This week I’m diving deep into long COVID. We’ve been so focused on the pandemic’s impact on lives lost that we’ve neglected to recognize health lost. This mini-series will be 5 posts in total on long COVID: burden, impact on specific organs, predictors, kids, and treatment. This is
I have one quibble with this post. You said, "For the vast majority of people, we don’t think symptoms will last forever. In other post-viral syndromes, the majority of people eventually recover and are able resume their lives."
There is a lot of overlap between ME and Long COVID. As someone who's 35+ years into ME and who knows many people who are 20+ years into it, I cannot understand why anyone thinks Long COVID symptoms won't last forever. Recovering from ME is unusual. Most of us claw our way up to a point where we can resume some activities, but the ME does not go away and our capacity is diminished from what it should be. I am the highest functioning ME patient I've ever come across. At my best, I got to about 80%. I'm not there any more. Some of us are housebound or bedbound for the rest of our lives. A few of us die of ME.
If you prefer to ignore ME as a parallel (and it is indeed not a perfect parallel), we can look at the brain injuries so clearly documented by the UK biobank brain scan study and see that recovery from that damage is unlikely. Partial reclamation of some function, yes, as cells that are damaged but not destroyed rebound. Recovery, no.
So it's nice to believe that most Long COVID patients will eventually recover enough to resume a more or less normal life, but what evidence we have strongly suggests reality will not be that nice.
Aside from that... Thank you so very much for all the work and thought you put into these posts. I do appreciate your willingness to share your knowledge & expertise, and don't want this comment to cause you to think I don't.
As a family doc I thank you for this rather comprehensive and easily understood, well cited review. However, I support the perspective of some other comments below that it is now obvious that long covid is equivalent to the mysteries of "chronic fatigue," "Chronic Epstein Barr," "ME." etc. As a rather traditional (I mean not 'complimentary medicine' type) allopathic family doc, I have seen goodly number of these patients over the years. Obviously many consults did not come up with actionable pathologies and often, unfortunately resulted in advice to see a psychiatrist. We can now clump all these cases into a "post viral syndrome." There is now a large cohort of patients which will help researchers elucidate pathophysiology.
I would humbly suggest that when you (or we) consider possible causes we look beyond (1) organ damage and (2) abnormal immune response (which seems to be the fad of the day) to (3)
an, as yet, undetermined mechanism (in medical history think of anaerobic bacteria, coronary artery occlusion, H. Pylorei, HPV and abnormal PAPs - all obscure in their times) which will give us new insight into human vulnerabilities and viral harms.
This is essential reading. Thank you so much. I’m guessing the medical community and insurance(both life and health) industries are shuddering at the long term ramifications-while the general public is NOT ready, or willing, to hear all this(for a whole host of reasons). The future social, political, and of course health implications…….ugh. Thanks once again.
Thank you so much. Long Covid is so important to discuss. You didn’t mention ME/CFS which for many is parallel to their Long Covid experience. Given the reality of ME/CFS the statement that most people recover from post-viral illness seems overly rosy.
You do a wonderful, awesome job. As a generalist clinician with 50 years experience under my belt I have seen diagnostic fads come and go, not to mention real progress and insights. The whole area of the gut microbiome is a good example.
"Chronic fatigue" in otherwise high functioning patients without any other evident pathologies has been a very frustrating clinical problem. The medical establishment will now be motivated to take a good look at this problem.
Thank you very much for this. What is missing from your first graphic depiction is the long term medical consequences not yet seen. You may be planning to address this in your future parts of this series. We'll need to consider diseases/conditions we know that other common viruses impact and/or things we've learned Covid specifically impacts: cancer (HepB, HepC, HTLV1, EBV), mental health and schizophrenia (other viral illnesses), Diabetes 1 specifically in Covid, MS and EBV...etc. Slightly different but related (figuring out personal risk of infection) I have been unable to figure out the case numbers and percent of population at risk of infection in a usual year of influenza. I feel this aspect of trying to figure out how to compare Covid with other illnesses is missing from the public discussion.
Long COVID Mini-Series: Burden
I have one quibble with this post. You said, "For the vast majority of people, we don’t think symptoms will last forever. In other post-viral syndromes, the majority of people eventually recover and are able resume their lives."
There is a lot of overlap between ME and Long COVID. As someone who's 35+ years into ME and who knows many people who are 20+ years into it, I cannot understand why anyone thinks Long COVID symptoms won't last forever. Recovering from ME is unusual. Most of us claw our way up to a point where we can resume some activities, but the ME does not go away and our capacity is diminished from what it should be. I am the highest functioning ME patient I've ever come across. At my best, I got to about 80%. I'm not there any more. Some of us are housebound or bedbound for the rest of our lives. A few of us die of ME.
If you prefer to ignore ME as a parallel (and it is indeed not a perfect parallel), we can look at the brain injuries so clearly documented by the UK biobank brain scan study and see that recovery from that damage is unlikely. Partial reclamation of some function, yes, as cells that are damaged but not destroyed rebound. Recovery, no.
So it's nice to believe that most Long COVID patients will eventually recover enough to resume a more or less normal life, but what evidence we have strongly suggests reality will not be that nice.
Aside from that... Thank you so very much for all the work and thought you put into these posts. I do appreciate your willingness to share your knowledge & expertise, and don't want this comment to cause you to think I don't.
Just want to thank you for all you are doing...these are great, must-reads that I share within my organization
As a family doc I thank you for this rather comprehensive and easily understood, well cited review. However, I support the perspective of some other comments below that it is now obvious that long covid is equivalent to the mysteries of "chronic fatigue," "Chronic Epstein Barr," "ME." etc. As a rather traditional (I mean not 'complimentary medicine' type) allopathic family doc, I have seen goodly number of these patients over the years. Obviously many consults did not come up with actionable pathologies and often, unfortunately resulted in advice to see a psychiatrist. We can now clump all these cases into a "post viral syndrome." There is now a large cohort of patients which will help researchers elucidate pathophysiology.
I would humbly suggest that when you (or we) consider possible causes we look beyond (1) organ damage and (2) abnormal immune response (which seems to be the fad of the day) to (3)
an, as yet, undetermined mechanism (in medical history think of anaerobic bacteria, coronary artery occlusion, H. Pylorei, HPV and abnormal PAPs - all obscure in their times) which will give us new insight into human vulnerabilities and viral harms.
This is essential reading. Thank you so much. I’m guessing the medical community and insurance(both life and health) industries are shuddering at the long term ramifications-while the general public is NOT ready, or willing, to hear all this(for a whole host of reasons). The future social, political, and of course health implications…….ugh. Thanks once again.
This makes me wonder if part of the reason employers are having a hard time finding workers is because so many have long Covid or have died.
Thank you so much. Long Covid is so important to discuss. You didn’t mention ME/CFS which for many is parallel to their Long Covid experience. Given the reality of ME/CFS the statement that most people recover from post-viral illness seems overly rosy.
You do a wonderful, awesome job. As a generalist clinician with 50 years experience under my belt I have seen diagnostic fads come and go, not to mention real progress and insights. The whole area of the gut microbiome is a good example.
"Chronic fatigue" in otherwise high functioning patients without any other evident pathologies has been a very frustrating clinical problem. The medical establishment will now be motivated to take a good look at this problem.
We should open to any heuristic hypothesis.
This is the series I've been waiting for! Thanks for your work on it. Great so far.
Thank you very much for this. What is missing from your first graphic depiction is the long term medical consequences not yet seen. You may be planning to address this in your future parts of this series. We'll need to consider diseases/conditions we know that other common viruses impact and/or things we've learned Covid specifically impacts: cancer (HepB, HepC, HTLV1, EBV), mental health and schizophrenia (other viral illnesses), Diabetes 1 specifically in Covid, MS and EBV...etc. Slightly different but related (figuring out personal risk of infection) I have been unable to figure out the case numbers and percent of population at risk of infection in a usual year of influenza. I feel this aspect of trying to figure out how to compare Covid with other illnesses is missing from the public discussion.