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Ryan McNamara, MD's avatar

Having seen hundreds (if not thousands) of individuals with severe covid in the hospital, I have perhaps a different take. Early in the pandemic, up to 15% of COVID19 sufferers were admitted to hospitals. As therapies improved (steroids, then monoclonal antibodies), and outpatient oxygen became more available, that percentage certainly declined, though the hospitalization number increased wave-by-wave here in Tennessee. It declined further of course after vaccinations and/or prior infections became commonplace. That said, it was a huge number of people.

And *most* of them had persistent symptoms >4-6 weeks after their illness.

Viral pneumonia/ARDS wrecks the lungs. It leaves scars. (Severe cases of pneumonia from other pathogens do as well, of course)

Covid-19 wrecks the brain. The average person hospitalized with covid, according to UK researchers, loses 5-7 IQ points. If ICU, 10-15. I can’t count how many elderly patients I admitted in ‘20 who started with mild cognitive impairment, but were discharged with severe dementia.

Blood clots, myocarditis, acute liver or pancreatic injury; all of those acute manifestations may have long term consequences.

We had great success in improving outcomes throughout the pandemic. But there was a lot of trial and error on the way. Among survivors of covid-19 from 2020? *Way* more than 1% were physically damaged permanently. Maybe it was even as high as the lower bar 10% figure. There were certainly many more who never got admitted whose symptoms were severe enough to forbid work, and which persisted a long time. I know quite a few healthcare providers in that group. Maybe half again as many? An additional 5%? Like you, the 30% figure seems absurd to me too.

Even among 2020 survivors.

The covid experience is entirely different now, with a mostly-partially-immune population. <5% of covid cases get hospitalized now, and despite their typically advanced ages, they’re not nearly *as sick*. Considering that vastly more Americans got covid in ‘21 and ‘22, and the prevalence of long term injury dropped so greatly (I will not comment here upon my Southeast USA Delta variant experience last summer…), that 10-15% has been diluted out such that I’m sure long covid now is <5% of the total.

Regards.

I enjoy your blog!

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J Burk Gossom's avatar

I suspect we are dealing with 3 distinctly different populations. One may represent low grade persistent viremia. The next covid neurologic injury. The last is the group of patients that chronically do not feel well and are looking for a explanation whether it be chronic EB, chronic fatigue, total environmental allergies etc. Ultimately all we have to offer is supportive individualized management requiring deft clinical care which cannot occur if we try to put everyone in the same box. J. Burk Gossom MD

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