There are many other questions that we still need to address regarding the ongoing COVID-19 pandemic, such as the long-term health consequences, viability of interventions, vaccine development, and strategies where we are lacking and need to ramp up efforts. Part 2 of the knowledge update is dedicated to discussing the potential long-term health consequences of COVID-19, as well as our current understanding of the risk factors associated with serious cases.
How Deadly is COVID-19?
Back in April, I wrote and published an article on my website titled Covid-19, the Aversion of Aging Science, and the Psychology of Fear in which I predicted that the true infection fatality rate (IFR) could be as low as 0.2%, and no higher than 0.5%. This was at a time when many still believed the death rate of COVID-19 to be at 3–5%, based solely on the case fatality rate (CFR). The IFR and CFR can dramatically differ, as the IFR is the true death rate from an infection, whereas the CFR is the death rate based on known and confirmed infections. This means that when many cases are not reported or confirmed, such as asymptomatic cases, the statistics between the CFR and the true mortality rate, or IFR, can be worlds apart.
Since I wrote this piece, research has trended towards demonstrating this was reasonably accurate. For instance, researchers from Iceland — whose CFR was 0.5%, as the country who tested the highest amount of their citizens per capita — have now published a paper in the New England Journal of Medicine where they estimated the true IFR at 0.3%. This is in line (in the middle of estimates) with other serological studies that have been published in numerous countries. Knowing this, we need to reassess our reaction to this risk. I want to make it crystal clear that a 0.3% IFR, with how infectious and easily transmitted the novel coronavirus is, is not a matter to take lightly. It also means it is not the greatest threat humanity has ever faced or is currently facing. We need to take a step back and reassess all the evidence in a level-headed manner, which is something that we have not done, as I had discussed 2 weeks ago in my article regarding the deepening emotional rift caused by COVID-19 politics and responses.
Unfortunately, the death rate of COVID-19 is not the only thing we need to be concerned about.
Long-Term Health Consequences
My biggest concern regarding the virus itself, and not the worldwide lasting consequences of our response to the virus, isn’t the death toll, but the lingering, potentially permanent, consequences of serious cases. The fatality rate of COVID-19 is dramatically lower than what we had initially believed, which I addressed in this article, and will continue to decline with better treatments and strategies. The question is, will long-lasting consequences of having fought the virus linger, even as we are saving more lives? The reason that I state I am more concerned with long-term consequences than immediate deaths is two-fold:
Long-term consequences will likely mean shortened health span and lifespan, resulting in a greater premature loss of human life.
The drawn-out deterioration of health will cause a larger burden on society than quickly succumbing to the virus.
Emotions aside, premature loss of life is premature loss of life. It’s far more tragic and shocking to lose someone abruptly, as opposed to losing them after a long battle. There is no time to come to terms with it and to accept the inevitable loss. We need to be thinking about overall health and prosperity and not just about the immediate tragedy. Focusing on addressing the lingering and potentially permanent side effects should be just as much or more of a priority than aiming to reduce immediate fatalities. Let’s take a look at some of the known damage of COVID-19, even in individuals who survived this disease.
Our knowledge of the virus is evolving. First, it was believed that COVID-19 primarily affected the lungs. Then, we started learning about its troubling negative consequences on the brain. Now, we are learning that COVID-19 may be serious for the heart, as well. In one study, which conducted autopsies to examine 39 deceased patients,1 24 patients had high levels of the virus in their hearts. This small study wasn’t too troubling considering the average age of the deceased individuals was 85 years old.
In another study, 100 recovered COVID-19 patients with a mean age of 49 were recruited.2 A total of 67 of these patients had not required hospitalization, with mild cases of COVID-19 allowing them to recover at home (18 patients were asymptomatic, and 49 had mild to moderate symptoms). After a minimum of 2 weeks following resolution of symptoms, they had their cardiac health assessed and compared to 50 healthy controls and 57 individuals with risk factors for cardiac issues. It was found that a shocking 60% of the participants had elevated heart inflammation, and 78% had structural changes to their heart.
In another study, which is yet to be peer reviewed, scientists injected the novel coronavirus into heart cells in vitro,3 and carnage ensued.
“Maybe we should think of COVID-19 as a heart disease.
When SARS-CoV-2 virus was added to human heart cells grown in lab dishes, the long muscle fibers that keep hearts beating were diced into short bits, alarming scientists at the San Francisco–based Gladstone Institutes.”4
— Stat News
This is one serious issue that seems to put children at risk, as well. 5
“Multisystem inflammatory syndrome in children (MIS-C), believed to be linked to COVID-19, damages the heart to such an extent that some children will need lifelong monitoring and interventions, said the senior author of a medical literature review published Sept. 4 in EClinicalMedicine, a journal of The Lancet.”
Young or old, our hearts may be at risk, which is why we need solutions to protect ourselves. Before you jump to the conclusion that the children must have been sick or at risk, read the following:
“Case studies also show MIS-C can strike seemingly healthy children without warning three or four weeks after asymptomatic infections,” said Alvaro Moreira, MD, MSc, of The University of Texas Health Science Center at San Antonio. Dr. Moreira, a neonatologist, is an assistant professor of pediatrics in the university’s Joe R. and Teresa Lozano Long School of Medicine.
“According to the literature, children did not need to exhibit the classic upper respiratory symptoms of COVID-19 to develop MIS-C, which is frightening,” Dr. Moreira said. “Children might have no symptoms, no one knew they had the disease, and a few weeks later, they may develop this exaggerated inflammation in the body.”
Effects on the Brain
For myself, and many others, I do not think there is anything more concerning than permanent neurological issues or injuries. Loss of use of other organs or body parts, while devastating, can largely be overcome. I know from experience, having arthritis in 11 spots and the complete absence of cartilage in my glenohumeral joint, accompanied with labral tears and tendon tears. Permanent damage to tissues and organs, and many have it much worse than I do, can take years to come to terms with. The thing is, you can adapt to these changes, learn from them, and find new passions in life.
Loss of brain function is loss of identity, and also loss of who you are and what makes you “you.” The thought of developing Alzheimer’s disease (AD) is more concerning to me than death, for instance. This issue is compounded by my having had multiple concussions and possessing one ApoE4 allele.
New research shows that COVID-19 could lead to multiple, lasting, neurological issues.
For instance, one study determined that neurological complications of COVID-19 can include delirium, brain inflammation, stroke and nerve damage.6 This seems to be prevalent in a large percentage of cases, even some that were quite mild, as detailed by STAT:
“Early on, patients with both mild and severe Covid-19 say they can’t breathe. Now, after recovering from the infection, some of them say they can’t think.
Even people who were never sick enough to go to a hospital, much less lie in an ICU bed with a ventilator, report feeling something as ill-defined as “Covid fog” or as frightening as numbed limbs. They’re unable to carry on with their lives, exhausted by crossing the street, fumbling for words, or laid low by depression, anxiety, or PTSD.
As many as 1 in 3 patients recovering from Covid-19 could experience neurological or psychological after-effects of their infections, experts told STAT, reflecting a growing consensus that the disease can have lasting impact on the brain. Beyond the fatigue felt by “long haulers” as they heal post-Covid, these neuropsychological problems range from headache, dizziness, and lingering loss of smell or taste to mood disorders and deeper cognitive impairment. Dating to early reports from China and Europe, clinicians have seen people suffer from depression and anxiety. Muscle weakness and nerve damage sometimes mean they can’t walk.
“It’s not only an acute problem. This is going to be a chronic illness,” said Wes Ely, a pulmonologist and critical care physician at Vanderbilt University Medical Center who studies delirium during intensive care stays. “The problem for these people is not over when they leave the hospital.”
Much more information is needed on permanent health consequences, and the frequency of case severity to lingering health issues. As STAT explains, we can begin to draw information from other viral infections that have shown similar lingering effects such as mononucleosis. It seems that hospitalized cases roughly double the chances of lingering side effects compared to mild cases. It also seems that ventilated patients are at a higher risk of developing potentially permanent nerve damage.
COVID-19 is a serious threat, not just because of its death toll. We need to continue exploring effective treatments to mitigate these long-term consequences.
There will be many more COVID-19 updates coming over the following weeks. I will touch on risk factors, emerging treatments, therapies, and interventions, as well as solutions to improve testing so we can operate society again, and where we stand with vaccine development.