Post-covid syndrome (Long COVID)

So many people are focusing on the number of deaths and chances of death when reckoning how worried we need to be about catching Covid. Many are even asserting that, since it’s seldom fatal for younger people, they hardly need to be overly concerned about it. Hence, they blithely brush it off as more or less equivalent to getting an ordinary bout of flu.

But that is completely misguided!

There’s also an extremely serious problem with what medical professionals have been calling “long Covid” or “post-Covid syndrome”, which often involves such terrible long-term health effects that it leaves victims in constant pain and hardly able to function. The so-called “brain fog” that countless people have reported, a severe and debilitating impairment of brain function, is especially a cause for concern.

I’ve not seen any mention of long Covid in this thread or in other local reports or discussions, and I find that very surprising.

In the UK, well over a million people are estimated to have been afflicted with long Covid, almost ten times as many as the number who have lost their lives to the virus. Many of the long Covid sufferers only experienced very mild symptoms when infected with Covid, or even had no symptoms at all.

It is an extremely nasty virus that can completely wreck people’s health, and absolutely should not be taken lightly by anyone!

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Because it doesn’t exist. At least not as a well-documented, clearly-defined medical problem that’s unique to COVID. It’s just a lot of rumour right now. And in any case, imposing martial law in order to avert some relatively trivial harm has not been done in recent history. Interventions to control epidemics have always had the explicit intent of minimizing deaths. There are two good reasons for that: 1) death is a “hard endpoint”, that isn’t subject to debate in the statistics; 2) everybody agrees that death is a bad thing, and that sacrifices can be made if it saves lives. If you pick different endpoints, you can keep the “emergency” going forever … which is precisely what’s happening here.

Evidence? Since “long COVID”, to the extent that it’s even a thing, cannot be a binary condition (you have it or you don’t) numbers like this are meaningless. Even if we take this estimate at face value, you seem to be asserting that 1.5% of the population could have been spared this outcome if the government had done … what, exactly, to the other 98.5%?

This would be hard to spot in the UK, at least.

Define “many”’. The reports I’ve read so far suggest that it’s primarily the cohort who were hospitalised who have long-term issues, and they are the expected sequelae of hospitalisation (which in and of itself causes psychological disturbance) and of pneumonia.

You are conflating “taking it lightly” with a realistic assessment of risk based on known statistics from 2020. You also seem to be assuming that just because a risk exists, and the cause is known, you can control that risk. In this case, you cannot.

The approach that Mayor Ko seems to be advocating is this: it’s acceptable for government to cause death and harm in order to prevent death and harm by other means. Since he has quantified neither one, this stance is unjustified.

You surprise me, Omni.

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“Doesn’t exist”, you say? It certainly is recognized and taken very seriously by the NHS, which ought to be authoritative enough to sweep away the skepticism of even the most hard-boiled doubting Thomas.

I’ll quote from just one of the thousands of published accounts that ought to fully and finally dispose of any doubts about its reality.

Can you really assert that the NHS would be investing tens of millions of pounds in long Covid clinics if long Covid didn’t really exist?

I’ve always thought of you as a highly rational and sensible person, so cannot but be surprised if that is indeed what you’re saying.

A 12-week programme for sufferers of long Covid has launched in Leeds with the aim of helping the increasing number of patients recover from debilitating long-term symptoms.

The “first of its kind” scheme is being run by Nuffield Health, the UK’s largest healthcare charity, and “blends together physical therapy and mental health support” to treat the estimated one in ten people who suffer from long Covid after catching the virus.

“Having initially been run as a pilot at four locations”, the programme “has launched across Nuffield Health fitness and wellbeing centres and will be expanded to over 40 locations by May”.

What is long Covid?

Although not a medical term, “long Covid” is widely used to describe effects of Covid-19 that continue for weeks or months after the initial illness.

A study by experts from the National Institute for Health Research (NIHR) and the University of Leicester also found that one in five patients with long Covid reach the threshold for being defined as having a “new disability”.

A separate joint research project between the EU and UK last year that analysed screening results from 200 “low-risk” long Covid patients - “those who are relatively young and without any underlying health complaints” - found that almost 70% had signs of “impairments in one or more organs, including the heart, lungs, liver and pancreas”.

What are the main symptoms?

According to the NHS, symptoms of long Covid can include:
• extreme tiredness (fatigue)
• shortness of breath
• chest pain or tightness
• problems with memory and concentration (“brain fog”)
• difficulty sleeping (insomnia)
• heart palpitations
• dizziness
• pins and needles
• joint pain
• depression and anxiety
• tinnitus, earaches
• feeling sick, diarrhoea, stomach aches, loss of appetite
• a high temperature, cough, headaches, sore throat, changes to sense of smell or taste
• rashes

Anyone who thinks they may be suffering from the symptoms of long Covid should contact their GP.

In October last year, the government announced that £10m would be invested “to help kick start and designate long Covid clinics in every area across England”. The clinics provide “joined-up care” for the range of physical, neurological and mental-health symptoms associated with the condition, bringing together doctors, nurses, physiotherapists and occupational therapists.

By May 2021, investment in long Covid clinics by NHS England had reached £34m with 83 centres operating across the country. Today, Dr Kiren Collison, chair of the National Long Covid Taskforce, warned that the specialist clinics may be needed beyond April 2022, exceeding current funding.

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This was my point. While there might be some nebulous collection of symptoms that people colloquially refer to as “long COVID”, it is not a recognised condition. It is not defined. It is not clear how it differs from postviral syndrome, from the after-effects of hospitalisation,
from the ordinary effects of a respiratory disease, or from the chronic ill-health which afflicts about 50% of the British population. And since it’s undefined, we don’t know how many people have it or to what degree.

The government deliberately, knowingly induced mass panic in the general population during 2020 in order to achieve fearful compliance (that’s a matter of public record, not speculation). This may well have resulted in an outbreak of psychosomatic symptoms - which, in turn, would explain why it’s so hard to characterise exactly what long COVID really is.

The NHS are, apparently, setting up a treatment programme for something that isn’t characterised, isn’t understood, and has no best-practice management protocol established.

OMG yes. Absolutely. The primary aim of the NHS today, it seems to me, is to waste shitloads of money on mythical problems. I’ve done entire threads about that. Just to rehash one particular bugbear of mine: they had an opportunity, early on in the crisis, to address the known correlation between COVID complications and metabolic syndrome. Not only did they fail to do that - resulting in thousands of unnecessary deaths - they continued to spread misinformation about m.s. throughout 2020. So you’ll excuse me if I believe the NHS (as an organisation - individual footsoldiers are probably a different matter) doesn’t have anybody’s best interests at heart except their own.

The UK gov’t also has a strong incentive to play up the awfulness of COVID. The story that they spun at the beginning must remain “true”, because if it isn’t/wasn’t true, then all of the mayhem they inflicted on the British public during 2020 was unjustified, and probably illegal in the context of the UK Coronavirus Act and the Health and Social Care Act on which it was based.

In any case my comment was referring to the risk-benefit tradeoff that Taiwan faces now. It is not acceptable, in my view, to cause serious harms to the whole of society on the basis that some very small fraction of the population might suffer “for weeks or months after the initial illness”. To do so with only a very small probability of success is criminal.

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Liked your post for that comment alone. Hilarious.

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More on long covid, from The Economist:

In the 1890s, one of the biggest pandemics in history, known at the time as “Russian flu”, swept the world. It left 1m people dead. Russian flu is now thought to have been misnamed. It was probably not influenza, but rather a coronavirus ancestral to one that now just causes symptoms described by sufferers as “a cold”. When it was new, however, few people had immunity to it, so it was often lethal. And not only that. For, as the pandemic receded, it left in its wake a wave of nervous disorders. A similar wave followed the next big pandemic, the “Spanish” flu of 1918 (which, though nothing much to do with Spain, really was influenza). One common symptom was lethargy so bad that in Tanganyika (modern-day Tanzania) it helped cause a famine because so many people were too debilitated to pick the harvest.

Something similar is happening now, with the covid-19 pandemic. A wave of what has become known as “long covid” in emerging in countries where acute cases have been falling.

Why on earth anyone would try to deny the clearly established existence of long covid is somewhat hard to comprehend.

But then again, there are people who deny that covid itself exists, or deny that it’s in any way more serious than ordinary flu.

There are also people who deny the reality of global warming and climate change, others who deny the Holocaust or deny that man ever landed on the moon. There are even some holders of high office in the US who continue to deny that Trump lost the 2020 presidential election!

Such denialism isn’t hard to understand when it’s motivated by economic, political or financial self-interest, or blind adherence to religious dogma.

It’s harder to understand when it’s expressed by otherwise intelligent people from whom one would hardly expect it. Then it can only be attributed to a conscious choice to deny reality as a way to avoid a psychologically uncomfortable truth, a defence mechanism meant to protect the psyche of the denialist against mentally disturbing facts.

So yes, long covid does exist. Conclusively, factually, and undeniably.

But disturbing though that is, there’s good news emerging of people whose long covid symptoms have disappeared as soon as they’ve been inoculated with a covid vaccine.

So we’ve some grounds for being cautiously hopeful that vaccination will not only offer us protection from contracting covid in the first place, or from being made gravely ill by it, but will also offer us protection from the debilitating effects of long covid.

Hooray for those vaccines! Now please get them to us here in Taiwan as quickly as possible.

Actually, a lot of the pushback against the notion of “long COVID” came from the medical establishment. Lots of doctors don’t like being presented with patients who have symptoms that are hard to pin down and could be associated with any number of things, especially if lab tests don’t provide obvious answers.

In reality, “long COVID” isn’t surprising and it probably shouldn’t even be called “long COVID”. That people can have a variety of ailments emerge after viral and bacterial infections, as well as other environmental triggers, is well-established.

Post-viral/post-infection illness is probably a better term.

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As for the existence of long COVID : what Baobab said. Undoubtedly, some people experience symptoms that persist for some time after the initial infection; up to a point, that’s normal. We really don’t know if there is anything unique about COVID in this regard. Or, if we do, it’s obscured by the usual political grandstanding, lying, and manipulation of facts that has characterized the whole pandemic. The Economist article is unmitigated bollocks. COVID is nothing like as debilitating, or as vicious, as those 19th/20th century waves of 'flu. The closest comparison seems to be the 1957-58 flu, which killed a similar fraction of the world population as COVID and passed into history with barely a mention in the archives.

I can’t help wondering if a lot of people may have decided that they have “long COVID” because, after a year of being paid for not working, they’ve discovered that they rather enjoy being unemployed. British people in particular are adept at the art of the sickie, and British GPs are accustomed to indulging their hypochondriac fantasies; doing otherwise tends to cause ructions.

There are actually strong parallels here with the climate-change debate. While there are certainly plenty of people who deny outright that such a thing exists, it turns out that most people have a more pragmatic question that they want answered: what are we supposed to do about it, with the least disruption and the greatest benefit? The debate rages over exactly how important climate change is, and how much investment we should throw into a “mitigation” sinkhole.

My personal views on climate change seem to overlap with my views on COVID.

  • It’s a thing.
  • It’s an important thing.
  • It is not the most important thing in the world.
  • We should not allow the entire human conversation to revolve around it, because that’s unhealthy; and we should not pour endless resources into “fixing” it when the proposed fixes are of dubious value (and indeed have done nothing useful to date).

As I’ve said many times before, my opinion on COVID is that we should spend our (limited) resources on people who are likely to benefit from interventions, and to choose those interventions that deliver the maximum payback for the minimum investment. Throwing resources away in the form of “sacrifices” (destroying businesses and putting lives on hold) is even worse than spending resources on things that aren’t going to help anybody.

I’ve said similar things about climate change; in reality, it’s a completely tractable problem and it doesn’t need to consume anything like the amount of effort, money and handwringing that has been thrown at it for the last 20 years. But people are trying to solve it by entirely inappropriate means - eg., by chasing whiz-bang technology that’ll be available “real soon now”, or by viewing Nature as our mortal enemy instead of looking at how She can help us fix this, or by jabbering a lot at international conferences. Worst of all, they’re making up spurious problems (“X% of all greenhouse gases are caused by meat-eating”) and coming up with spurious “solutions”. And so here we all are, no further along.

So, if you want to raise issues like “long COVID”, important questions need to be asked, and we need to be brutally honest about the answers:

  • How much of a problem is it? How many people does it affect? In what way does it affect them?
  • Can we do anything about it?
  • How useful is it to divert resources from problems A, B, or C and spend them on fixing “long COVID”?

If you don’t have practical solutions to the problem that don’t involve harming hundreds of other people for each person “saved” from a (relatively) minor disruption to their lives, you’re going to do more harm than good.

If your solution is merely to pray for vaccines, well, OK. But in that event there’s not much more to be said on the matter.

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According to a vast study conducted by this cognitive neuroscientist at Imperial College London, something definitely happens with the cognitive functions of people who have had COVID, even those who were not hospitalized.

While this neuroscientist readily acknowledges that more longitudinal studies are needed, his findings so far indicate that the cognitive effects of COVID appear to be something more than random blokes who “rather enjoy being unemployed.”

Guy

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Finley you wrote this in May. I wonder if through your extensive reading you have arrived at other conclusions now.

Guy

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I think I posted this somewhere else on this forum, but it should go in this thread:

Glandular fever and what is called “Long Covid” have many things in common. Symptoms are similar. More than 95% of healthy adults have a “latent” or dormant infection of the Epstein-Barr virus (EBV), a type of herpes virus. Illness and other stressors can reactivate the infection.

Studies suggest that “many long COVID symptoms may not be a direct result of the SARS-CoV-2 virus but may be the result of COVID-19 inflammation-induced EBV reactivation.”

Sure, maybe Covid is a trigger, but the pre-existing condition is the actual cause.

It’s also known that being obese induces a chronic immune-mediated inflammation and affects the cellular immune response to infections, thus increasing one’s risk of being affected by EBV and/or Covid.

Maybe one day we’ll stop blaming anything and everything on Covid. There’s many factors at play. It’s not so simplistic as we tend to hear. man_shrugging:

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Except when Covid causes things like triggering dormant diseases or previously non-existing conditions in obese people. We’ll keep blaming those on Covid.

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In case anyone was wondering, the research findings summarized in that helpful piece posted by tempo were from a team at Royal College of Surgeons in Ireland.

Guy

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Interesting. The study concluded: “Sustained endotheliopathy was more frequent in older, comorbid patients and those requiring hospitalization.” That is to be expected.

There are a few studies of this nature. They usually propose some drug treatments for it as well.

Does that study say that Covid actually caused the blood clotting? Or that blood-clotting was an underlying precondition, exacerbated by Covid? I checked it and really couldn’t find that info.

In any case, there are a few reasons someone might have blood clots:

1. Obesity

People who are obese are more than twice as likely to develop a thrombus (blood clot in the leg) compared with people of a normal weight. This is because obesity causes chronic inflammation and reduced fibrinolysis (ability to breakdown clots).

Chronic inflammation also happens as a result of having less nitric oxide in the body. Nitric oxide is a molecule that protects the specialised endothelium (the blood vessel’s lining) and prevents cells from sticking to the endothelial surface. Even at an early age, people who are obese have significantly lower levels of nitric oxide. It’s this reduced amount of nitric oxide in obese people that increases damage to the lining of blood vessels, in turn, increasing the risk of clots forming.

2. Smoking

Smoking increases the risk of blood clots forming by up to threefold.

As with obesity, smoking reduces the amount of nitric oxide in the body and encourages the blood to stick together to form clots. This process is driven in part by significantly increased levels of fibrinogen, an important component in clotting, present in the blood of smokers. Chemicals in cigarettes also cause platelets in the blood to stick together. Together, these factors make the blood thicker, making it harder for the heart to pump it around the body, in turn, damaging the inner lining of the blood vessels.

3. Flying and inactivity

Travelling long distances in aircraft, or being immobilised for a long period after major surgery, can increase the risk of blood clots in the form of deep vein thrombosis (DVT) – blood clots in the legs. The typical incidence of DVT is one in 1,000, but it increases up to threefold on flights longer than three hours.

Because the blood is not flowing as much, the cells and proteins in blood settle out and form clumps. When the person starts moving again, these clots can move around the body and block a blood vessel if they are not broken down. Increased body mass index, age and smoking increase the risk of developing DVT from inactivity or on flights.

4. Trauma and cancer

As many as one in four people who have had major trauma, which causes damage to blood vessels – such as if large bones have been broken – develop clots. In such cases, the clot formation is linked to both the injuries to the blood vessels themselves, as well as the often prolonged bed rest associated with treatment and recovery.

Similarly, people with cancer are five to seven times more likely to develop blood clots. This is because some cancers produce increasing amounts of coagulation factors that promote clotting. Cancer also damages healthy tissues, which causes them to swell and clot.

5. Contraceptive pill

Women taking the combined oral contraceptive pill containing artificial oestrogen and progesterone have been found to have a small increased risk of blood clots. Other oral contraceptives show similar levels of increase, with about 6-17 extra events per 10,000 women treated depending on the drug used, compared with women who don’t take the oral contraceptive.

The ingredients in contraceptives increase the levels of several clotting factors circulating in the blood, which increases the odds of blood forming clots in veins.

COVID-19

Research also shows that COVID-19 patients have significantly elevated levels of a molecule that forms when clots are present. This is because COVID-19 attacks the endothelial cells lining blood vessels, causing an increase in clots throughout the body and presenting as a vascular disease. One study also found between 2%-9% of COVID-19 patients develop pulmonary emboli (blood clots in the lungs). And COVID-19 patients are between three to six times more likely to develop blood clots in the veins compared with the rest of the population.

Other factors – such as bed rest and [age](Factors associated with COVID-19-related death using OpenSAFELY | Nature) – may increase the risk of blood clots in COVID-19.

Important to note: The prevalence of obesity among people over 60 in the US is around 40%.

Among the obese population age 51 and older, a disproportionate share — three-quarters — are age 51 to 69.

I suspect, when you combine inactivity, age, and poor diet, you’re gonna have a much higher susceptibility to blood clots, Covid or no Covid.

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It seems you got that from a Conversation article , would be better to link to it…

Here’s another article about Long Covid.

I am very interested to understand the main causes and if other viruses previously caused similar issues but were poorly characterised (some folks remember M.E. I am sure…They called it the Yuppie flu and I knew one classmate who had it).

These blood clots in the lungs could be a big issue.

I’m pretty sure I had Long Viral syndrome when my sense of smell was kaboshed for about three months a few years ago (I thought it was a severe allergy but it was an infection in hindsight ). So I believe what these people are going through is real from my own experience.

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I remember reading about changes people suffered from the 1918 influenza.

German Study on long covid after recovery from mild covid infection:

Multi-organ assessment in mainly non-hospitalized individuals after SARS-CoV-2 infection.

Bodyplethysmography documented mildly lower total lung volume (regression coefficient − 3.24, adjusted P = 0.014) and higher specific airway resistance (regression coefficient 8.11, adjusted P = 0.001) after SARS-CoV-2 infection. Cardiac assessment revealed slightly lower measures of left (regression coefficient for left ventricular ejection fraction on transthoracic echocardiography − 0.93, adjusted P = 0.015) and right ventricular function and higher concentrations of cardiac biomarkers (factor 1.14 for high-sensitivity troponin, 1.41 for N-terminal pro-B-type natriuretic peptide, adjusted P ≤ 0.01) in post-SARS-CoV-2 patients compared with matched controls, but no significant differences in cardiac magnetic resonance imaging findings. Sonographically non-compressible femoral veins, suggesting deep vein thrombosis, were substantially more frequent after SARS-CoV-2 infection (odds ratio 2.68, adjusted P , 0.001).

English: https://www.uke.de/dateien/einrichtungen/unternehmenskommunikation/pressemitteilungen/2022/ehab914_au.pdf

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For healthy people some deterioration in health is not that big of a deal, but for those who already have issues this is a big burden on top of that and it can cause chain effects from bad to worse.

I also see problems for professional athletes as they will struggle to achieve same results in competitions as before.

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Any results from that study on cognition?

Guy