Long-term effects of COVID-19 may create a generation of the disabled
Welcome, dear readers, to my semi-regular coronavirus roundup.
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Long-term health effects
More research and anecdotal evidence indicate that those who survive the coronavirus often suffer long-term and recurring effects. This illustrates the foolishness of celebrating a lower death rate as indicative of a less severe outbreak.
The Journal of the American Medical Association published a study of Italian 143 patients (average age 56) discharged from the hospital after “recovery” from COVID-19. Two months later, only 13% were symptom-free. 87.4% reported persistence of at least 1 symptom, particularly fatigue and dyspnea (labored breathing). Worsened quality of life was observed among 44.1% of patients.
- Further reading: “Report Suggests Some ‘Mildly Symptomatic’ Covid-19 Patients Endure Serious Long-Term Effects,” Forbes, summarizes European studies
There is increasing evidence that COVID-19 causes permanent lung-scarring:
In a study from China, published in March, 66 of 70 patients still had some level of lung damage after being discharged from hospital.
Radiologists in the UK say, based on the early results of follow-up scans, they are concerned about the long term-effects of a serious infection. “In the six-week scans we’re seeing, so far I would say between 20% and 30% of patients who have been in hospital appear to show some early signs of lung scarring,” says Dr Hare, who helped draw up NHS radiology protocols to diagnose Covid-19.
According to Berkley’s John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology, other organs are negatively impacted, too:
Another area is the heart. There is evidence now that the virus can directly attack heart muscle cells, and there’s also evidence that the cytokine storm that the virus triggers in the body not only damages the lungs, but can damage the heart… it could be that we will have a population of people who survive COVID-19 only to go on and have chronic cardiac problems.
The third organ system that we’re now pretty clear about is the central nervous system. There is evidence of direct involvement of the virus with neurons, and also the cytokine storm and inflammatory mediators can cause damage to the central nervous system. This is manifesting itself not only in neurologic clinical findings, but also psychological findings…
Finally, it has become clear that infection with SARS-CoV-2 triggers abnormal clotting of the blood in some people. This has led to pulmonary emboli, which are blood clots that travel to and damage the lungs, and strokes, which are blood clots in the vascular system of the brain. Both pulmonary emboli and strokes may have long-term consequences for these two organs.
- Further reading: “Severe brain damage possible even with mild coronavirus symptoms,” DW
The Atlantic interviewed nine people who have COVID-19 and were never admitted to an ICU, meaning they qualify as having a “mild” case of the disease. However, they are just a handful of thousands suffering long-term health challenges as a result.
…their lives have nonetheless been flattened by relentless and rolling waves of symptoms that make it hard to concentrate, exercise, or perform simple physical tasks. Most are young. Most were previously fit and healthy. “It is mild relative to dying in a hospital, but this virus has ruined my life,” LeClerc said. “Even reading a book is challenging and exhausting. What small joys other people are experiencing in lockdown—yoga, bread baking—are beyond the realms of possibility for me.”
…As many people reported “brain fogs” and concentration challenges as coughs or fevers. Some have experienced hallucinations, delirium, short-term memory loss, or strange vibrating sensations when they touch surfaces. Others are likely having problems with their sympathetic nervous system, which controls unconscious processes like heartbeats and breathing: They’ll be out of breath even when their oxygen level is normal, or experience what feel like heart attacks even though EKG readings and chest X-rays are clear. These symptoms wax, wane, and warp over time.
Further reading: “How Covid-19 can damage the brain,” BBC; “New-Onset Diabetes in Covid-19,” PubMed; “Lifelong Lung Damage: The Serious COVID-19 Complication That Can Hit People in Their 20s,” Heathline
Equipment and supplies
The National Stockpile is still short on personal protective equipment (PPE)… An internal report revealed that:
- FEMA and the national stockpile have fewer than 900,000 gloves in reserve after shipping 82.7 million of them — or just 30 percent of the amount requested by state, local and tribal governments — since the COVID-19 crisis began
- there are 329,000 pairs of goggles on hand, and the administration has only been able to provide 29 percent of the 4.9 million requested by state and local governments so far, according to the tables.
- Similarly, 8.5 million gowns are warehoused — the HHS Department did not break down how many are surgical and how many are nonsurgical — while only 5.2 million of the 17.9 million surgical gowns requested (29 percent) have been shipped out.
- The administration has also struggled in its efforts to procure body bags. State and local governments have requested 175,797 of them, according to the HHS data, but only 69,067 have been provided.
In particular, nursing homes and long-term care facilities say there is a major personal protective equipment shortage.
“Currently, nearly 20 percent of nursing homes report to CDC [the Centers for Disease Control and Prevention] that they either do not have or have less than a one-week supply of PPE, and more than half of assisted living communities have less than a two-week supply of N-95 masks and gowns… N-95 masks are still not available and were not included in the FEMA shipments to nursing homes.”
- Further reading: America is running short on masks, gowns, and gloves. Again. Health-care workers are scrambling for supplies and reusing equipment as the coronavirus pandemic surges
- Further reading: Nearly four months after invoking the Defense Production Act, the Trump administration has made only sparing use of its authorities, leaving front-line workers in dire need of supplies like masks, gowns, and gloves amid the recent surge in cases.
- Further reading: Private sector officials testified to the House Oversight Cmte that the Trump administration’s failure to bring procurement efforts under a federal umbrella was “one of the biggest missed opportunities.” The companies informed Committee staff that they have serious concerns that “raw material for PPE is now in a really bad position worldwide.” As one company official stated: “Supply is still coming in, but not enough to meet demand.”
Some White House staffers argued against a DOJ effort to stop price-gouging and scamming during the pandemic… These “free-marketeers” felt the massive influx of people wheeling and dealing for PPE was a sign that the free market was working efficiently to move materials where they needed to go. However, some watchdog groups say that the DOJ’s task force didn’t go far enough.
Two federal agencies gave nearly $20 million in contracts to a newly formed California company without realizing the owner was sued by the same government. Jason Cardiff, of VPL Medical LLC, was sanctioned by the Federal Trade Commission for running a fraudulent scheme.
- Further reading: The federal government is essentially providing seed money to PPE startups, including some run by people accused of fraud. Mask brokers describe a simple blueprint for buying masks from China to get rich.
Trump Is Donating Ventilators to Countries That Don’t Need or Can’t Use Them… White House officials have pushed the U.S. Agency for International Development to purchase thousands of the expensive devices from U.S. companies and donate them abroad…The administration’s decisions on ventilator distribution appear to have little correlation to the number of coronavirus deaths or infections in a country.
Testing in the U.S.
Numerous states are reporting shortages in testing supplies are significantly slowing down their testing capacity. For instance, Louisiana, Oregon, Arkansas, Nebraska, and California have experienced have seen a shortage in testing kits, chemical reagents, and other necessary supplies.
- On Wednesday, House Speaker Nancy Pelosi called on Trump to use the Defense Production Act “immediately to address the need for the testing equipment” and “equipment to make judgments about positive or negative.”
Some areas are experiencing testing delays of over a week, so long that the results are proving useless to the effort to control the disease. The surge in infection, especially in the southern states, has overwhelmed labs and caused a shortage of supplies across the nation. Private labs Quest and LabCorp say the backlog is growing unsustainably large.
- The federal government never fixed fundamental infrastructure problems, experts say: “Instead of building that out, our federal response was to do the very least possible. So each time the system is stretched now, it breaks down all over again,” said Ashish K. Jha, who directs the Harvard Global Health Institute. “It’s frustrating because . . . it’s not like, ‘Oh my god, we just figured out we need to do testing.’ We’ve literally been talking about this for months.”
The ripple effect of the increased cases in the south has impacted other states, causing backlogs across the nation. Washington Gov. Jay Inslee: “This is a challenge because these southern states are creating a huge demand on these commercial labs…But we need help from the federal government. I’ve said this now for four or five months… We need to have a very rapid turnaround time so that our contact tracing can be successful and we need national leadership to help in that regard”
The number of daily coronavirus tests being conducted in the U.S. is only 39% of the target rate needed to mitigate the spread of the virus. Just 12 states—Maine, Vermont, New York, Connecticut, Massachusetts, New Jersey, Alaska, Hawaii, West Virginia, Montana, Kansas, and Washington, D.C.—are testing at the optimal rate, NYT reported.
Trump has continued to rant about testing “creating” cases of COVID-19. “Test everybody, pull-up parking lots, everything else, what we’ve done is we’ve created a tremendous number of cases.” Trump told Fox News commentator Sean Hannity in a phone interview (video).
- Fact check: The US is testing slightly more than similar places (113 tests/1000 people, vs 99/1000 people in the UK, 92/1000 people in Italy, 73/1000 people in Germany.) But it’s finding a proportionately greater share of cases (U.S.: 9,250 cases/million, vs. 4,400 cases/million in UK, 3,900 cases/million in Italy and 2,500 cases/million in Germany.)
Some further reading on reopening schools:
- ‘Science should not stand in the way’ of schools reopening, White House Press Secretary Kayleigh McEnany says.
- The CDC will not release a set of documents this week aimed at giving schools advice on how to reopen. Instead, the full set will be published before the end of the month, a CDC spokesperson says.
- This summer camp in Missouri took extraordinary covid-19 precautions. It still failed. More than 80 campers, counselors, and staff tested positive.
- At least 30 and possibly as many as 85 kids and counselors at two Georgia YMCA camps tested positive for the coronavirus, forcing closure.
- Nearly a Thousand COVID-19 Cases Reported in California Day Cares
- Millions of Seniors Live In Households with School-Age Children
- Two researchers presented their ideas (informed by “pandemic math”) of how to most safely reopen schools: (1) stagger start dates, (2) have small groups of students alternate school days and work from home days to reduce class sizes, (3) everyone must wear masks and eat lunch in classrooms. The authors state that communities with high infection rates should postpone reopening schools.
Masks and anti-masks
- States that now have a statewide mask requirement in public indoor spaces include: Alabama (Repub. governor), Arkansas (R), California (Dem. governor), Colorado (D), Connecticut (D), Delaware (D), D.C. (D), Illinois (D), Kansas (D), Kentucky (D), Louisiana (D), Maine (D), Maryland (R), Massachusetts (R), Michigan (D), Nevada (D), New Jersey (D), New Mexico (D), New York (D), North Carolina (D), Oregon (D), Pennsylvania (D), Rhode Island (D), Texas (R), Virginia (D), Washington (D), and West Virginia (R). Montana is not yet on that list but issued a face-mask order on Wednesday.
- Conspicuously absent from this list: Georgia, Florida, and Arizona, three of the biggest hot spots in the country. In fact, yesterday Georgia Gov. Brian Kemp banned cities from issuing face mask orders and sued Atlanta to invalidate the mayor’s mandate.
- 15 major grocery and retail chains are now requiring face masks in their stores, including Walmart, Kroger, Costco, CVS, and Target.
- Putting the onus on employees to enforce face mask requirements is adding stress to jobs previously lauded as “essential.” WaPo: “People see it as this big political message when it’s really just about public health,” said Shilo Barrett, 26, a shift supervisor at a Starbucks in Los Angeles, where about 10 percent of shoppers come in without masks despite local and state mandates. “It’s already unfair that we have to work right now because we have bills to pay, and now you’re going to put us in a compromising situation because you don’t want to wear a mask for 5 minutes? That’s not cool.”
- A nationwide mask mandate would bring the coronavirus under control within 2 months, according to CDC Director Robert Redfield (video). However, presented with this fact during yesterday’s White House press briefing, McEnany said Trump will not issue such an order. “We leave it to localities to make the decisions with regard to face coverings,” she said.
- Measuring geotagged Twitter posts that reference hashtags like “nomask” and “burnyourmask” revealed that Arizona, Nevada, Florida, Idaho, and Maine contain the most anti-mask sentiment. Keep in mind that prolific users and/or bots can drive these trends, though.
- The international president of the Association of Flight Attendants-CWA believes it’s “absurd” that the Federal Aviation Administration has not mandated that travelers wear masks on all flights during the pandemic.