Long Covid

Covid-19 discussion, bring your own statistics
Post Reply
User avatar
lpm
Dorkwood
Posts: 1449
Joined: Mon Nov 11, 2019 1:05 pm
Location: IMPEACH AND EXTERMINATE

Long Covid

Post by lpm » Thu Jun 25, 2020 8:33 am

Sounds grim as. Particularly the possible impact on the nervous system and brain.

But I don't have a sense of context.

Is it normal? Do most almost-fatal infections leave damage for months or permanent damage? Some of the sufferers of Long Covid were close to death for days or weeks, only alive due to medical science - is long term damage a normal consequence? But some were only normally ill with Covid, yet still suffer months afterwards.

Is it just the scale of the epidemic? With 300,000 official UK cases, are we just looking at 0.01% outliers? Would we see similar long symptoms for other infections, but there's just never enough to be noticeable?

The 1918 pandemic caused damage to the brain and nervous system for millions of people world wide. There appears to be a link between severe flu and depression. Are we heading to disability from lung damage, early death, and disability from brain damage?
I'll miss him after he's died in the pandemic

User avatar
Woodchopper
After Pie
Posts: 1611
Joined: Sat Oct 12, 2019 9:05 am

Re: Long Covid

Post by Woodchopper » Thu Jun 25, 2020 9:02 am

lpm wrote:
Thu Jun 25, 2020 8:33 am
Is it just the scale of the epidemic? With 300,000 official UK cases, are we just looking at 0.01% outliers?
There's some info here from the UK's Covid Symptom Study. Looks like symptoms lasting longer than three weeks affect a lot more than 0.01%.
https://covid19.joinzoe.com/post/covid-long-term

ETA
How the novel coronavirus attacks our entire body
COVID-19 is known primarily as a respiratory illness. However, the aggressive pathogen SARS-CoV-2 attacks not only the lungs but also the heart, nerves, brain, vessels, kidneys and skin.
https://www.dw.com/en/how-the-novel-cor ... a-53389908

bagpuss
Fuzzable
Posts: 325
Joined: Tue Nov 12, 2019 12:10 pm

Re: Long Covid

Post by bagpuss » Thu Jun 25, 2020 11:11 am

Pneumonia is known to have longer term effects on mortality, the brain and mental health as well. I can't find stats to compare "normal" pneumonia with SARS-Cov-2, though, so don't know if the latter is worse than regular pneumonia. If no-one else beats me to it, I'll try and have a look later. But it seems extremely likely that there will be further deaths happening earlier than they otherwise would have, plus other significant impairments to health affecting those who have "recovered" from SARS-Cov-2.

Chucking an anecdote into the mix, my grandfather-in-law was diagnosed with vascular dementia while still in hospital recovering from pneumonia. He was 96 so it's possible that it was just his age but from an entirely layperson's perspective, he was very well for his age and showing no signs of dementia detectable to me when I last saw him a couple of months before his pneumonia but it was unmissable when we saw him in hospital when he was recovering after the pneumonia.

User avatar
Bird on a Fire
Stummy Beige
Posts: 2986
Joined: Fri Oct 11, 2019 5:05 pm
Location: nadir of brie

Re: Long Covid

Post by Bird on a Fire » Thu Jun 25, 2020 11:25 am

Something similar happened with my grandmother, at a similar age, but with a fall rather than pneumonia. I think the break in routine, unfamiliar surroundings and circumstances all contribute to the apparently "sudden" appearance of symptoms, at least as much as the trauma and effects of medication etc.
Born at 356.32 ppm CO2

User avatar
Gentleman Jim
Catbabel
Posts: 617
Joined: Mon Nov 11, 2019 9:38 pm

Re: Long Covid

Post by Gentleman Jim » Thu Jun 25, 2020 11:42 am

Since vascular dementia is linked to reduced oxygen levels in the brain, either though blockage or bleeding, and any lung infection will reduce oxygen levels in the blood, then I guess the two will be inter-linked.
I know from my mother's case that her dementia worsened noticeably after each TIA
Rules are for the guidance of wise men and the obedience of fools.

User avatar
Woodchopper
After Pie
Posts: 1611
Joined: Sat Oct 12, 2019 9:05 am

Re: Long Covid

Post by Woodchopper » Thu Jun 25, 2020 1:35 pm

Many of those who survive a severe bout of covid-19 are likely to have long-term health problems. The Society of Critical Care Medicine based in America has identified a collection of health problems including poor muscle strength and sub-par heart and lung function as “post-intensive care syndrome”; people who have had ARDS get it worse than most. Damaged lungs and kidneys can be expected to make good a lot of the harm done to them once a crisis is over, but for some it will take time, and long-term loss of function is possible.

A big worry is what happens to the brain. Sherry Chou of the University of Pittsburgh says that there is no evidence so far that SARS-COV-2 directly harms the brain or the central nervous system, but in parts of the brain, the spinal cord and the nerves the inflammation associated with the disease can lead to muscle weakness and other problems.

The mere fact of being in an ICU can also lead to cognitive impairment. The effect of more than a week in intensive care is comparable to that of a major head injury. The problems are linked to the delirium people often fall into when severely ill and heavily sedated in an unfamiliar environment. Delirium is a particular problem with covid-19, says Dale Needham of Johns Hopkins University. Patients spend a long time in the ICU during which they see no one they know—and the strangers caring for them in heavy-duty protective wear “look like aliens”.

Patients who have come through ARDS may also suffer from anxiety and post-traumatic stress disorder. It all adds up to a bleak prospect. In 2017 a study in the Baltimore-Washington area found that a third of previously employed patients who survived ARDS were not back at work five years on. Covid-19 will cast as long a shadow over some survivors’ lives as it will over those who mourn the dead.
https://www.economist.com/briefing/2020 ... n-covid-19

User avatar
Woodchopper
After Pie
Posts: 1611
Joined: Sat Oct 12, 2019 9:05 am

Re: Long Covid

Post by Woodchopper » Sun Jun 28, 2020 9:05 am

Scientists just beginning to understand the many health problems caused by COVID-19

https://www.reuters.com/article/us-heal ... SKBN23X1BZ

User avatar
jimbob
Dorkwood
Posts: 1203
Joined: Mon Nov 11, 2019 4:04 pm
Location: High Peak/Manchester

Re: Long Covid

Post by jimbob » Sun Jun 28, 2020 10:14 am

Dr Nisreen Alwan of Southampton has been talking about the unknown long-term effects even before she was infected.

Here's one of her latest tweets on the subject.

https://twitter.com/Dr2NisreenAlwan/sta ... 64576?s=20

one of here earlier points about it:
https://twitter.com/Dr2NisreenAlwan/sta ... 81344?s=20
Have you considered stupidity as an explanation

User avatar
Woodchopper
After Pie
Posts: 1611
Joined: Sat Oct 12, 2019 9:05 am

Re: Long Covid

Post by Woodchopper » Fri Jul 10, 2020 4:26 am

Persistent Symptoms in Patients After Acute COVID-19
https://jamanetwork.com/journals/jama/f ... le/2768351

User avatar
Woodchopper
After Pie
Posts: 1611
Joined: Sat Oct 12, 2019 9:05 am

Re: Long Covid

Post by Woodchopper » Sun Jul 12, 2020 5:08 am

Warning of serious brain disorders in people with mild coronavirus symptoms
https://www.theguardian.com/world/2020/ ... SApp_Other

User avatar
lpm
Dorkwood
Posts: 1449
Joined: Mon Nov 11, 2019 1:05 pm
Location: IMPEACH AND EXTERMINATE

Re: Long Covid

Post by lpm » Sun Jul 12, 2020 9:03 am

This doesn't sound very nice:

https://edition.cnn.com/2020/07/10/heal ... index.html
The autopsies also showed something unusual about megakaryocytes, or large bone marrow cells. They usually don't circulate outside the bones and lungs, Rapkiewicz said.

"We found them in the heart and the kidneys and the liver and other organs," she said. "Notably in the heart, megakaryocytes produce something called platelets that are intimately involved in blood clotting."
Implies hidden damage to organs of survivors?
I'll miss him after he's died in the pandemic

User avatar
Woodchopper
After Pie
Posts: 1611
Joined: Sat Oct 12, 2019 9:05 am

Re: Long Covid

Post by Woodchopper » Sat Jul 25, 2020 10:07 am

In a multistate telephone survey of symptomatic adults who had a positive outpatient test result for SARS-CoV-2 infection, 35% had not returned to their usual state of health when interviewed 2–3 weeks after testing. Among persons aged 18–34 years with no chronic medical conditions, one in five had not returned to their usual state of health.
https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm

raven
Clardic Fug
Posts: 201
Joined: Mon Nov 11, 2019 8:58 pm

Re: Long Covid

Post by raven » Sat Jul 25, 2020 2:12 pm

What would comparable figures be for 'flu or a bad sinus infection, I wonder. Those tend to wipe me out for a good 2 or 3 weeks.

The NHS site says coughs generally clear up within 3-4weeks.

User avatar
Woodchopper
After Pie
Posts: 1611
Joined: Sat Oct 12, 2019 9:05 am

Re: Long Covid

Post by Woodchopper » Wed Jul 29, 2020 3:32 am

raven wrote:
Sat Jul 25, 2020 2:12 pm
What would comparable figures be for 'flu or a bad sinus infection, I wonder. Those tend to wipe me out for a good 2 or 3 weeks.

The NHS site says coughs generally clear up within 3-4weeks.
Good question. I don’t know the answer.

User avatar
Woodchopper
After Pie
Posts: 1611
Joined: Sat Oct 12, 2019 9:05 am

Re: Long Covid

Post by Woodchopper » Wed Jul 29, 2020 3:33 am

Findings In this cohort study including 100 patients recently recovered from COVID-19 identified from a COVID-19 test center, cardiac magnetic resonance imaging revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), which was independent of preexisting conditions, severity and overall course of the acute illness, and the time from the original diagnosis.

Meaning These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19.
https://jamanetwork.com/journals/jamaca ... le/2768916

User avatar
jdc
Hilda Ogden
Posts: 450
Joined: Wed Sep 25, 2019 4:31 pm

Re: Long Covid

Post by jdc » Thu Jul 30, 2020 3:19 pm

Woodchopper wrote:
Wed Jul 29, 2020 3:32 am
raven wrote:
Sat Jul 25, 2020 2:12 pm
What would comparable figures be for 'flu or a bad sinus infection, I wonder. Those tend to wipe me out for a good 2 or 3 weeks.

The NHS site says coughs generally clear up within 3-4weeks.
Good question. I don’t know the answer.
Nor me. Last time I copped for flu my symptoms started Boxing Day and I think I went back to work 15th Jan which I reckon was a week of symptoms and two weeks fatigue.

https://www.health.harvard.edu/staying- ... e-flu-last says symptoms last 5-7 days and you may still have fatigue after the virus has gone. https://www.cdc.gov/flu/professionals/acip/clinical.htm "Uncomplicated influenza signs and symptoms typically resolve after 3-7 days for the majority of people, although cough and malaise can persist for >2 weeks" and https://www.everydayhealth.com/flu/guid ... -flu-last/ "A bout of the flu typically lasts for several days or occasionally weeks, with severe symptoms subsiding in two to three days. However, weakness, fatigue, dry cough, and a reduced ability to exercise can linger for six to eight weeks."

That last one has the Merck manual as a reference: https://www.msdmanuals.com/en-gb/home/i ... luenza-flu
Most symptoms subside after 2 or 3 days. However, fever sometimes lasts up to 5 days. Cough, weakness, sweating, and fatigue may persist for several days or occasionally weeks. Mild airway irritation, which can result in a decrease in how long or hard a person can exercise, or slight wheezing may take 6 to 8 weeks to completely resolve.
Looks like it's normally done within a week or two but can go on a bit longer, but nothing I've found so far seems to give me any numbers to compare with the 35% figure for Covid. The yellow book chapter on flu just gives the same sort of thing as above (Influenza illness typically resolves within 1 week for most previously healthy children and adults who do not receive antiviral medication, although cough and malaise can persist for >2 weeks, especially in the elderly) and I'm having trouble finding any individual studies into duration of symptoms (although I didn't exactly spend ages trawling through papers on pubmed).

User avatar
Woodchopper
After Pie
Posts: 1611
Joined: Sat Oct 12, 2019 9:05 am

Re: Long Covid

Post by Woodchopper » Wed Aug 05, 2020 6:53 pm

Coronavirus Disease 2019 (COVID-19) and the Heart—Is Heart Failure the Next Chapter?

Multiple data sets now confirm the increased risk for morbid and mortal complications due to coronavirus disease 2019 (COVID-19) in individuals with preexisting cardiovascular diseases including hypertension, coronary artery disease, and heart failure.1,2 These salient observations have strengthened preventive strategies and undoubtedly have resulted in lives saved. Although episodes of clinical myocarditis have been suspected and a few cases have been reported in the literature,3 direct cardiac involvement due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been difficult to confirm.

In this issue of JAMA Cardiology, Linder and colleagues4 report on 39 autopsy cases of patients with COVID-19 in whom pneumonia was the clinical cause of death in 35 of 39 (89.7%). While histopathologic evaluation did not meet criteria seen in acute myocarditis, there was evidence of virus present in the heart in 24 of 39 patients (61.5%) with a viral load more than 1000 copies per microgram of RNA in 16 of 24 patients (66.7%). Evidence of active viral replication was also noted. In situ hybridization suggested that the most likely localization of the viral infection was in interstitial cells or macrophages infiltrating the myocardial tissue rather than localization in the myocytes themselves. Further using a panel of 6 proinflammatory genes, the investigators demonstrated increased activity among hearts with evidence of viral infection compared with hearts with no SARS-CoV-2 viral infection detected.4 These new findings provide intriguing evidence that COVID-19 is associated with at least some component of myocardial injury, perhaps as the result of direct viral infection of the heart.

The discoveries highlighted in this issue of JAMA Cardiology by Puntmann and colleagues5 are also informative. In 100 recovering patients included in the study, 67% of whom recovered at home, evaluated a mean of 71 days after confirmed COVID-19 diagnosis, 78% had demonstrable cardiac involvement via cardiac magnetic resonance imaging, 76% had detectable high-sensitivity troponin, and 60% had evidence of active myocardial inflammation by abnormal native T1 and T2. Compared with controls including those with a similar profile of preexisting conditions, left ventricular ejection fraction was lower and volumes higher, as well as 32% manifesting late gadolinium enhancement and 22% with pericardial involvement. There are important residual questions about potential selection bias and generalizability and not all of the patients may have recovered, but the observations cannot be dismissed. Months after a COVID-19 diagnosis, the possibility exists of residual left ventricular dysfunction and ongoing inflammation, both of sufficient concern to represent a nidus for new-onset heart failure and other cardiovascular complications. Moreover, we cannot dismiss important other clinical pathophysiological observations, including clinical syndromes consistent with acute myocarditis, the cascade of immunologic responses, a prothrombotic milieu with microvascular clot formation, and/or myocardial injury due to supply-demand mismatch. When added to the postmortem pathological findings from Linder et al,4 we see the plot thickening and we are inclined to raise a new and very evident concern that cardiomyopathy and heart failure related to COVID-19 may potentially evolve as the natural history of this infection becomes clearer.

We wish not to generate additional anxiety but rather to incite other investigators to carefully examine existing and prospectively collect new data in other populations to confirm or refute these findings. We hope these findings represent that of a select cohort of patients. Yet, if this high rate of risk is confirmed, the pathologic basis for progressive left ventricular dysfunction is validated, and especially if longitudinal assessment reveals new-onset heart failure in the recovery phase of COVID-19, then the crisis of COVID-19 will not abate but will instead shift to a new de novo incidence of heart failure and other chronic cardiovascular complications.

Given the pressing burden of the ongoing COVID-19 crisis, as well as the initiation of longitudinal care models for those recovering from COVID-19, the concerns we are raising are not theoretical but instead practical and require our due diligence to study and prepare for what may be another dimension of the COVID-19 crisis.
https://jamanetwork.com/journals/jamaca ... le/2768915

Post Reply