun and I don’t recommend rubbing up against anyone with a rash right now, but it does mean transmission’s slower and more difficult.

It’s also less deadly than Covid. 

If that’s not reassuring enough, existing vaccines can slow the spread–or they can once production catches up with the need.

On the other hand, it’s popping up in a wide range of countries and seems to have surprised the experts.

Monkeypox could (I’ve read) go in two directions: It could establish itself in many countries as a sexually (an also not-sexually) transmitted disease that people will have to deal with or it could be gotten under control. The first prospect isn’t fun, but it’s still not Covid all over again.

What causes long Covid?

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A lot of clever people are chasing the cause of long Covid, but so far the virus is outrunning them–and we’re talking about a virus, remember, that doesn’t have a degree in either science or medicine and that’s rumored to be illiterate.

Not that I’m making fun of those clever people. Long covid scares the bejeezus out of me and I’m grateful for the work they’re doing, but I’m also painfully aware that they haven’t even found all the puzzle pieces yet, never mind gotten them in the right place. 

Puzzle pieces? What happened to the chase metaphor? 

I couldn’t keep up with it and had to grab something else off the shelf where I store my cliches.

Irrelevant photos: Morning glories–or as the British call them, bindweed.

But back to our actual subject: The clever folk are at the stage where they have theories, but that’s not all bad. Theories open up possibilities and they’re a good place to start. Let’s check in with a few of them:

Pediatrician Danilo Buonsenso noticed that some of his patients–these are kids, remember, with their habit of showing up at pediatricians’ offices and licking their fingers before touching the toys–

Where were we? Some of his patients who’d had mild Covid cases were left short of breath, exhausted and sporting a variety of other symptoms. That’s not common in post-Covid kids, but what with him being a doctor and all, and one who specializes in infectious diseases (I know, I didn’t get around to mentioning that earlier)–well, the kids he’s most likely to see are the ones who are sick, which skews the sample.

As the article I stole this from explains it, “He now suspects that, in some of them, the cells and tissues that control blood flow are damaged and the blood’s tendency to clot is amplified. Minute blood clots, leftover from the viral assault or fueled by its aftermath, might be gumming up the body’s circulation, to disastrous effect from the brain to joints. ‘In some patients we have specific areas where no blood flow comes in’ or the flow is reduced, Buonsenso says. 

Another theory comes from  microbiologist Amy Proal: that the virus hangs on in the body after the acute stage of the infection is over. Studies show that “the virus is capable of persistence in a wide range of body sites,” she said. 

A third theory comes from Chansavath Phetsouphanh, who’s observed that the immune cells of long Covid patients are still on high alert as much as eight months after they first tested positive. 

A fourth theory comes from Nick Reynolds, who found amyloid clumps in the brains of people with the neurological symptoms of  long Covid. They’re similar to the clumps that cause Alzheimer’s disease and dementia. That doesn’t necessarily mean the patients will have lasting damage or that the drugs used to treat those diseases help in these different circumstances. On the other hand–well, who knows at this stage? It might.

Are any of the theories right? Are all of them showing us a small piece of a large picture? Tune in sometime later–possibly a lot later–for the next exciting episode of What’re We Going to Do to Get Out of This Mess? And keep in mind that once the clever people figure out what’s driving long Covid, they or some colleagues still need to figure out a treatment.

Don’t you just feel better after you hang around here? 

In the meantime, an assortment of studies are following up on the possibilities these theories raise. Wish them well, please. It won’t make any material difference, but it might make you feel like you contributed to the effort.

 

Numbers

How many people actually have long Covid? Answering that depends on how we define long Covid, but let’s set that aside. We’re not scientists–or most of us aren’t and anyone who is must be slumming. We can get away with being hazy when it suits us. 

In May, the U.S. Centers for Disease Control and Prevention rampaged through the medical records of some 2 million people and reported that at least 1 in 5 people who’d had Covid came away with long Covid symptoms. For some of them, that meant struggling but hanging onto their normal lives. For others, it meant struggling, only with nobut at the end of the sentence.  

In the UK, some 2 million people have long Covid according to the Office for National Statistics, which does have a definition of the thing but never mind what it is. We’re not scientists, remember? Or else we’re slumming and will have to put up with the way other people’s minds work. 

Proal (remember her?) said, “I consider Long Covid to be a massive emergency.”

 

Who’s most at risk of long Covid?

A small study from Japan found that being over 40 increased the odds. So did being over 60. Since I’m over both (it took a while, but I got there), this is not good news where I live. 

In contrast to other studies, it didn’t find sex to be a big factor, although long Covid seemed to have a harder psychological impact on women than on men. 

In contrast, a UK study found that being female, being in poor pre-pandemic mental and physical health, being obese, and having asthma all increased the odds of long Covid. 

Do the two studies contradict each other? Partially. The data they’re working from is sketchy, but the issue’s important enough to use it anyway. Take them for what they’re worth.

The UK study finds that between 7.8% and 17%of the people who reported having Covid also reported symptoms that lasted longer than longer than 12 weeks, and between 1.2% to 4.8% reported  that the symptoms were debilitating. 

Why the range? I haven’t a clue. I find numbers debilitating.

The numbers were lower when they worked from doctors’ records as opposed to self-reports, but that could be because doctors weren’t reporting long Covid before November 2020.

 

A shred of good news

The omicron variant may be less likely than delta to cause long Covid–20 to 50% lower. To put that another way, with omicron, 4.4% of cases turned into long Covid. With delta, that was 10.8%. But that’s still a shitload of people.

 

More numbers: What have vaccinations ever done for us?

Well, in the first year they were available, they prevented an estimated 19.8 million Covid deaths. That’s based on excess deaths in 185 countries and territories. 

Excess deaths? It’s the figure you use when you don’t have any other consistent or reliable way to count the pandemic’s impact. In rough terms, it compares deaths during the pandemic to deaths in some pre-pandemic year. It’s imperfect, but the other systems are even more so. If you don’t use it, you end up counting the number of people who (if they weren’t dead) could brag about having Covid listed on their death certificates. You miss a lot of people that way. You can also count the number who are known to have had Covid and who then went on to die, leaving you counting people who died because a brick fell on their head and missing some who died undiagnosed. Or you can count people who die within 28 days of a diagnosis and miss the ones who took too long to die as well as include a few who had unfortunate encounters with bricks.

The UK switched methods midway through the pandemic, probably because the government wanted it to look like fewer people had died and the new way yielded a lower number. 

Yeah, I have absolute faith in the people leading the country. They’ll do whatever works best for them and to hell with everything and everyone else.

Not only is none of the systems accurate, different countries rely on different definitions of a Covid death, raising hell with international studies. 

But let’s put death on the shelf for a minute and go back to vaccines and lives saved, which is what we’re pretending to talk about. The study estimates that 599,300 more lives would’ve been saved if the world, lower case, had met the World (upper case) Health Organization’s target of getting  two or more vaccine doses to 40% of the population of every country by the end of 2021. 

By now, 66% of the world’s population has received at least one dose of vaccine.

 

More numbers

In 2020 and 2021, Covid was the third leading cause of death in the United States, crossing the finish line after cancer and heart disease. So it gets a bronze medal and modest bragging rights, but not as much glory as it was hoping for. 

The future of Covid, and some updates on the fight against it

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A while back, I summarized a theory that the Covid virus is unlikely to pick up the number of mutations it would need if it’s going to evade the vaccines. I felt a lot better after reading that, but let’s look at an opposing theory so we can all get depressed together.

This theory raises the possibility that in addition to the virus picking up small mutations over time (that’s called antigenic drift), there’s the possibility of antigenic shift, which involves more dramatic changes caused by the virus recombining with other human coronaviruses. Viruses do that. Basically, they hold a swap meet. Or a bring and buy sale if you’re more used to them. They don’t actually use money–their evolution hasn’t brought them to that exalted stage–but they do trade strategies for making money-using creatures sick.

If they swap the right bits of knowledge, the current crop of vaccines will need to be re-engineered. We’ll all move back to Go and start the game over again.

It’s also possible that Covid will infect animals we share space with and then cross back to humans in some more powerful form. That’s reverse zoonosis.

Irrelevant photo: Japanese anemone, with a bite out of it. That’s to prove the beauty of imperfection and all that deep philosophical stuff.

As a general rule, long-term evolution favors viruses that don’t make their hosts too sick. The very sick tend to crawl away somewhere and keep their germs to themselves, which (seeing this from the germs’ point of view) isn’t an efficient use of a host. And the dead die, which also limits their opportunities to share. That’s even more inefficient. 

From that base, any number of people argue that (after a trail of death and destruction) epidemic diseases get milder over time. Everyone who doesn’t die lives happily ever after. They point to the 1918 flu epidemic (or the Black Death, or some other cheery moment in human history) and assure us that this is the natural order of things. 

According to this theory, that is indeed one possibility but it’s not the only one. 

The British government’s group of scientific advisors, SAGE, thinks the virus isn’t likely to become less virulent in the short term. (Virulence isn’t about a disease’s ability to spread–that’s transmissibility. It’s about how sick it makes a person.) SAGE considers that a long-term possibility, but it also considers it a realistic possibility that a more virulent strain will emerge. 

Sorry. I don’t create the possibilities, I just write about them.

So what direction will it evolve in? Basically, no one’s sure.  

However, all isn’t lost. A lot of work’s being done on how to cope with Covid.

 

The Covid-killing mask 

A group of researchers have created a surgical mask that deactivates not just the Covid virus but any enveloped virus (that includes the flu), plus some antibiotic-resistant bacteria like a couple of the staphylococci. 

What’s an enveloped virus? I’m so glad you asked, because I have an answer right here in my pocket. It’s “any virus in which a nucleoprotein core is surrounded by a lipoprotein envelope consisting of a closed bilayer of lipid derived from that of the host cell’s membrane(s), with glycoprotein.”

You’re welcome. I didn’t understand it either, but I’m glad to get it out of my pocket.

The masks are the first ones that don’t just protect both the rest of the world from the wearer but also protect the wearer from the rest of the world. 

Okay, not completely, but virus- and staphylococcuses-wise, it will. If someone’s trying to hit you on the head with a hammer, the masks are no help at all.

I’ve seen masks promoted as antiviral. Advertising copy for masks with a copper layer, for example, talks about copper’s antiviral properties without actually claiming that the masks will kill Covid. From what I’ve read, they don’t have enough copper to do more than provide carefully worded hype.

The new masks are called FFP Covid masks, they come in adult and child sizes, and according to the article I read they’re very affordable.

How affordable is very affordable? After bumping around the internet for a while, I found some on sale for one euro. That’s not bad, but whether it’s affordable depends on how much you have in your wallet, and how long it takes to renew itself once you pull some of it out to buy masks.

Not to mention how many other calls you have on it.

Are the masks reusable? That’ll affect people’s opinion of their affordability, and the definitive answer is, I’m not sure. They look disposable, but that’s strictly a guess. 

Another limiting factor for most of us–since this is an English-language site–is that the only place I could find them for sale is in Spain, which is where they were developed. Presumably they’ll make their way into the rest of the world at some point. 

Still, whatever the mask’s immediate impact, it’s an important step.

 

Quick updates

Multiple new Covid treatments and vaccines are in the works. Here’s a sampling:

An inhalable powder works against Covid, MERS, and one version of the flu. In animals. It has yet to be tried in  humans–at least in this form. As a pill, it’s used against leukemia, but when you turn it into a powder and inhale it, it becomes a whole ‘nother thing. In addition to landing in a different part of the body and possibly needing a different dose, it opens up the possibility of Covid treatment taking on some bad-boy chic: You roll up a hundred-dollar bill and snort your meds.  

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Repurposing a drug that’s already in use to treat a new disease isn’t, it turns out, as simple as it sounds. You may have to shift from a pill to a powder. You may need a dose so high that it turns toxic, at which point you may need to rethink the whole idea.

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Another drug that’s already in use, this one to treat fatty substances in the blood (no, don’t ask me), could reduce Covid infection by 70%. Could. So far, it’s worked only in human cells in the lab. Two clinical trials are underway, though.

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An antiviral called molnupiravir halves the chances of an infected, high-risk person needing hospitalization or dying from Covid, and Merck will be asking for emergency approval in the U.S. Molnupiravir doesn’t seem to be as effective as monoclonal antibodies, but because it’s a pill it can be used outside of hospital settings, so it’s much easier to use.. 

Down sides? It costs $700 for a five-day course of treatment, which makes it cheaper than and easier to type than monoclonal antibodies, but it’s still expensive. And some experts are warning about potential side effects. Plus it doesn’t seem to help patients who are already sick enough to be hospitalized. So although it’s gotten a lot of press coverage and is, without question, important, it’s not the answer to all problems.

Other antiviral pills are also in the works. 

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Vaccines? Why yes. A new vaccine in development uses only a single shot and can be stored at room temperature for up to a month. In trials with primates, it gave near-complete immunity that stayed at its peak level for eleven months.

It’s called an AAVCOVID vaccine, AAV being the vector the vaccine uses. 

What am I talking about? The vector’s the horse the vaccine rides in on. Or if you want to sound marginally more sensible, it’s the  strategy the developers use. I’m not going to try to explain this one, because I’m pretty sure I’ll get it wrong. Let’s just say that if this strategy works, it’ll help get the vaccine out to places where refrigeration’s a barrier. 

The team that’s developing it is also exploring needle-less delivery systems.

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Another vaccine in the works is using a new model that I’d love to explain but I’m not even close to understanding it, so let me quote: It combines “the advantages of the two types of traditional vaccines—virus-based vaccines and protein-based vaccines—by preparing a bacterial protein that self-assembles into a virus-like particle. By displaying a COVID-19 protein on the surface of this virus-like particle, researchers produced a novel vaccine that is well recognized by the mammalian immune system, but yet does not have any viral infectivity.”

If I understand that correctly, it behaves like one of those transformers kids used to play with, and for all I know still do. You introduce it into a body as a motorcycle, it clicks a few of its own pieces, turns green, and suddenly it’s the Hulk, chasing down unsuspecting Covid viruses.

Early tests show it being effective against the Covid variants and setting up a strong immune response.

Come to me anytime you need a high-grade scientific explanation.

 

Long Covid numbers

I’ve found some numbers on long Covid, finally: About a third of the people who come down with Covid get at least one long Covid  symptom. 

First question, who are we talking about when we say people who get Covid? As far as I can tell, it’s people who actually got sick, because the article talks about them recovering. So I think we can rule out anyone who gets infected but stays asymptomatic. 

We need all the good news we can get, so let’s play nice and say thanks for that.

Second question, how are they defining long Covid? You get to pick from nine core symptoms, and they have (or it has, if you only get one) to last at least 90 days. The most common ones are breathing problems, abdominal symptoms, fatigue, pain, and anxiety and depression.They’re more common in people who’ve been hospitalized and slightly more common in women than in men. The same symptoms occur after the flu, but they’re 1.5 times more common after Covid.

Next shred of good news? If long Covid symptoms are more common in people who’ve been hospitalized, less than a third of people with milder symptoms are likely to come down with it. 

Has anything like long Covid happened before?

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Well, yes or I wouldn’t ask the question. Let’s start with the Russian flu, which ran from 1889 to 1892, and its after effects.

 

The Russian flu

Geographical names for pandemics have gone out of fashion, since they’re generally wrong and lead people to blame entire countries for things they suffered from themselves, but the Russian flu was at least first spotted in Russia and to date no one seems to have gotten around to renaming it. So, Russian flu it is. 

Извините, Россия.

That doesn’t make the name correct, though. The Russian flu might not have been a flu at all but a coronavirus. And just to confuse the issue a bit more, the flu was also called the grippe at the time. That becomes relevant in a few paragraphs.

Whatever we call it, the Russian flu seems to have been highly infectious. Half the population of St. Petersburg got it, and it (that’s the disease, not half the population of St. Petersburg) moved across Europe, arriving eventually in Britain. Not because it had been watching Downton Abby and wanted to tour the great houses. Diseases don’t have destinations or intentions or TV sets, and Britain wasn’t its final destination anyway, just a stopover. I give Britain special mention because it’s what I allegedly write about here, although the pandemic’s led me off in other, less predictable directions. 

The Russian flu is now considered the first modern pandemic (no, we’re not going to stop and define that), spreading worldwide along the paths so helpfully laid out by train lines, roads, navigable rivers, and steamships, and demonstrating that it was spread by human contact and by the wonderful ways that humans could now travel.

The Black Death was green with envy. 

Irrelevant photo: roses

In a nifty preview of what would happen with Covid, public health officials in the US watched the virus cross Europe and played it down. It was a particularly mild strain of flu, they said. And when it inevitably disembarked, without passport or visa, on American soil, they swore the first cases were either common colds or just a seasonal flu. 

Nothing to worry about, folks. It’s all under control.

The New York Evening World wrote, “It is not deadly, not even necessarily dangerous. . . . But it will afford a grand opportunity for the dealers to work off their surplus of bandanas.” 

Yeah, I’m having flashbacks to the beginning of the Covid pandemic myself.

This wasn’t a mild disease. Worldwide, an estimated 1 million people died. A survivor said, “I felt as if I had been beaten with clubs for about an hour and then plunged into a bath of ice. My teeth chattered like castanets, and I consider myself lucky now to have gotten off with a whole tongue.”

It also had serious after effects and some uncounted but substantial number of people had them. More than three months after having been ill, the English women’s rights campaigner Josephine Butler wrote, “I am so weak that if I read or write for half an hour I become so tired and faint that I have to lie down.” 

If exhaustion wasn’t bad enough, some people had the added insult of insomnia. 

A Victorian doctor, Morell Mackenzie, said the flu seemed to, “run up and down the nervous keyboard stirring up disorder and pain in different parts of the body with what almost seems malicious caprice.” 

That sounds like he’s describing the flu itself, not the after effects, but the Lancet, which is a medical journal and can be assumed to know what it’s talking about, put that quote and the next one inside a discussion of the after effects. 

Another doctor, Julius Althaus, wrote, “There are few disorders or diseases of the nervous system which are not liable to occur as consequences of grip”.

The collection of symptoms went by an assortment of names: neuralgia, neurasthenia, neuritis, nerve exhaustion, grippe catalepsy, post-grippal numbness, psychoses, prostration, inertia, anxiety, and paranoia. The range on offer backs up my theory that when you can’t cure a disease it helps to change its name from time to time. 

We’d be on shaky ground if we tried to sort the after effects of the Russian flu from–well, everything else that might’ve been available, including psychosomatic problems, tight corsets, and zombies, but observers in the mid-1890s blamed it for everything from a high suicide rate to general malaise. According to the Lancet article, the image of England at the time was “of a nation of convalescents, too debilitated to work or return to daily routines.” 

I would have assumed that the description applied only to the upper class, who could afford not to return to work or daily routines, but what happened in Tanzania (called Tanganyika at the time) shows that I’d be underestimating what post-viral syndromes can do to a person.

 

The 1918 flu

Let’s back up briefly. 

The 1918 flu epidemic used to be called the Spanish flu and sometimes still is. It didn’t originate in Spain, it’s just that Spain put up the first Instagram post. But it was at least genuinely influenza.

How serious was it? Worldwide, at least 50 million people died. About half a billion people—that was a third of the world’s population–were infected. So no, this is not the pandemic you’d want to challenge to a wrestling match. 

Like the Russian flu, its after effects were fierce. They included apathy, depression, tremors, restlessness, and sleeplessness. 

A New Zealand book collecting people’s experiences includes references to “loss of muscular energy” and “nervous complications.” Along similar lines, a South African collection includes this: “We were leaden-footed for weeks, to the point where each step meant a determined effort. . . . It also was very difficult to remember any simple thing, even for five minutes.”

But they got off lightly compared to people in Tanzania, where the flu was followed by a wave of exhaustion so severe that in some parts of the country people couldn’t plant when the rains came and in others couldn’t harvest when the crops were ripe. The result was a two-year famine, called the famine of corms, named after a part of the banana plant that people ate in desperation. 

One strand of post-epidemic symptoms was called encephalitis lethargica–EL for short–or sleepy sickness. It left people not fully asleep but not what you’d call awake either. They were aware of their surroundings but not functioning in anything like a normal way. 

Worldwide, an estimated 500,000 people had EL. A third died, a third recovered, and in the final third the symptoms went on.

Unborn children were also affected. A 2009 study looked at people who, based on when they were born, could have been exposed to in the womb to the 1918 flu. Compared to people born either slightly before or slightly after them, they were 25% more likely to have heart disease after the age of 60. They were more likely to have diabetes. They were, on average, shorter. They had less education and their “economic productivity” was lower. I think that means they made less money. I can’t think how else anyone would measure it. 

 

What does that mean for the Covid pandemic?

No one knows yet how many people have long Covid, which is of several names for Covid’s after effects. No one knows how many people will recover and how many will carry at least some of the effects with them through life. 

No one has a clue what the effects will be on children born during or just after the pandemic, or if there’ll be any, and I’d be surprised if many people are worrying about that yet. They’re kind of busy with more immediate problems.

No one’s even agreed on a definition of long Covid.

It is known that people who have mild or even asymptomatic cases can get long Covid, and that children can. 

It is, as one researcher put it, “One of the reasons I worry so much for people with long-Covid is the . . . uncharted aspect of it. . . . It’s one of the reasons why I do worry when I see people being laissez faire, saying ‘Well, if we’ve got [to] the stage where people aren’t dying, and aren’t filling up the intensive care units, do we need to care?’ And the answer is, I think, until we’ve got more data, we don’t know how much we need to care.

 

A recent study identified 203 symptoms in 10 organ systems. After seven months, many people in the study still hadn’t gotten back to their earlier levels of functioning. When the study was conducted, 45% had to work a reduced schedule and 22% weren’t able to work at all. 

And in a peripherally related seam of worries, a study has called attention to the estimated 1.5 million children around the world who’ve lost a parent or a grandparent who was either raising them or lived with them. It’s an overlooked side effect of the pandemic.

We don’t need zombies, folks. This is scary enough.

Are the fully vaccinated likely to get long Covid?

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A bit of scientific brooding over Covid’s statistical tea leaves tells us that the chances of getting long Covid if you’re fully vaccinated are probably small. 

But with the emphasis on probably.

Was anyone other than me worried? After all, the statistics tell us that a vaccinated person who does catch Covid will probably have a mild case. Unfortunately, though, mild cases fairly often leave people with long Covid. 

So far, the information that’s coming in is anecdotal, and the experts say that it’s too early to be certain. In six months, it’s possible that a significant number of vaccinated people will start showing up with long Covid. It’s also possible that they won’t. 

So stay tuned. That’s not the reassurance I was hoping for but it’s the best we’ve got. 

Irrelevant photo: traveler’s joy

 

Do young people have Get out of Covid Free cards?

By now, we all know that young people are unlikely to get seriously frightening cases of Covid, at least when compared with old coots. 

But that doesn’t mean they’re immune. Like anyone else, they’re liable to come down with long Covid even after a mild case of the virus, and the small number who are sick enough to be hospitalized are almost as likely to have organ damage as the old coots are–almost 4 out of 10 of them. 

The message here is that Covid is not the flu. And that young people don’t have a free pass on this.

Young, by the way, is defined as anywhere between 19 and 50. Which from where I stand looks younger all the time. 

 

Taking quarantine seriously

Australia and China have decided that the new Covid variants are too contagious for hotel quarantine to be safe. They’re planning special quarantine centers. 

Compare that with the way Britain’s treated quarantine, which ranges on the strict end from hotel quarantine after sharing air with passengers who won’t be quarantining to, on the loose end, go home and look in the other direction when you pass other people on your way there.

 

The Covid news from Britain

Over twelve hundred scientists from around the world have signed a letter objecting to Boris Johnson’s policy of lifting all Covid restrictions on July 19. It will, they say, help spread the Delta variant around the world.

As professor Christina Pagel put it, “Because of our position as a global travel hub, any variant that becomes dominant in the UK will likely spread to the rest of the world. . . . UK policy doesn’t just affect us–it affects everybody. . . .

“What I’m most worried about is the potential for a new variant to emerge this summer. When you have incredibly high levels of Covid, which we have now in England–and it’s not going to go away any time soon–and a partially vaccinated population, any mutation that can infect vaccinated people better has a big selection advantage and can spread.”

Some of the experts described the policy as “murderous” and “herd immunity by mass infection.” The words unscientific and unethical also came up. If you pay careful attention, you’ll come away with the impression that they’re pretty pissed off. Not to mention scared. 

In the meantime, the number of people hospitalized with Covid in Britain is doubling about every three weeks and could reach what England’s chief medical officer, Chris Whitty, called “quite scary numbers.” Soon.

The government’s been telling us that vaccination has uncoupled the train car of hospitalizations from the accelerating engine of Covid cases. The problem is that they watched too many westerns when they were young, and uncoupling the cars from a runaway engine solved any problem involving railroads. 

Unfortunately, this is a pandemic, not a train. Or a western.

More cautious voices say they’ve weakened the link between Covid cases and hospitalization, but not uncoupled it. 

On Friday of last week, we had 50,000 cases, which is the highest  number since January. And 49 Covid deaths. 

Office for National Statistics data suggests that 1 in 95 people in England had Covid last week. I’m not sure why it only suggests that, but I’ve learned not to mess with the wording of things I don’t understand. 

The health secretary, Sajid Javid, is one of those new cases. He just came down with Covid. After having visited a care home earlier in the week–a visit that I’d guess was more pr and photo op than anything necessary. 

He’s fully vaccinated and says his symptoms are mild. He’s now self-isolating. No word on how things are going at the care home.

 

So what about Britain’s world-beating Covid tracing app?

Well, it’s been pinging a lot of people and telling them they’ve been exposed to Covid. That means they should self-isolate. Which means they should miss work. Which means the places they work, a lot fo which are already short on staff, are shorter on staff.

Which means no one’s in a good mood.

There was talk–quite definite-sounding talk–about dialing down the app’s sensitivity. People were uninstallling it, the government said, so as not to be bothered by its nagging. It was too sensitive, they said. The number of people pinged had grown by almost 50% in a week, to over 500,000. Transportation, trash collection, and health care were being affected, along with meat processing and car manufacturing. 

Then there was talk about not dialing down its sensitivity. It wasn’t too sensitive. The number of cases had grown, so of course the number of people exposed to Covid had grown right along with it.

So, the government mumbled to itself, what if we say that people who’ve had both their vaccinations are exempt from having to isolate themselves? They’ll get pinged, but they’ll be able to work? 

Last I heard, it hadn’t answered the question and was still mumbling. In other words, it’s taken the worst elements of both choices: It’s changed nothing but called the usefulness of the app into question and by saying lots of people are uninstalling it, it’s encouraged people to uninstall it. 

Will the pandemic ever end?

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The pandemic, it turns out, is not a war. It won’t end in either complete victory or in a negotiated treaty. That leaves us with no clear line between pandemic and not-pandemic. 

The consensus among public health experts and epidemiologists is that Covid will, at best, turn into a background danger, something that pops up in localized and seasonal outbreaks that we have to live with and work around. 

But that’s the best outcome, not the guaranteed one. Everything depends on how many people get vaccinated and what variants develop. And because no variant can be contained in one country or region, one country’s problem is every other country’s problem.

According to Alessandro Vespignani, professor of physics, computer science, and health sciences, “Vaccination of the low- and middle-income countries is the most altruistic thought and at the same time, the most selfish. Because we have to protect those populations so that we can protect us.” 

Irrelevant photo: The Bude Canal

So that’s a definite maybe on the pandemic ending, not a resounding yes. Pack away the trumpets, the confetti, the Mission Accomplished banners. That banner stuff looked a little silly anyway, back when Bush Jr. tried it. And keep your eye on what’s happening in the worst prepared countries, because what happens there will be knocking on your door and mine in no time at all.

 

More on long Covid

First, the disclaimer: There’s no one definition of long Covid, so if this all seems a little murky, that’s because it is. Long Covid’s symptoms range from the annoying to the life-changingly disastrous, and at this point they all get lumped in together. Some of them go away after a while and others get milder. Some do neither–they set up housekeeping. 

If that sounds ominous, allow me to make the picture worse:

Almost a fifth of the people who caught Covid infections but had no symptoms show symptoms “consistent with long Covid” a month after they got infected. In other words, people who had no symptoms may be going on to develop long Covid. 

And 27.5% of non-hospitalized people with symptomatic Covid did the same thing, as did 50% of the people who were hospitalized. 

That comes from an analysis of medical insurance claims by 1.96 million people in the U.S. The weaknesses of the study are that it didn’t have a control group and that it only studied people who had certain kinds of insurance. In the U.S., what kind of insurance you have says a lot about your class, which in turn says a lot about how Covid hits you.

Did I say “class”? Sorry. Everyone in the U.S. is middle class. It’s just that a very few members of the middle class are obscenely rich, some are doing fine, some are just hanging on, and some are long-term broke.

I’ve been away so long. I sometimes forget. 

But back to the study. Its strength is that it’s huge. 

But you can’t look at it and say, “This group of people definitely had long Covid.” On the other hand, with no solid definition of long Covid, it’s hard to look at any group of people and say that. At the very least, it’s enough to make us stop and think about what we’re dealing with in the long term. The pandemic is likely to leave us with a long-term public health problem, something individuals, families, health systems, and governments will all have to deal with.

The report also “drives home the point that long Covid can affect nearly every organ system,” according to Dr. Ziyad Al-Aly, chief of the research and development service at the Veterans Administration St. Louis Health Care System. “Some of these manifestations are chronic conditions that will last a lifetime and will forever scar some individuals and families.”

Just to keep from scaring ourselves witless, let’s remember that some of the manifestations (that translates to symptoms) aren’t likely to leave scars forever. No one seems completely sure of how wide and how deep the problem of long Covid will go. It scares the hell out of me, but there’s no point in getting so scared we can’t function anymore.

If, in fact, we ever did function (she said cheerily).

 

So when do we go back to normal?

England–or its government, anyway–has put off lifting the last of its lockdown rules. That makes the prime minister very sad. He wanted to let us know that we all live in paradise, have enough money to live well, and are at our ideal body weight. 

Yea, every last lumpy one of us.

The postponement came because multiple experts have been warning of a possible third wave. Last I heard, England’s R number–the rate at which the virus is spreading–was estimated to be 1.4. Anything above 1 means the number of infections is growing. The numbers aren’t high yet, but the direction’s not good. 

If we do have a third wave, it’s expected to be caused by the more transmissible and possibly more dangerous Delta version of Covid. The hope is that keeping those last restrictions for a while means there’ll be time to vaccinate more people, preferably with two doses of a vaccine, not just one. 

 

Vaccine updatelets

In the region at the center of Britain’s outbreak, vaccination numbers have dropped in the last month. I’d love to give you more detail, but the article’s behind a paywall on a site I don’t want to subscribe to, so it’s headlines only on this. 

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People working in care homes in England will have to get vaccinated in the next 16 weeks if they’re going to keep working with patients–or in some cases, keep working at all. The only exceptions will be people with a medical reason not to get the vaccine. No one knows how this will play out, but assorted organizations of medical professionals are opposing it.

The requirement may be extended to National Health Service staff.

“Compulsion is a blunt instrument that carries its own risks,” the British Medical Association said. An (unnamed) NHS boss said it was setting up a confrontation with staff “at a time when you’re denying them a decent pay rise but also saying how much you love them.”

Both fields already have staff recruitment problems. That have been made worse by Brexit. And low pay. And at least in the NHS, pandemic working conditions. 

In early June, 89% of NHS staff was at least half vaccinated and 82% fully vaccinated. In adult care homes, that was 83% and 68%. 

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A new vaccine, this one made by Novavax, has come through stage 3 trials showing 90.4% effectiveness against mild and moderate Covid and 100% effectiveness against severe cases. It was tested against the Alpha, Beta, and Gamma variants. The Delta variant overslept and missed the test.

Delta will receive a failing grade but will be eligible to take the test the next time it’s scheduled. A spokesperson for the variant said, “Delta has other priorities at the moment and will be in touch when its schedule allows. It has no further comment at the present time and will not take questions.”

The Novavax is a two-dose vaccine. 

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A small study dropped hints that a third Covid vaccine does might give transplant patients a better immune response. People with transplanted organs have to take drugs that suppress their immune systems in order to keep their transplants from being attacked by the aforesaid immune systems. Two doses don’t seem to be enough to rev up their Covid immunity.

A larger study is planned. In the meantime, the people who understand these things are feeling hopeful.