Coronavirus Chronicles — It Ain’t Over ‘Til It’s Over

The title quotation has been attributed to various speakers, and has been appropriated as a song title by numerous musicians. It is a truism that can apply to a lot of things, including COVID-19 in both senses — the existence and extent of the pandemic in the world, and the presence and effects of the disease in each affected individual.

We tend to hear all kinds of crazy numbers. In the United Kingdom, somewhere between 10% and 30% of coronavirus patients get long-term symptoms. A study looked at around 48,000 patients who were hospitalized with the virus, and then discharged. One in three was readmitted within a few months. More than 10% of these patients later died of complications. Ed Yong, for TheAtlantic.com, wrote,

From the start, COVID-19 has been portrayed as a disease that mostly causes mild symptoms in people who quickly recover, and occasionally causes severe illness that leads to hospitalization and death. This two-sided caricature — severe or mild, sick or recovered — has erased the thousands of “long-haulers” who have endured months of debilitating symptoms at home with neither recognition nor care.

Currently, the same cautious advice is heard from many directions, to someone who thinks they had a mild case and got over it; and to someone who is vaccinated, for at least two weeks after the last shot — continue with mask-wearing, distancing, and hand hygiene — the whole nine yards. Thomas Smith, who writes about technology, says,

On a personal level, if you’ve tested positive for Covid-19 and feel fine now, don’t assume your disease is over… [I]f you still have symptoms after your Covid-19 test has turned negative, and are told that these are unrelated to the disease, be skeptical.

To truly measure (and react to) the long-term impacts of the pandemic, we need more nuanced measures.

A distinction has been drawn between the acute phase, when the immune system is actively engaged in combatting the disease, and PASC, or Post-Acute Sequelae of SARS-CoV-2. But at this point, it seems there is very little difference between talking about the acute and long-term versions, because it is really not clear, yet, that anyone ever truly recovers and stays better. One of the problems here is in accurately collecting statistics, and another is in making sense out of them.

Populations are not routinely tested to see if they even have the illness, and this was especially true in the first months of the pandemic. Since then, some countries have placed value on widespread testing. Others, not so much.

What we don’t know can hurt us

This could prove to be very dangerous, because quite a few people have it without ever knowing. They are asymptomatic, and if not tested, their numbers are not counted in relation to any other factors having to do with the disease. As a consequence, all kinds of statistics are skewed from the start, by not taking into account these undiagnosed coronavirus victims. Also, people whose active infection is deemed to have passed, tend to be left out of statistical analyses.

One of the few things we know for certain is that the affinity between the virus and obesity is shared by adults and children. As the months drag on, more and more medical professionals and laypeople alike are coming to realize that the direct, physical effect on kids cannot be ignored or discounted. They get it, and they transmit it. We will look more at both the physical realities, and the ever-expanding universe of secondary effects that the pandemic is having on children’s ability to resist or escape obesity.

Your responses and feedback are welcome!

Source: “Almost 30% of Covid patients in England readmitted to hospital after discharge — study,” TheGuardian.com, 01/18/21
Source: “America Is Trapped in a Pandemic Spiral,” TheAtlantic.com, 09/09/20
Source: “Official Covid-19 Statistics Are Missing Something Critical,” Medium.com08/09/20
Image by Mike Finn/CC BY 2.0

Coronavirus Chronicles — PASC, Another Spoonful of Alphabet Soup

Post-Acute Sequelae of SARS-CoV-2, or PASC, is the official new name for “long Covid,” which until recently was not even believed to exist. Last year, a survey of 1,567 “long-haulers” identified the top 10 problems faced by patients who are supposedly over it. (Of course, many suffer from multiple symptoms.). Here they are:

100% Fatigue
66.8% Muscle or body aches
65.1% Shortness of breath or difficulty breathing
59.0% Difficulty concentrating or focusing
58.5% Inability to exercise or be active
57.6% Headache
49.9% Difficulty sleeping
47.6% Anxiety
45.6% Memory problems
41.9% Dizziness

Then, there are all the additional problems that don’t even make the Top Ten, like nausea, severe acid reflux, loss of appetite, and GI tract disorders including diarrhea for weeks; extreme tachycardia (racing heartbeat), fever, rashes on the skin and broken blood vessels visible beneath it; nerve pain in hands and legs, tremors, seizures, agonizing sinus pain, dry cough, loss of feeling in arms and hands, phantom smells, tinnitus, and hypersensitivity to noise and light. Patients have also reported such random problems as viral arthritis and loss of vision in one eye.

The aforementioned muscle and body aches include stiff neck, aching ribs, chest pain, back pain, kidney pain, and a burning sensation in the chest. The fatigue feels terminal, and a person might be able to function with something resembling normalcy for as little as four hours per day. The “difficulty in concentrating or focusing” encompasses confusion, brain fog, loss of cognitive function, and word loss.

A person might struggle to understand words on a page or screen; find it difficult to follow a conversation; and even — having supposedly recovered weeks or months ago — forget their own partner’s name. That’s how bad it is.

Writer Eleanor Cummins recorded the testimony of a 32-year-old patient:

It’s such a different disease than [I] have ever experienced before,” she says. “You know you have it. It feels like it’s searching through your body,” looking for vulnerable new tissues to penetrate.

And in finding new territory to invade and conquer, the virus succeeds abundantly. It sounds crazy, but people have reported over 100 different manifestations of PASC. Researchers are making it official with documentation. At an Indiana University, reports were logged of 98 different symptoms experienced by long-haulers. National Institutes of Health (NPH) is actively seeking analyses of data in aid of figuring out what is going on with this now-acknowledged very real problem.

All this has been background and prelude to the discussion in upcoming posts.

Your responses and feedback are welcome!

Source: “New Survey Identifies 98 Long-Lasting Covid Symptoms,” Medium.com, 08/13/20
Source: “Almost a third of people with ‘mild’ Covid-19 still battle symptoms months later, study finds,” CNN.com, 02/19/21
Source: Dani Oliver on Twitter, 07/03/20
Source: “Guidelines Say Covid-19 Symptoms Last Two Weeks. Survivors Know Better.,” Medium.com, 05/20/20
Source: “‘Dying not only worry’: Coronavirus ‘long-hauler’ details horrific symptoms,” Yahoo.com, 08/02/20
Image by Sodanie Chea/CC BY 2.0

Coronavirus Chronicles — The Lingering Effects of COVID-19

Researchers at Johns Hopkins have identified several ways in which the virus attacks our brains to produce neurological symptoms. Viral material can reach the brain through the circulatory system and even through the spinal cord. A hyper-reaction of the immune system can cause nerve damage. Oxygen shortage can affect the brain; blood clots can make strokes. Also, delirium can be caused by “chaos in the body from all the various biological changes and symptoms.”

There are well-known psychological repercussions that follow serious illnesses and lengthy ICU stays. Anyone who has been through such an ordeal can benefit from therapy. But with certain patients, something else is going on. Their recovery is described as glacially slow. Often, progress is illusory, with a “three steps forward, two steps back” quality. Eventually, it is no longer a difficult recovery, but a chronic condition.

An earlier post left off quoting a patient who said, “You start to think you’re losing your grip or maybe it’s all in your head.” For a while there, a lot of medical professionals and others were brushing off these lingering effects, classifying them as hypochondriasis, anxiety, or other emotional baggage. But realization has begun to dawn, that seeming anomalies might be part of a bigger picture. Increasingly, authorities acknowledge that the disease is not binary. Alive or dead are not the only possible outcomes.

It’s written up and named

Institutions are starting to catch on, like the University of Washington, where researchers characterize SARS-CoV-2 as “tricky” because while some people never even know they are infected, others are serious enough to be hospitalized, and for a certain number, it is fatal. And then, there are the unremittingly stubborn cases.

The experts followed up on 177 coronavirus patients for as long as nine months, including 150 with “mild” cases, who were not hospitalized. Almost one-third reported persistent symptoms. Dr. Sanjay Gupta writes,

A growing group of people get sick and then never fully recover. In support groups, they sometimes refer to themselves as long-haulers; their condition is alternately called long Covid, continued Covid, post-Covid syndrome or post-acute Covid syndrome.

NIAID Director Dr. Anthony Fauci recently announced that the official name is now PASC, which stands for Post Acute Sequelae of SARS-CoV-2. Technical writer Thomas Smith speaks of those who suffer a long-term illness, or die from complications, who are not included in the body count:

Morbidity […] includes the complications, health issues, and other negative outcomes (other than death) that a disease causes. Basically, it’s all the ways that a disease can make you unwell, even if it doesn’t actually kill you.

[O]fficial statistics miss quite a lot. Specifically, they fail to represent Covid-19 morbidity — the harm that the disease causes, even in people that it doesn’t kill. In terms of measuring the long-term impact of the disease — and accurately evaluating risk — that’s a big problem.

(To be continued…)

Your responses and feedback are welcome!

Source: “How the Coronavirus May Attack the Brain,” Coronavirus.medium.com, 07/08/20
Source: “Almost a third of people with ‘mild’ Covid-19 still battle symptoms months later, study finds,” CNN.com, 02/19/21
Source: “Official Covid-19 Statistics Are Missing Something Critical,” Medium.com, 07/09/20
Image by Sarah/CC BY 2.0

Coronavirus Chronicles — The Fallacy of False Dichotomy

In previous posts, we have mentioned how researchers are reluctant to declare certainty for the record unless there is a preponderance of the evidence, and how this conflicts with the public’s “We want it NOW” attitude.

It is almost as if the public is more eager to find reasons to complain than to absorb information, and this makes the scientists’ job more difficult. Of course, as always, there are scientists whose conclusions differ, and when so many people are looking for reasons to minimize or deny a very real threat, the result is a mess.

One of the biggest obstacles to progress is the insistence, from many quarters, on making coronavirus an either/or situation. A widespread and belligerent mindset that says patients either die or live, and if they live, everything is fine, and there is no need to worry about them any longer.

But no. A huge third realm of reality is involved. Just because someone was never an inpatient, or was hospitalized and then discharged, that does not mean they are fine. Some people are plenty sick, and for long time. Some ostensibly get better, but are never as well as they started out, and many suffer recurring attacks that arbitrarily strike different bodily systems with varying intensity. How does this affect children? In two major ways, which we will look at further along.

Conflicting accounts

According to the Centers for Disease Control, the disease lasts from two to six weeks, but multitudes of patients beg to differ. Let’s look at recovery time for someone who is sick enough to be hospitalized. Reuters journalist Julie Steenhuysen interviewed Dr. Sadiya Khan, who defines recovery as when a person returns to the same level of function as before the illness. This very often does not happen. When it does, it could take a week of rehabilitation time for every day they spent in the hospital.

For instance, if a patient was inside for week, it could take seven weeks to recover. That’s two months. It’s one-sixth of a year. And it does not even include the time they spent being sick at home before entering the hospital. This is official news, factual enough to be published. But it only scratches the surface of what is really going on.

Hard-headed deniers like to say that only the elderly and unfit succumb to the illness’s worst effects, but Athena Akrami is just 38, and before getting sick she regularly worked out at a gym three times a week. After supposedly recovering from the virus, the University College of London neuroscientist was unable to return to work, and she is one of many whose experiences disproves the “old and weak” misconception. Akrami told a reporter,

Everybody talks about a binary situation, you either get it mild and recover quickly, or you get really sick and wind up in the ICU… My physical activity is bed to couch, maybe couch to kitchen.

But not everyone has journalists reaching out to them. Most feel that nobody else wants to listen, so they form online forums and support groups to share their narratives. One such patient, Dani Oliver, wrote,

You’ll wake up feeling better and assume, like would be true for the flu or a cold, you’re on the mend. But then… you get worse. & then you’re feeling better again! & then you’re bedridden, worse than before. It makes no sense. You start to think you’re losing your grip or maybe it’s all in your head. It isn’t. Thousands & thousands are experiencing these cycles.

Your responses and feedback are welcome!

Source: “Scientists just beginning to understand the many health problems caused by COVID-19,” Reuters.com, 06/26/20
Source: “From ‘brain fog’ to heart damage, COVID-19’s lingering problems alarm scientists,” ScienceMag.org, 07/31/20
Source: “Thread,” Twitter.com, 07/03/20
Image by Phil Venditti/CC BY 2.0

Coronavirus Chronicles — Listening to the Science

In discussing a broad area of psychology known as “risk compensation,” which a lot of writers have tackled from many different angles, we considered how the public reacts to news from scientists. The public’s interpretation of, and feelings about, such news will change the public’s behavior — thus generating even more news, to which it will then react, and so on, ad infinitum.

The underlying problem can be that all this information, whatever its quality, goes off on its own separate tangents that might have very little to do with the objective truth of the situation. If “signal” is the righteous unvarnished truth, risk compensation is one of the human foibles that add obstructive and counterproductive “noise” to the discourse.

A mere bagatelle

Currently, many Americans believe that COVID-19 is no big deal. Deniers constantly quote the overall death rate, which sounds low, and may or may not be as low as it sounds, after several important details about the recording and reporting of statistics are factored in. Deniers insist that the same bug causes the common cold and garden-variety flu, so it’s no big deal. They refuse to be duped by what they characterize as propaganda designed to instill fear. They shame their family members and neighbors as sheep, brainwashed into wearing muzzles.

They start to feel confident — and this is where the risk compensation mindset becomes truly dangerous — because the number of the new cases goes down for a few days, or because some flashy politician announces that it’s all nonsense. Or word goes around that maybe we don’t need to worry so much about fomite transmission (catching it from unsanitized surfaces).

Listen to the science! But which science?

In essence, the whole risk compensation problem can be summarized as two groups of people with megaphones, angrily taunting each other: “Listen to the science!” But which science? Aye, there’s the rub. A lot of energy is expended on defending the credentials of various individuals and institutions. People, as they also tend to do with holy scriptures, will cherry-pick from scientific publications and put the nicest polish on the theories they can benefit from selling at the moment.

Conversely, risk compensation expert Jennifer Hu of UC Berkeley’s Bioengineering department reminds us of the habits of scientists:

Out of an abundance of caution, “they” don’t want to tell “us” too much good news about the COVID vaccines, even when that good news is scientifically reasonable.

The public has no tolerance for nuance or uncertainty. The public, which under other circumstances often says to the government, “How dare you tell us what to do!,” now says, “Tell us what to do! If you don’t issue precise and effective instructions right now, that proves you must be a fraud.”

There is often the possibility that a prediction will turn out not to be true. A lot of experts feel that it is better to say nothing, than to say something that proves to be wrong, and destroys public trust. The Atlantic‘s Zeynep Tufekci reminds us,

Some outlets emphasize the worst or misinterpret the research. Some public-health officials are wary of encouraging the relaxation of any precautions. Some prominent experts on social media — even those with seemingly solid credentials — tend to respond to everything with alarm and sirens.

A reputable practitioner of science wants to avoid misleading the public either one way or the other. If people are not frightened enough of a legitimate threat, they throw caution to the winds and endanger themselves and others. If they are too frightened, next thing you know they are out rounding up witches to burn at the stake.

For those who are not fazed by uncertainty and have a tolerance for speculation, there is a way to find out what experts talk about with each other, when they are not being pressured to issue statements and make definitive declarations. The Society for Post-Acute and Long-Term Care Medicine offers a resource called AMDA COVID-19 Grand Rounds.

Your responses and feedback are welcome!

Source: “What is it that they don’t want to tell us about the COVID-19 vaccine?,” Quora.com, 03/08/21
Source: “5 Pandemic Mistakes We Keep Repeating,” TheAtlantic.com, 02/26/21
Image by AJC1/CC BY-SA 2.0

Coronavirus Chronicles — Information and Belief

Jennifer Hu, Ph.D. candidate at UC Berkeley-UCSF Bioengineering, writes about a concept called “risk compensation.” While people may not be familiar with the term, there is no need, because it concerns the kinds of existential questions raised in conversations a lot of us have had, very late at night, in a dorm room or a tent.

It is always important to consider who sends a message — if the media, then what subdivision of the media? Or does it come from one of the government agencies that Americans agree to fund for our mutual benefit?

When a politician says, “I didn’t want to start a panic,” this is what they are probably, though clumsily, trying to express — a belief that when the public is worried, it will inevitably react with noise, violence, and/or hoarding. The government feels the responsibility to do something to prevent people from killing each other over the store’s last 32-pack of toilet paper. If that can be accomplished through the judicious distribution or withholding of information, so much the better.

The point of quoting this author in this context is that the coronavirus pandemic affects children, and evidence mounts every day pointing to how very much it hurts them. Obesity as a co-morbidity is, as we have seen, only one part of the big and ugly story. It matters, what people believe about COVID-19. Hu says,

The most vivid example of this backfiring is the early messaging telling people not to wear masks, out of fears that people would 1) panic-buy and hoard high-quality masks, 2) touch their faces more often to adjust ill-fitting masks, and 3) engage in riskier behaviors because they felt protected. It was common to see a well-meaning tendency to argue that partial receiver protection was basically useless, or worse than useless.

But, as it turns out, we should all be wearing masks a large part of the time, even after being vaccinated. Even when 6 feet away from others in an enclosed space because, as it turns out, the frequent and vigorous exchange of indoor air is of paramount importance.

So, risk compensation does not always perform as intended. This mask debacle is a prime illustration of the public’s tendency to demand to be told everything, right now, and then to freely misinterpret news in 99 different ways and get everybody all riled up. This is so deleterious because while the public is eager for access to the first whisper of evidence about anything, at the same time the public also adds the proviso, “And whatever you say right now, we will hold you to it forever. So make sure it’s a hill you are willing to die on.”

Like many other issues, that particular one grew into a massive problem. The crazy part is that scientists are the first to advise against jumping to conclusions. An astonishing number of peer-reviewed, published scientific papers close by affirming that more research needs to be done. As Wu says,

Scientists do not like to claim that the data shows any more than precisely what it shows, even though any scientist worth their salt can go on to discuss likely implications and draw inferences from other data points. But when a scientist says “We don’t have evidence X is true”, they could easily be thinking “X is probably true but we don’t have the slam-dunk data yet and we shouldn’t jump to conclusions”. Meanwhile, the media and the general public can misinterpret it as “X is false”.

(To be continued…)

Your responses and feedback are welcome!

Source: “What is it that they don’t want to tell us about the COVID-19 vaccine?,” Quora.com, 03/08/21
Image by Mesaj/CC BY 2.0