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.
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
Jul 24, 2022·edited Jul 24, 2022Liked by Buzz Hollander MD
What percentage of those with long COVID were vaccinated/unvaccinated? I am surprised this was not addressed. Could the overstimulated immune systems have been the result of vaccines?
I have had COVID twice. Latest round in July of 22. This time I am having fatigue and brain fog. complaining of fatigue and muscle weakness, My doctor gave me an anti depressant prescription and sent me on my way. I changed doctors immediately, and asked for a stress test on my heart. I've always been energetic, strong and capable. It's terrifying to feel this way and I tell my wife I feel like I'm going to die. Like stage 4 cancer exhaustion. I'm not sleeping that much but everything is an effort mentally and physically. It's real, it's scary, and it medical community seems completely incapable of acknowledging it. We've had 3 years to study and prepare for this stuff and the only solution was to force an experimental vaccine on us. I'm 51 years old, vaxed and boosted so I didn't lose my job. Much too young to feel this d@#$ old. Our medical system and government have failed to meet the moment.
"The results “suggest that physical symptoms persisting 10 to 12 months after the COVID-19 pandemic first wave may be associated more with the belief in having experienced COVID-19 infection than with actually being infected with the SARS-CoV-2 virus,” the authors wrote in JAMA Internal Medicine."
I am not a physician but last night I watched a segment on Long Covid on the PBS Weekend News. It had the usual public television presentation of an articulate spokesperson who was said to be suffering from the disorder along with a physician who was researching the problem or at least supposedly compiling statistical data and who spoke of the underrecognized ubiquity of the problem. As a psychotherapist for over 50 years, I have seen medicine's frustration with vague constellations of symptoms with no clear findings on the usual array of medical tests. The insistence that their suffering is real in the face of will-o'-the-wisp findings is invariably as much a political problem as a medical one. Multiple chemical sensitivity syndrome as well as others mentioned by Dr. Hollander come to mind.
I have long covid. Its dreadful. . My guess is that the body just has to heal ( or not) and there is not much medicine can do to help. But my anger is related to this: The damn virus was made in a lab, result of diabolical animal research on gain of function. The research, jointly financed by multiple countries, was done in China surely because sooner or later they need human subjects to infect and they can't get those easily in western countries. This monstrous research needs to stop. Leaks will happen again, its inevitable. It appears there are dozens (?) or scores (?) of labs doing gain of function research and bio weapon research. This is the real cause of the suffering. We need an International treaty to ban it.
I think the biggest problem in defining “long covid” at present comes out of the US CDC’s rather unhelpful definition.
4 weeks of vague symptoms with no specific criteria to pin down the diagnosis?
That’s not a diagnostic criterion, it’s a fishing expedition.
A mild depressive episode that requires no specific medical treatment will easily fall under the criteria you list above, not to mention a wide variety of other medical conditions.
I mean, I wonder if your surveyed everyone with a bad case of the flu, what proportion would have at least some of these symptoms for 4-5 weeks after infection?
I’ve been following the 3 month timeline advised by the WHO and poof! magically most people feel better if you wait a few more weeks after their covid diagnosis as they get back to a normal life.
This isn’t to deny the reality of people with actual long covid. But it’s going to continue causing problems if the media and some medical authorities continue telling people they might have a highly disabling medical condition simply because their viral illness laid them up for 1 month.
Long Covid is the same bucket as Fibromyalgia, where effete, liberal leaning cat ladies put their need for attention. It’s perfect because it requires no provable symptoms and doctors are happy to take our money on phantoms.
The comparison of symptoms to MCAS is interesting, on a MCAS page I read occasionally I see a number of people feeling they have developed MCAS a from a bout with Covid. I don’t know if any have had a medical diagnosis or are seeing the similarities in symptoms themselves.
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!
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
What percentage of those with long COVID were vaccinated/unvaccinated? I am surprised this was not addressed. Could the overstimulated immune systems have been the result of vaccines?
The shadow of evil lies heavy upon the land.
I have had COVID twice. Latest round in July of 22. This time I am having fatigue and brain fog. complaining of fatigue and muscle weakness, My doctor gave me an anti depressant prescription and sent me on my way. I changed doctors immediately, and asked for a stress test on my heart. I've always been energetic, strong and capable. It's terrifying to feel this way and I tell my wife I feel like I'm going to die. Like stage 4 cancer exhaustion. I'm not sleeping that much but everything is an effort mentally and physically. It's real, it's scary, and it medical community seems completely incapable of acknowledging it. We've had 3 years to study and prepare for this stuff and the only solution was to force an experimental vaccine on us. I'm 51 years old, vaxed and boosted so I didn't lose my job. Much too young to feel this d@#$ old. Our medical system and government have failed to meet the moment.
"The results “suggest that physical symptoms persisting 10 to 12 months after the COVID-19 pandemic first wave may be associated more with the belief in having experienced COVID-19 infection than with actually being infected with the SARS-CoV-2 virus,” the authors wrote in JAMA Internal Medicine."
https://jamanetwork.com/journals/jama/article-abstract/2787741
Many of the symptoms described (with the exception of hard symptoms like taste disturbance) are suspiciously similar to anxiety disorders.
Now we know that societal reaction to covid has resulted in a significant increase in psychological disorders.
Is this just misdiagnosis?
I am not a physician but last night I watched a segment on Long Covid on the PBS Weekend News. It had the usual public television presentation of an articulate spokesperson who was said to be suffering from the disorder along with a physician who was researching the problem or at least supposedly compiling statistical data and who spoke of the underrecognized ubiquity of the problem. As a psychotherapist for over 50 years, I have seen medicine's frustration with vague constellations of symptoms with no clear findings on the usual array of medical tests. The insistence that their suffering is real in the face of will-o'-the-wisp findings is invariably as much a political problem as a medical one. Multiple chemical sensitivity syndrome as well as others mentioned by Dr. Hollander come to mind.
I have long covid. Its dreadful. . My guess is that the body just has to heal ( or not) and there is not much medicine can do to help. But my anger is related to this: The damn virus was made in a lab, result of diabolical animal research on gain of function. The research, jointly financed by multiple countries, was done in China surely because sooner or later they need human subjects to infect and they can't get those easily in western countries. This monstrous research needs to stop. Leaks will happen again, its inevitable. It appears there are dozens (?) or scores (?) of labs doing gain of function research and bio weapon research. This is the real cause of the suffering. We need an International treaty to ban it.
Thanks for your take, Buzz.
I think the biggest problem in defining “long covid” at present comes out of the US CDC’s rather unhelpful definition.
4 weeks of vague symptoms with no specific criteria to pin down the diagnosis?
That’s not a diagnostic criterion, it’s a fishing expedition.
A mild depressive episode that requires no specific medical treatment will easily fall under the criteria you list above, not to mention a wide variety of other medical conditions.
I mean, I wonder if your surveyed everyone with a bad case of the flu, what proportion would have at least some of these symptoms for 4-5 weeks after infection?
I’ve been following the 3 month timeline advised by the WHO and poof! magically most people feel better if you wait a few more weeks after their covid diagnosis as they get back to a normal life.
This isn’t to deny the reality of people with actual long covid. But it’s going to continue causing problems if the media and some medical authorities continue telling people they might have a highly disabling medical condition simply because their viral illness laid them up for 1 month.
Long Covid is the same bucket as Fibromyalgia, where effete, liberal leaning cat ladies put their need for attention. It’s perfect because it requires no provable symptoms and doctors are happy to take our money on phantoms.
The comparison of symptoms to MCAS is interesting, on a MCAS page I read occasionally I see a number of people feeling they have developed MCAS a from a bout with Covid. I don’t know if any have had a medical diagnosis or are seeing the similarities in symptoms themselves.