Our Collective Long Covid

Our Collective Long Covid 1

We hate to play our regular role of being the (early) bearer of bad tidings. For some time, we’ve been pointing to information and developments that suggest that efforts to contain Covid are having only limited success. That means Covid will be with us a very long time. Yet there’s still a tremendous amount of wishful thinking and denial which has the potential to make this bad situation worse.

Ambrit’s take yesterday: “The Pandemic is not even slowing down, yet, a false sense of triumphalism holds sway on that front” is consistent with by a Bloomberg article last week, When Will Covid End? We Must Start Planning For a Permanent Pandemic. In other words, even as the idea that Covid will be with us for years at best is moving from the fringes to a legitimate viewpoint, more and more people (outside the EU and UK) are acting on the assumption that normalcy is nigh.

Consider:

Poor countries denied Covid vaccines until 2023. That means virus will keep circulating there. Even if these countries get to be very successful at identifying and distributing prophylactics, they have to be administered regularly, which is even more difficult logistically than administering vaccines, so there are certain to be large gaps in who will get these treatments. That insures that variants will keep developing.

Only temporary immunity. Pfizer is already salivating from the profit potential of annual Covid shots. Immunity to other common coronaviruses lasts anywhere from 6 months to 34 months. Various studies, like the large-scale periodic surveys in the UK, have suggested immunity lasts six months, and some have argued at least eight months. But then we come across datapoints like this one: SARS-CoV-2 seropositivity and subsequent infection risk in healthy young adults: a prospective cohort study:

Seropositive young adults had about one-fifth the risk of subsequent infection compared with seronegative individuals.

The “healthy young adults” were Marines undergoing basic training. Of the ones who had tested positive, 10% tested positive again during a six-week follow up. The reinfections were of the same strain. And the Daily Mail layperson translation stressed:

Researchers say the three negative tests during quarantine helped ensure that infections diagnosed during basic training were not persistent infections but rather new infections.

We don’t know how much the vaccines reduce contagion. Given the concerted effort to vaccinate nursing home residents and staffs, the impressive decline in cases there points more to vaccine success among the vaccinated than in reducing transmission. The assumption has been that the vaccines will reduce disease spread since they considerably reduce the number of severe cases, and lower viral loads and fewer Covid coughs ought to mean less disease propagation. We’re flying even blinder in the US than we ought to be because in the US, the push for vaccinations has pulled resources away from testing.

But we now also know that mild and asymptomatic cases can spread the disease, and can also produce lasting damage, to lungs, kidneys, the heart, as well as long Covid.

Uncertainty about effectiveness of existing vaccines will be with new variants. mRNA vaccines are touted for speed of development, so it should come as no surprise that Pfizer and Moderna are looking into whether a third shot will be necessary to contend with new variants.

Vaccination levels won’t be high enough tamp down the disease. This is not new news but it bears repeating. From Bloomberg’s “permanent pandemic” piece:

In the case of SARS-CoV-2, however, recent developments suggest that we may never achieve herd immunity. Even the U.S., which leads most other countries in vaccinations and already had large outbreaks, won’t get there. That’s the upshot of an analysis by Christopher Murray at the University of Washington and Peter Piot at the London School of Hygiene and Tropical Medicine.

The main reason is the ongoing emergence of new variants that behave almost like new viruses. A clinical vaccine trial in South Africa showed that people in the placebo group who had previously been infected with one strain had no immunity against its mutated descendant and became reinfected. There are similar reports from parts of Brazil that had massive outbreaks and subsequently suffered renewed epidemics.

That leaves only vaccination as a path toward lasting herd immunity. And admittedly, some of the shots available today are still somewhat effective against some of the new variants. But over time they will become powerless against the coming mutations.

Of course, vaccine makers are already feverishly working on making new jabs. In particular, inoculations based on the revolutionary mRNA technology I’ve previously described can be updated faster than any vaccine in history. But the serum still needs to be made, shipped, distributed and jabbed.

And that process can’t happen fast enough, nor cover the planet widely enough.

And from a newer story in Bloomberg:

What that means is that new Covid cases will likely emerge in younger age groups. That occurred in Israel, where infections were recently plateauing despite the country’s world-leading immunization program. It turned out that cases among young people were surging, even as infections dropped in the 50-and-older crowd.

Mind you, the problem of variant development within and outside the US alone is enough to defeat getting infection levels down any time soon, even before you get to the wee problem of 30% to 40% of Americans being either anti-vaxxers or vaccine hesitant.

Lack of will to take stringent enough control measures. South Korea has shown how to get Covid down to a low enough level to allow for normal life to continue: impose strict quarantines for all incoming travelers, track and trace any new infections, and require those exposed to quarantine. In the West, we’ve only done leaky lockdowns and our quarantines have almost all been jokes (see New York as an example). By contrast, a friend’s significant other went to Poland to see her family. She was under a strict quarantine at her parent’s home, not even allowed out in the yard, with cameras on the house and the neighbors enlisted as spies. The fine for a first violation was 5,000 euros; for the second, a 15,000 euro fine plus six to 12 months of incarceration.

But not only are US infections generally too high for contact tracing to work, but we also lack the capacity do do enough testing and decades of telemarketing (and now identity theft) abuses means many people won’t respond to a call or text from an unknown sender.

Inadequate official action compounded by optimism bias and compliance fatigue. Lambert and the Institute for New Economic Thinking both have warned that the CDC’s failure to take aerosol spread as a serious risk and its biased reading of other data have led it to recommend school reopenings without implementing adequate safety measures or pumping for improved ventilation. Here in Birmingham, the mask mandate has been lifted even though less than 13% of the public is fully vaccinated. Conventions are set to start again in Las Vegas in June.

It’s deeply unpleasant to consider that Covid restrictions might go on and on…that the US relaxed spring might lead to another wave of lite or tougher lockdowns. But the cost of Covid isn’t just death and disease, it’s also experienced professionals quitting, both in medicine and increasingly in schools. A short section from ‘I just feel broken’: doctors, mental health and the pandemic in the Financial Times last week:

Emerging research from countries including the UK, the US, China, India and Italy has shown alarmingly high rates of mental health disorders among front-line healthcare workers during the pandemic.

In February, a group of academics led by Talya Greene of the University of Haifa and Jo Billings of University College London published a paper in the European Journal of Psychotraumatology which found that, during the first wave of the pandemic, 22 per cent of all UK medical staff met the diagnostic criteria for post-traumatic stress disorder, 47 per cent for anxiety and the same number for depression.

Monica Durrette, a clinical psychologist in Virginia, says, “I have had physicians in tears during sessions, because they’re so exhausted, angry, frightened. And I’ve had people say, ‘This is breaking me, I just feel broken.’ It’s heart-wrenching.”

For many of these health workers, the bleak reality of their daily battle contrasts painfully with glowing narratives of heroism propagated in the media and local communities. It also illustrates a deeper crisis that long predates the pandemic, an undercurrent of burnout and mental illness plaguing a profession that should be uniquely placed to look after itself.

According to Gary Price, president of the Physicians Foundation, 300-400 doctors took their own lives every year in the US, even before the pandemic — the highest suicide rate of any profession. “That translates out at a conservative estimate to about one million patients losing their physician every year just to suicide,” Price says

The article describes at length one of the common features of post-traumatic stress disorder, that of moral injury, a feeling that they’d violated their own fundamental values, and how many Covid doctors are afflicted by it:

In addition to witnessing extraordinarily high volumes of death and suffering over the past year, many have been forced to make unprecedented ethical decisions that they would never have been faced with in normal practice, such as choosing which patient gets a ventilator and which doesn’t….

Natalia Guzman-Seda, a resident anaesthesiologist at a teaching hospital in Brooklyn, says the case numbers during the first wave were so overwhelming that she and her colleagues barely had time to restock their supplies to keep up with the influx. At the peak of the first wave in early April 2020, New York City had more than 6,000 new cases a day.

“I would go to intubate a patient, and then go back to the [operating room] to restock, and then I would get another [call] and I would say, I feel like I’ve been here before,” she says. “And I realised that I’m intubating the neighbour of the patient that I had intubated earlier. And that one was already dead.”…

As New York City’s case numbers started to climb again later that year, Guzman-Seda began experiencing panic attacks, as well as a paralysing sense of guilt about her actions during the first wave…

In particular, she was fixated on the idea that she had assured patients she was intubating that they would be OK if they allowed her to insert the breathing tube into their airway – necessary for them to be placed on a ventilator – despite knowing that very few would survive. “I felt like, Who am I to take away hope from them?” she says. “But at the same time I feel very conflicted… I felt, in a way, I was lying to them.”

It’s not just that there are no easy answers. There are also no good answers. We live in a complex and highly interdependent society. We blew the chance to do a hard lockdown, restrict transportation, particularly internationally, unlock state by state, region by region, when infection rates got low with test and trace and possibly a resumption of restrictions as necessary. We ignored South Korea’s lesson to our peril.

Large-scale, leaky restrictions mean some businesses and workers suffer acutely, yet we don’t really strangle infection numbers down as far as we could even with this approach. And legitimately increasing the rejection of this approach, and the US and most other countries have done a terrible job of keeping the hard-hit afloat and making it easier to stay at home, particularly for those who are asked to quarantine. Yet if we keep going as we are, we’ll see so much attrition among doctors and nurses that getting adequate turnaround at the ER in years to come will be even dicier, and even worse area crises like earthquakes or fires.

So keep wearing your masks. It’s the least you can do. If nothing else, it shows solidarity with the medical community.

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