The long-term damage from COVID you’re not hearing about

It is certainly important to give children responsibility as they grow up. Chores are more than just a means to keep the house in order, they are a means of teaching children the importance of contributing to the family, of giving up their present desires for a higher goal. While this is all wonderful for parenting books and magazine articles it generally ignores a major problem with children, especially smaller ones, performing these essential household duties – they’re typically not very good at them. This was our first problem.

The second problem can be best illustrated by my wife regularly expressing consternation about the fact that everything smells like garlic. Shortly after I recovered from COVID in March she developed the now infamous symptom of a total loss of smell and taste. At the time this was a novel thing. I had offered her reassurance that in most cases the sense come back in a few weeks. In her case they did not, or at least not back to normal and not yet.

So when my wife went to grab to cooking spray to make bread she didn’t notice that she had actually grabbed the oven cleaning spray. The children had cleaned the kitchen and put it in the cabinet with the cooking sundries (see the first problem above). When she sprayed the counter she didn’t smell the chemicals. Fortunately, she noticed before poisoning us.

Morbidity is not a statistic that has been reported in the news because its not as attention grabbing.

This is all by way of introduction to discuss an increasingly important problem with the COVID-19 pandemic that is not getting the attention it should. There is constant media attention on the mortality rates from the virus to the exclusion of many other important issues, namely the morbidity. In medicine we use the term morbidity to refer to all the bad stuff that happens from a disease aside from mortality. Morbidity is not a statistic that has been reported in the news because its not as attention grabbing. Every news outlet loves saying how many people have died from the virus but discussing how many survivors have suffered lasting serious effects from the virus drives less viewer traffic.

As physicians are getting better at treating the disease fewer people are dying which is a good thing but it also may create a large population of people who suffer significant morbidity. In fact, all those lives saved may actually increase the numbers with morbidities. People seeing the number of deaths coming down in news reports may be deluded into thinking the virus is less severe. There is no convincing evidence that it is weakening. There is also the false dichotomy that you either have severe disease and end up hospitalized or you have mild disease and have no major issues. In reality there is a large group of people that fall in between.

The prolonged loss of smell and taste (the technical terms are anosmia and ageusia for those of you who want to impress your friends) is a relatively minor consequence of the disease and in most cases return in a short time. Unfortunately there are a number of other long term consequences of the virus that are becoming more apparent as the pandemic drags on. One study found that almost 90% of patients who are hospitalized with COVID-19 were having issues 2 months after they “recovered”. These consequences can result from the prolonged hospitalizations people endure, a direct result of damage from the virus, or a consequence of the immune response. Unfortunately, the prolonged symptoms are as unpredictable as the acute ones.

The damage from the prolonged hospitalization is something that we who work in intensive care units have known about for a long time. The long term effects of critical illness can be devastating. When people are critically ill for several days or weeks they can develop permanent disability as a result of muscle wasting, immune deficiency, nerve injuries, or serious brain dysfunction. I can say from first hand experience that many of the patients with COVID-19 who are in the ICU get stuck in the unit for weeks and are never the same people again.

There is also long term direct damage from the virus itself or the immune response.

There is also long term direct damage from the virus itself or the immune response to it. For example, there is evidence of direct damage to the heart from SARS CoV-2 or the inflammation it triggers that can be prolonged and possibly permanent. One study showed that  78% of people with severe disease had cardiac abnormalities when their heart was imaged on average 10 weeks later.

A bigger concern is prolonged neurologic and psychiatric symptoms. A summary in a major neurology journal identified serious prolonged or permanent damage from inflammation in the central or peripheral nerves or strokes triggered by the virus itself.

Even those who had relatively mild disease can be plagued by a prolonged illness even after the initial infection is long gone. This has been referred to as the post-COVID syndrome and it can manifest with a wide range of symptoms. The most commonly reported symptom is a combination of “brain fog”, fatigue, and difficulty concentrating. There are also reports of prolonged joint pains, heart palpitations, and fever. These symptoms can be severe and debilitating. An app based study of COVID symptoms suggests that 15% of people who had “mild” cases have a slow recovery with persistent symptoms of varying severity.

There has been a lot of research and press over the past six months identifying who is “high risk” with COVID 19. Things such as advanced age, obesity, diabetes, and other comorbidities have been identified. This has led many young and healthy people to be less careful in preventing spread of disease because they feel they are not at risk. It is important to understand that risk factors such as age and comorbidities are risk factors for dying from COVID-19. It is not clear what factors put someone at risk from having prolonged life-altering symptoms. It may be that young and healthy people have the same (or even higher) risk for these issues and should be cautious for that reason.

To me this means that we should not become complacent when we see declining deaths from COVID. We should not assume this means the virus is “going away” or less severe. People should also not assume that, since they are “low risk”, they don’t have to be careful. They may be at low risk for death but could still be at risk of morbidity from the virus. The impact of this virus goes far beyond the death statistics. This is just one more reason to remain diligent and not let our guard down.

We should also be careful about putting away the oven cleaner.