Are We There Yet?

 

No, we are not.

One Way to End the Pandemic

 Just change how you measure stuff.

Not Over

And So We Wait

Of course, as soon as I wrapped up the previous post, I came upon more interesting stuff about the medical conditions that persist after recovering from COVID-19.

I'm focusing on this article because it describes, first of all, a really good reason not to get it, and secondly, it is a little scary and sound like a big deal.  And, thirdly, it makes it clear that, as I noted in that previous post, we need more time to really know for sure.

It's not a surprise that people who recover from COVID have been shown to suffer from blood clots and strokes at a greater rate than those who never had COVID.  It is the great prevalence of those conditions that is new and disturbing.  In an op-ed piece for CNN, Dr. Kent Sepkowitz, a physician and infection disease expert at Memorial Sloan Kettering Cancer Center in New York, notes 

The results are clear and very significant: Compared with similar people who had not been infected with SARS-CoV-2, those who recovered from infection had many more blood clots, heart problems and strokes. The extent of the differences across the 20 different cardiovascular conditions is among the greatest of any clinical study I have read. It is jaw-dropping.*

So there's that.  Whether this is included in the concept "long COVID," or in the wider category the CDC calls "Post COVID Conditions," it is, apparently, real, and frightening.  

But is is permanent?  How long will it persist? What else don't we know about the parameters of these findings?

The study has important limitations. It involves people infected in 2020 who are at least a year post-infection; these people likely had the initial "wild" strain of SARS-CoV-2 or perhaps the Alpha variant, which dominated in late 2020. Not enough time has passed to know if similar long-term dysfunctions of the blood vessels and heart also will occur among survivors of Delta or Omicron variant infections. And the study cannot predict the health impact of Covid-19 two and three and 10 years after recovery.

"Not enough time has passed."  And so we wait. 

 * - A more detailed look at the study results can be found here and here.

Too Short a Time for Long COVID

I want to write a post - or posts - about long COVID, because it will surely be a significant factor in the new world, a legacy of the pandemic that helps define "the new normal."  But we just don't know enough about it at this point.  It's been two years since WHO* declared the pandemic, and although research is being done with patients who contracted COVID early, and then showed symptoms of long COVID, no one has had it for long enough for us to learn much.  We can describe broad categories of symptoms** that characterize long COVID, but that's about it.

So no long COVID post yet - it could, actually, take years before we think we know enough.  But there are two related topics worth mentioning at this point:

• "Post-COVID Conditions" - the CDC has a whole page devoted to this topic.  Interestingly, it does not use the term "long COVID" but describes a wide variety of symptoms and conditions (and evidence of damage) that seems to include what we know about long COVID but goes well beyond it.  Included are MIS and post-intensive care syndrome (PICS), as well as exacerbation of pre-existing conditions, organ damage and auto-immune issues.  Obviously, more needs to be done before we can sort out what is going to be happening to who, when, and as a result of what level of illness.***
• It seems that insurance companies and worker's comp are not up to speed here; many of those suffering from long COVID are suffering even more because their claims for reimbursement for medical expenses, and/or workers' comp benefits, are being denied.  Interestingly, the impacts of long COVID do not seem to fit neatly into the categories and descriptions used to qualify claims.  Interesting article and worth a read.

I can promise you that this blog will not still be going strong five years from now, but that may be what it takes to get a sense of how all this will affect the new world.

 * - WHO.  Not "the WHO," unless it's Peter Townsend and Roger Daltry and it's 1969.

 ** - From the study's findings:  "breathing difficulties/breathlessness, fatigue/malaise, chest/throat pain, headache, abdominal symptoms, myalgia, other pain, cognitive symptoms, and anxiety/depression."

 *** - UPDATE:  I found the CDC's definition of "Post COVID Conditions: 

The term “Post-COVID Conditions” is an umbrella term for the wide range of physical and mental health consequences experienced by some patients that are present four or more weeks after SARS-CoV-2 infection, including by patients who had initial mild or asymptomatic acute infection.

This kind of vague categorization is what has to change as the years go by. 

A Roadmap - If We'll Follow It

A report published by a group which, as far as I can determine (and I looked), doesn't have a name, set out a roadmap for the new world.  The formal title of the report is "Getting to and Sustaining the Next Normal: A Roadmap to Living with Covid" and it's written by (according to the report) "more than two dozen of the world’s best epidemiologists, pharmacologists, virologists, immunologists, and policy experts."  The full report can be found here.

The Washington Post Magazine summarized the report, and here's the crucial paragraph:

The report plots a course to what its authors call the “next normal” — living with the SARS-CoV-2 virus as a continuing threat that needs to be managed. Doing so will require improvements on a number of fronts, from better surveillance for Covid and other pathogens to keeping tabs on how taxed hospitals are; and from efforts to address the air quality in buildings to continued investment in antiviral drugs and better vaccines. The authors also call for offering people sick with respiratory symptoms easy access to testing and, if they are positive for Covid or influenza, a quick prescription for the relevant antiviral drug.

The report goes on to propose three possible scenarios:  optimistic, pessimistic, and one midway between.  I think when you have these kinds of prognostications, it means that nobody really knows.  However, parameters are provided for annual deaths, with 15,000-30,000 a year in the optimistic scenario, and up to ten times that if we're being pessimistic.

The group suggests the country should aim to keep the annual death toll from respiratory infections like Covid, flu, and respiratory syncytial virus to about 60,000 a year — roughly the number of deaths that influenza causes in a bad flu season.

It sounds like, post-pandemic, we will be able to fold COVID deaths into the "normal" flu deaths and not increase the total.  But remember - this is a "go-for," not a prediction:

"...improvements the group is calling for — things like better indoor air quality — will help to reduce the toll of influenza and other flu-like illnesses as well as Covid."

It turns out - unsurprisingly - that the improvements noted above will result in better treatment and outcomes for most respiratory diseases, and lives will actually be saved as a result of our pandemic wake-up call.  

If we actually do them.  Once the pandemic becomes the endemic, we will be strongly tempted to put the terrible years behind us and move on to the new crisis.  History is clear about this - it's our preferred process, for all sorts of reasons.  

We'll see. 

A Bit of a Silver Lining

It's been a bad couple of years for mosquito-borne diseases.  First malaria, and now dengue fever.

Dengue fever , a tropical disease, is carried by the Aedes mosquito, who bites during the day.  Once you get the fever, you can't transmit it to anyone; only the mosquito can do that.  You're not likely to die - although young children are much more likely to die than older children and adults - and chances are you'll have a mild dose.  Wikipedia tells us "Dengue is common in more than 120 countries. In 2013 it caused about 60 million symptomatic infections worldwide, with 18% admitted to hospital and about 13,600 deaths. The worldwide cost of dengue case is estimated US$9 billion."  Some cases progress to dengue hemorrhagic fever and dengue shock syndrome, which you can look up because it sounds worse than I want to deal with at the moment. Among other things, internal bleeding and dangerously low blood pressure are involved.

A recent study of dengue cases in 23 countries found - apparently, to everyone's surprise - that during the pandemic, when people weren't able to move about or congregate as much as normal, there was a significant decrease in the occurrence of the disease.  Previous to this, the conventional wisdom was that most infected mosquito bites took place in the home, but that seems not to be true.

These results will move prevention efforts in a different direction.  Places where people congregate - especially schools - will be treated with insecticide, and contact tracing - to determine where infected children and adults were during the probable time of infection - will be done.  This should be good news.

And not just for the tropics:

"The World Health Organization says the global incidence of dengue is growing dramatically and estimates around half of the world's population is at risk of contracting dengue. Philip McCall, a professor at Liverpool School of Tropical Medicine... said the findings were important and required further investigation, 'because dengue is the disease of the 21st century' as it spreads further north as a result of climate change."

Half of us.  But maybe not, if the results of this study bear fruit in the next few years.  Perhaps the new world, as a result of the pandemic, will be just a little bit better world to live in.

Dozing in the Crow's Nest

Nearly every sailor on the ship has sighted land recently.  "Tierra!"  "Tierra!"  And then somehow it slips away.  Or someone else say, "Nah, that's not land.  You're seeing things."  Or we sail and sail and don't get any closer.  Pretty frustrating.

Countries like Denmark, Thailand, England, Japan, Spain and, in many places, the United States* have pretty much declared the pandemic over, even though countries like Mexico, New Zealand, South Korea, and especially Hong Kong (OK, not a country) are getting clobbered.  

What's the holdup?  Once everyone gets over Omicron, aren't we home free?  Why don't we declare victory and go home?  The answer:  variants.

Well, at least according to a whole string of articles and papers like this one and this one, all of which boil down to "we don't really know what the next variant, or the one after that, will come at us with."  Omicron features a massively improved ability to transmit itself, but it's less dangerous.  If you're vaxxed and boosted, you probably won't get really sick.**  But who knows what the next one will bring?

Omicron has also spawned over 50 mutations so far, that we know of.  The pandemic still rages around the world, regardless of our insistence on "moving on to normal," so there a vast and fertile field in which the virus will mutate.  

So - we are declaring our intention to "live with the virus."  The pandemic isn't over, and the new world is not in sight.  We wait for the end of Omicron, and we wait for the next variant of concern.  The lookouts doze in the crow's nest.  Does anyone believe in the new world any more?

 * - Over 90% of Americans live in a municipality which does not require masks.

** - Long COVID, however, is another story; any variant would probably come with this feature.