Coronavirus Chronicles — COVID-19 and Careers

Not long ago, in India, screen star Rubina Dilaik began to receive hate mail for gaining around seven kilos, which amounts to, for heaven’s sake, only about 15 pounds. Plus, she had a good reason — she had recovered from COVID-19 and decided to treat her body gently for a while. But rather than express gratitude that the actress’s life had been spared, some of her alleged fans got all blamey and judgy. Via social media, she replied, in part…

You are relentlessly sending hate mails and messages , you don’t see my worth… you are threatening to leave fandoms coz I am fat now… Well , I am indeed disappointed that, FOR YOU, my physical appearance is far more important than my talent and my commitment to my work…

“Long covid is destroying careers…,” read a Washington Post headline last month, as journalist Christopher Rowland published a detailed profile of long-haul COVID patient Tiffany Patino, who had been ill for a year. She, her boyfriend, and their 14-month-old child had been living rent-free in a relative’s basement, saving up for their own place, and maybe even for a better car. But now, at age 28, she finds a walk to the playground unbelievably taxing, and going back to work is a distant dream. The reporter describes her as “exhausted, racked with pain, short of breath, forgetful, bloated, swollen, depressed.”

Rowland’s research showed that many Americans have what can fairly be called long-haul COVID, with a percentage of the victims “experiencing such unbearable fatigue and other maladies that they can’t work, forcing them to drop out of the workforce, abandon careers and rack up huge debts.” As Patino said, “My world shattered, and everything just came crumbling down.”

Help is not easily available to these victims of a “newly emerging chronic disease that has no established diagnostic or treatment plan.” If they were not already suffering from the general pandemic conditions, coming down with the disease, and being unable to shake off its effects, has definitely brought depression and anxiety into their lives. Rowland writes,

Insurers are denying coverage for some tests, the public disability system is hesitant to approve many claims, and even people with long-term disability insurance say they are struggling to get benefits. Often referred to as “long haulers,” they experience mild symptoms to begin with, then get stuck with months of chronic fatigue, shortness of breath, confusion and memory loss, erratic and racing heartbeats, radical spikes in blood pressure, painful rashes, shooting pains, and gastrointestinal problems.

The symptoms sometimes subside, lulling long haulers into a false sense of relief, only to come roaring back after performing simple chores like vacuuming a living room or raking leaves.

The victims are not just people with low-income service jobs. Rowland interviewed 64-year-old emergency medicine physician John Buccellato, who rapidly went from treating patients in Manhattan to experiencing profound disability and helplessness. He told the reporter that not only had the virus had taken his career, but he could no longer pay to park his car in a garage, or even keep up his medical insurance. This is what happened to the doctor:

A lawyer helped him file a disability claim with the Social Security Administration, which a member of his support team said was recently successful. Because he left work for medical reasons, he was not eligible for unemployment insurance.

Rowland interviewed a Baltimore teacher who “has blown through $12,000 in savings and is on food stamps.” She too was planning to apply for disability. But both the government and private insurers have been slow on the uptake, says the reporter:

[M]any patients applying for disability insurance benefits are initially denied and require lengthy appeals, according to patients, doctors and lawyers, in part because the medical community is still grappling with how to diagnose their symptoms.

Your responses and feedback are welcome!

Source: “Rubina Dilaik trolled for gaining weight,” IndiaTimes.com, 11/24/21
Source: “Long covid is destroying careers, leaving economic distress in its wake,” WashingtonPost.com, 12/09/21
Image by Michael 1952/CC BY 2.0

Coronavirus Chronicles — It Loves Kids Just the Way They Are

We have been hearing more and more about the strange affinity the coronavirus has for fat; and not just for patients afflicted by obesity and its co-morbidities, but for actual fat tissue stored in the body.

At the Jackson Laboratory (JAX) in Maine, scientific director Nadia Rosenthal has been exploring these relationships with the help of small mammals and the COVID Diversity Mouse Initiative. They study lab mice of eight different inbred strains who, as it turns out, each show a diverse set of responses to SARS-COV-2 infection. Vivien Marx reported,

In some strains, only the males get sick; in another only the females do. [I]n one mouse strain, “one guy just walked away, gained weight” says Rosenthal, not unlike an asymptomatic human. Some animals dropped weight but bounced back, whereas others dropped weight and died.

Last April, when that was news, the researchers have barely begun to analyze the data. Their findings might point the way to some clarity about why different kinds of humans react to the virus in so many puzzling ways. Sadly, nothing further has been published yet.

Easier to prevent than treat

Soon afterward, journalist Sumathi Reddy spoke with various pediatricians whose office visits had increased during a relative lull in the pandemic. They found alarming weight gains in children who had not been seen for a while. Not only were the pounds piling on, but there was more high blood pressure and elevated blood cholesterol, and worsening fatty liver disease, and cases where pre-diabetes had graduated to full-fledged Type 2 diabetes.

At Children’s Hospital in Philadelphia, hundreds of new kids were signing up for the healthy weight program, and first-time appointments were being made two or three months out. The biggest increase in obesity was among the 5 – to 9-year-olds. In the nation’s capital, kids who had been in the 10th or 20th Body Mass Index percentile were coming back in the 70-th or 80th percentile.

Doctors blamed too much snacking and too many disrupted routines. Children’s patterns of eating, activity, learning, and sleep had all been disrupted. Their access to rec centers, playgrounds and parks had been restricted. In some cases, parents had to be away at work too much for good home management. In other cases, parents were sick or deceased.

And of course, the effect of COVID-19 is not always exercised first on adults and then reflected onto children. No, kids catch it too — even healthy kids. Some young humans catch it and nobody knows, because they are asymptomatic and not routinely tested.

Doctors were saying things like, “We never saw this last year,” harking back to the innocent early days of the pandemic in 2020, when some people were even still holding onto the belief that children do not catch it at all. But they do — or rather, it catches them, enthusiastically. The virus does not scold or fat-shame an overweight boy or girl. If the virus had eyes, its eyes would light up at the sight of a chubby child, and without waiting for an invitation, it would climb aboard.

Your responses and feedback are welcome!

Source: “Scientists set out to connect the dots on long COVID,” Nature.com, 04/28/21
Source: “Kids’ Weight Gain in the Pandemic Is Alarming Doctors,” WSJ.com, 05/10/21
Source: “Eric Feigl-Ding,” Twitter.com, 08/12/21
Image by Michael Coghlan/CC BY-SA 2.0

Coronavirus Chronicles — Obesity Plus COVID-19 Plus More

Physician and scientist Eric Topol tends to regard what happens in New York State as a portent of the future. Just a few days ago, it was like this:

For new cases/capita, [New York is] leading the US. If it were a country, it would now be the 2nd highest in the world.

Among other problems, the child vaccination rate there is very low. The state has been having a bad time lately and the numbers are dismal. Here are some:

The hospitalization rate for 0-4-year-olds increased 791% from week of Dec. 5-11 to week of Dec. 26.-Jan. 1, 335% for those 5-11 years and 1047% for those 12-18 years during the same time period.

The health department’s Summary says that hospitalization due to COVID increased among every age group, “but none faster than for those 18 years and younger.”

The public becomes confused when there is not enough explanation of basic information. As just one example, when people read stats from different institutions, it is never clear how comparable the situations really are. Political jurisdictions are fiefdoms that make their own rules.

The child COVID statistics come with a note stating that if an individual was seen in the ER but not actually admitted, their COVID status would not show up in this particular dataset. Despite the old saying that “numbers don’t lie,” there can be a lot of both honest clumsiness and deliberate malfeasance before the numbers are posted. The Summary says,

It is unclear from these real-time admissions data whether COVID-19 was a contributing cause to the medical issue that necessitated hospitalization. This often requires in-depth medical chart review by clinical staff, after patients are discharged.

Laypeople are not trained to recognize subtle cues in how medical information is phrased. For instance, there is a difference between being hospitalized for COVID and with COVID. “With” means they came in for something else, a broken leg or whatever, and routine testing revealed the virus. It suggests that there must be an awful lot of asymptomatic carriers wandering around out there.

If you’re not scared yet

Here is something to ponder — a report titled “Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 years — United States, March 1, 2020-June 28, 2021.” The headline is talking about people under 18; pediatrics cases; kids; children; and the keyword is diabetes.

People with diabetes are more likely to have severe cases of COVID-19, and this, of course, brings us back to the cozy relationship between COVID and obesity, because obesity and diabetes are often linked. The report describes two collections of information that were used to get an idea of what is going on, and said,

Among these patients, diabetes incidence was significantly higher among those with COVID-19 than among those without COVID-19 in both databases.

The observed increased risk for diabetes among persons aged <18 years who had COVID-19 highlights the importance of COVID-19 prevention strategies, including vaccination, for all eligible persons in this age group, in addition to chronic disease prevention and management.

Your responses and feedback are welcome!

Source: “Eric Topol,” Twitter.com, 01/07/22
Source: “Pediatric COVID-19 Update,” NY.gov, 01/07/22
Source: “Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 years — United States, March 1, 2020-June 28, 2021,” CDC.gov, 01/07/22
Image by Philippe Put/CC BY-SA 2.0

Coronavirus Chronicles — Other Deep Dives Into Obesity Plus COVID

The relationship between obesity and the coronavirus is one that deserves attention. In numerous ways, the two pandemics are staunch allies who serve each other’s unwholesome purposes. Could any good possibly be attributed to either? Surprisingly, yes. Dyxon Hansell is a World Health Organization health adviser in Samoa, who told The BMJ (formerly the British Medical Journal) that Pacific Islanders have experienced health benefits because of COVID-19.

For instance,

[L]ockdowns have led to people cooking at home more, resulting in healthier meals. Some island governments are also offering free online training on how to provide healthy food and drink in schools; healthy diets and recipes for home preparation; and online ordering of healthy food for delivery. With people being at home more, they are also being encouraged to grow more of their own food.

In a previous post, we mentioned two of the authors of the Cleveland Clinic research paper about long Covid (PASC). They are Bartolome Burguera, M.D., and Kristin Englund, M.D. For Healio.com, Erin Michael asked about the treatment options for Long COVID. Dr. Englund answered,

Patients who present with a post-COVID 19 disorder come in with a wide variety of symptom-related complaints. There is not one specific treatment. The treatment has to be specifically directed for each patient.

This echoes a point we made about how helping people who have this condition can be a lengthy and intricate process, definitely not in the category of “one size fits all.” Dr. Englund emphasizes that, three or six months after ostensibly recovering from the virus, a person might fall ill with a totally different symptom. They may not connect the two events in a causal way. Some people with a mild case of COVID, or even an asymptomatic case, never know they had the virus. People don’t know what signs to look for, in themselves or anyone else. So, when another bodily system konks out, they don’t see the link to a past event that hardly made an impression on them at the time.

There are practical considerations. Medical diagnostic equipment comes with a hefty price tag, and when a machine is re-engineered to accommodate very large patients, of course, the expense goes up. Such equipment is not accessible everywhere.

Childhood Obesity News has also mentioned the hesitancy that many obese people feel about stepping on scales and undressing in front of doctors. The interviewer asked about barriers to care that may obstruct patients who need treatment. Dr. Englund replied,

Some patients may not feel comfortable bringing up their symptoms for fear of being seen as someone who complains or feeling of being judged… The prospect of traveling to an exam and coming in for further testing may be a difficult prospect for patients who have a very high BMI. Some of the evaluations involve certain studies — e.g., pulmonary function test, echocardiogram — that may be challenging for people who have a high BMI.

One of Dr. Englund’s concerns is that Long COVID symptoms may be falsely attributed to obesity alone, rather than share the responsibility with COVID. There is plenty of room for misunderstanding and misdiagnosis.

Your responses and feedback are welcome!

Source: “Covid-19 has made the obesity epidemic worse, but failed to ignite enough action,” BMJ.com, 03/04/21
Source: “Long COVID-19 among patients with obesity ‘may be missed or misdiagnosed’,” Healio.com, 09/17/21
Image by Christopher Dombres/Public Domain

Coronavirus Chronicles — Another Deep Dive Into Obesity Plus COVID

Research published in the summer of 2021 showed something about obese people — yes, even the moderately obese — who catch COVID and survive. Compared to less weighty people, the obese are more likely to get PASC, also known as post-acute sequelae of SARS-CoV-2., or Long COVID.

The Cleveland Clinic study, originally published in Diabetes, Obesity and Metabolism, looked at a group of 2,839 patients who “did not require ICU admission and survived the acute phase of COVID-19.” Their likelihood of requiring hospitalization, if moderately obese, was 28% higher than healthy weight patients, and if severely obese, was 30% higher. The report said,

Obesity […] is associated with an increased risk for cardiovascular disease, blood clots and lung conditions. In addition, obesity weakens the immune system and creates a chronic inflammatory state. Those conditions can lead to poor outcomes after an infection…

During the followup period after their COVID was no longer acute, “those with obesity were more likely to require diagnostic tests for the heart, lung, and kidney; for gastrointestinal or hormonal symptoms; or blood disorders; and for mental health problems.” However, obesity was not explicitly associated with a higher death rate during that period. As always, the authors called for further studies.

“To our knowledge, this current study for the first time suggests that patients with moderate to severe obesity are at a greater risk of developing long-term complications of COVID-19 beyond the acute phase,” said Ali Aminian, M.D., principal investigator of the research.

Two of the other Cleveland Clinic study authors, Bartolome Burguera, M.D., Chair of the Endocrinology and Metabolism Institute, and Kristin Englund, M.D., the infectious disease physician who leads the center for Long COVID patients, were interviewed. Erin Michael of Healio.com. asked about the reasons for elevated risk. Dr. Burguera described obesity as a “pro-inflammatory and pro-thrombotic disease” whose underlying causes include hyper-inflammation, immune dysfunction, and comorbidities. He added,

Those conditions can lead to poor outcomes in the acute phase of COVID-19 in patients with obesity and could possibly lead to an increased risk for long-term complications of COVID-19 in this patient population.

Dr. Englund made a point with important implications:

As we learn more about who is most at risk for PASC, we can hopefully start to decrease the number of people who develop PASC by focusing on prevention.

These are matters that most people probably do not consider. The virus is not just a problem that causes death, bereavement, and multi-million-dollar hospital bills. It is also a problem that sentences a certain number of people to an undetermined number of years suffering from a condition that manifests itself in at least 100 ways.

It’s a whole bunch of people who will need entire teams of specialists to figure out what is wrong with them and how to fix it. Many of those condemned patients are children today, and some are even obese children, whose futures are at a whole lot of risk.

Your responses and feedback are welcome!

Source: “Association of obesity with postacute sequelae of COVID-19,” Wiley.com, 06/01/21
Source: “Obesity may increase risk of long-term complications of COVID-19, study shows,” ScienceDaily.com, 06/03/21
Source: “Obesity Increases Risk of Long-COVID, Study Finds,” WebMD.com, 06/08/21
Source: “Long COVID-19 among patients with obesity ‘may be missed or misdiagnosed’,” Healio.com, 09/17/21
Image by Dunk/CC BY 2.0

Coronavirus Chronicles — Obesity and COVID-19, Deep Dives

All along, researchers and theorists have taken deep dives into various aspects of the pandemic. One of these specialized realms is the relationship between COVID-19 and obesity.

In the early days, the tendency of COVID patients to be obese was noticed and remarked upon, and this coincidence soon graduated from the anecdotal stage, to be studied with the rigor appropriate to a scientific query. In August of 2020, Obesity Reviews published what is described as “the first meta-analysis of its kind,” based on data gathered from very close to 400,000 patients. According to the study,

They found that people with obesity who contracted SARS-CoV-2 were 113% more likely than people of healthy weight to land in the hospital, 74% more likely to be admitted to an ICU, and 48% more likely to die.

Why? Because obesity often includes chronic inflammation, reduced immunity, metabolic syndrome, and sticky, clotty blood. Abdominal fat pushes on the diaphragm and impedes lung airflow. A lot of different systems are influenced by excess body fat, and also by COVID. In addition, there seems to be a whole range of auxiliary reasons that are not physical. We have seen, for instance, how the consciousness of stigma often causes obese people to keep their distance from doctors.

In November of 2020, for Science.org, Meredith Wadman quoted the University of Vermont’s Dr. Anne Dixon:

It’s not until more recently that we’ve realized the devastating impact of obesity, particularly in younger people.

The writer explained how the link between obesity and COVID…

[…] has come into sharper focus as large new population studies have cemented the association and demonstrated that even people who are merely overweight are at higher risk.

As luck would have it, 32% of Americans are overweight. And what about the rest, the folks whose weight stays within normal limits? The writer also explains how the disease can “infiltrate the organs where immune cells are produced and stored.” This should put an end to the smugness of critics who say “only obese people get Covid.” We all have fat cells.

To make matters worse, fat cells exert a bad influence on the cells that protect immunity. Apparently, fat cells are consistent with the presence of fewer T-cells, while the T-cells the victim does retain are less able to destroy virus-infected cells. Fat cells secrete cytokines, the messengers that trigger inflammation that fights invasion. But the body can overreact and fight itself rather than the invaders, which could explain many COVID-related problems.

So, fat helps COVID, and COVID returns the favor by helping fat. The writer also quotes Patty Nece of the Obesity Action Coalition, who had lost 100 pounds before the pandemic came along and caused enough stress eating to make her regain 30 pounds. Another all-around disadvantage is that the required studies of helpful drug efficacy rarely include obese subjects in their trials. There is a further obstacle to protecting the young. What we are particularly interested in here, COVID in its extended form (PASC), has mainly been studied in adult patients, not children.

Your responses and feedback are welcome!

Source: “Why COVID-19 is more deadly in people with obesity—even if they’re young,” Science.org, 09/08/20
Image by Mike Licht/CC BY-SA 2.0

Coronavirus Chronicles — PASC and Kids, Not a Pretty Picture

We have been counting up the reasons why it is not a good idea to let children catch the COVID virus in any of its insidious forms. PASC (post-acute sequelae SARS-CoV-2 infection), or Long COVID, is a tricky subject to discuss, because when people don’t believe the disease is a big deal in the first place, they are not inclined to sit still for any narrative about how it seems to go away, and then mysteriously returns later, perhaps even in worse form.

Doubters can be shown an article, like one that appeared in the journal Nature last April, about 73,000 research subjects who had COVID-19 but were not hospitalized. The scientific team followed them up for six months, and learned that during this period their death rate was significantly higher than the statistic for comparable people who had never had the virus. But doubters tend to dismiss and ignore certain things, and to not be moved by a sentence like this:

The Covid survivors experienced a vast array of long-term medical problems that they had never had before — not just lung issues from the respiratory effects of the virus, but symptoms that could affect virtually any organ system or part of the body, from neurological to cardiovascular to gastrointestinal.

A doubter does not want to hear from PASC expert Dr. Christian Sandrock, who has studied enough “Long Covid” patients to sort their chief symptoms into recognizable groups.

A bevy of problems caused by COVID

Heart inflammation goes under cardiovascular; abnormal pulmonary function and decreased exercise tolerance are respiratory. Chest pain and shortness of breath can appear under either of those main categories. The dermatologic category includes rashes, hair loss, and tooth loss. The neurological group is unpleasant, with “loss of smell and taste, sleep dysregulation, altered cognition and memory impairment.” Depression, anxiety, and mood changes come under psychiatric, while a category Dr. Sandrock calls constitutional encompasses “fatigue, brain fog, and not feeling like oneself.”

With patients enduring such a bizarre array of symptoms, there is no “one size fits all” treatment. There might be a need for cardiac, pulmonary, or cognitive rehabilitation therapy. At least five different types of medications might be considered. This is not a future to which children should be thoughtlessly consigned.

From Britain, the University of Exeter’s Dr. David Strain reminded the public that, based on his own observation, pediatric Long COVID cases were increasing. This led him to believe that the prevalence of PASC in children was probably being underestimated everywhere. At the same time Frances Simpson, parent of two children who caught the virus, told a reporter:

My daughter’s got Covid toes at the moment, which she only developed 11 months after getting Covid. She started complaining of her feet feeling painful and numb. It’s mad… Quite a lot of these children have the initial infection and can be asymptomatic, but then they start with symptoms of long Covid a month, two months, three months later. And the symptoms fluctuate. It’s a mystery — it’s very worrying.

Your responses and feedback are welcome!

Source: “Patients With Long Covid Face Lingering Worrisome Health Risks, Study Finds,” NYTimes.com, 04/22/21
Source: “Almost a third of people with ‘mild’ Covid-19 still battle symptoms months later, study finds,” CNN.com, 02/19/21
Source: “The race to cure long Covid, the world’s next health crisis,” TheTimes.co.uk, 04/24/21
Image by Navy Medicine/Public Domain

Coronavirus Chronicles — By Any Other Name, Just As Awful

The numbers are not considered statistically impressive (yet), but the children and youth who are affected by the coronavirus may be in for a much rougher time than anyone currently expects. In addition to now having an official name (post-acute sequelae SARS-CoV-2 infection) and an acronym (PASC), long-haul COVID is also known as post-acute COVID, or chronic COVID. Neither term is reassuring.

Post-acute just means “not in the hospital hooked up to machines.” One narrow usage of “chronic” refers to an illness lasting more than three months. In other health contexts it means of lengthy duration, persistently recurring, or forever. Another expression being used is “long-term,” and nobody knows what long means in this context.

Humankind has been learning about COVID-19 for only a couple of years, so its overall toxicity is an unknown quantity. One valid possibility, at least until we know a lot more, is that Long COVID could last for, like, 50 years. At this moment in time, its potential to ruin a person’s entire life has not been fully assessed.

Minimizing the danger to children from COVID-19

There is something terribly dismissive and uncaring about a bunch of adults going around saying “Oh, it’s not so bad for kids,” because we don’t know any such thing. Sure, the number of kids who have lost limbs to COVID is objectively quite small. But it is pretty significant to the kids involved. There is a certain callousness involved in discounting children’s pain, similar to telling a kid with a compound fracture to “walk it off.”

Here is another thing. Nobody knows the number of adults who have been infected by child carriers of the virus, which is a sensible reason for trying to limit the number of children who catch it. The grownups likely to be infected by children are the very grownups most needed by those children — their parents and other caregivers; their teachers; their mentors.

Some researchers have discovered what appears to be evidence that the virus can lurk in the body, undetectable by testing, for as many weeks or months as it pleases.

The light of distant stars

Then, it can pull a slick maneuver called recrudescence, and come roaring back in full potency. Or it launches a series of surprise attacks on different systems and organs. This could prove to be a huge obstacle for the young person who has a sport to train for, or a batch of college applications to prepare.

The Long COVID’s bag of tricks holds another twist. When adults suspect they have it, they can hark back to a positive test or at least to an increasingly well-documented pile of symptoms. But children, says writer Dyani Lewis, “rarely experience severe initial symptoms of COVID-19.” So when a child turns up with a motley list of improbable problems, there might be no apparent relation to the length or severity of their COVID infection. The fact that they ever had a case of the virus might not even have been initially recognized.

In order for Long COVID to be treated, it first has to be identified, and this can be a difficult step for many reasons. The non-acknowledgment of an initial case of COVID-19 is only one, and that itself can stem from various causes, like the unavailability of test kits or the lack of institutions and personnel able to administer them. Much as we hate to face this, in some jurisdictions, record-keeping and reporting are not as accurate as we might wish.

Within a family, there might be one main, very sick patient, who absorbs all the attention and concern, making it less likely that a child’s long-lasting symptoms will be noticed. There might be a parent who believes the child is malingering. It all makes for a very complicated situation.

Your responses and feedback are welcome!

Source: “Long COVID and kids: scientists race to find answers,” Nature.com, 07/14/21
Image by Nenad Stojkovic/CC BY 2.0