Tag Archives: post-viral syndrome

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.

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.