11/22/20: COVID-19 CASES STATEWIDE TOP 4,500 IN ONE DAY; A Dare County Woman Is Hospitalized; And a Word About Post-Covid Syndrome.

For a news report on post-COVID syndrome, tune into ’60 Minutes’ tonight at 7 on CBS.

Single-day COVID-19 cases statewide hit a record-high 4,514 today, according to the N.C. Dept. of Health and Human Services’ dashboard, while current hospitalizations declined in number, but remained high at 1,571.

The NCDHHS also reported a positivity rate of 8.5 percent.

Thus far this weekend, the Dare County Dept. of Health and Human Services has reported only five new COVID-19 cases—three among locals—but one of them is a Dare County woman age 65 or older who has been hospitalized.

The number of hospitalizations of Dare County residents jumped from four to six on the DCDHHS dashboard yesterday, with no explanation for the other case. Either an error was made, or someone in isolation has regressed and needs hospitalization—a “status change” that went unreported by the DCDHHS.

Dare County’s new-case count for today will likely be posted after 5 p.m., if the DCDHHS conforms to its recent timing for updating the dashboard. (UPDATE: The DCDHSS reported four new cases at 5:30 p.m., two residents and two nonresidents. One resident is a man age 65 or older. The other three cases are people in the 18-to-24 age group. All are in isolation.)

Even though the U.S. Centers for Disease Control and Prevention recommended last Thursday that people stay home and not travel for Thanksgiving, The Washington Post and other news organizations reported yesterday that more than 1 million people passed through the nation’s airports on Friday, as counted by the Transportation Security Admin. (TSA).

CNN reported today that the number of TSA screenings yesterday brought the total number of people traveling by air Friday and Saturday to more than 2 million.

These numbers are 42 percent of the total screenings performed on the Friday and Saturday before Thanksgiving last year, CNN said, but they are also the second and third-busiest U.S. air travel days since mid-March. (For some reason, 1.03 million passengers were screened on Oct. 18, the news network reported.)

The CDC reached its recommendation after being alarmed to see 1 million new COVID-19 cases reported across the county during the immediately preceding week.

Earlier, the CDC had reported that more than 50 percent of COVID-19 transmission is caused by infected people who are asymptomatic or presymptomatic and do not feel ill.

See Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2 | CDC

We appreciate that, whether people travel or stay home, dine alone or with a large party, they are doing their own risk-benefit assessments, and we do not intend to second-guess them—provided they take precautions to protect other people from possible contagion.

But we do wonder how many people have given any thought to contracting the virus and never recovering from some of its vexing effects or spreading it to someone else who becomes a “long hauler”?

WHAT IS LONG-HAUL COVID-19 SYNDROME?

We have been reading for months about post-COVID syndrome, aka long-haul COVID-19, long-hauler syndrome, or, as it is known in the United Kingdom, long COVID, and wondering when the nation’s and the state’s public-health experts would start talking about it.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, first brought it to our attention in June or July when he spoke about a post-COVID 19 syndrome characterized by “profound fatigue” and “brain fog.”

We previously had read about severe long-term damage to the lungs, hearts, and brains of COVID-19 patients, but this was not what Dr. Fauci called post-COVID.  

COVID-19 long haulers are patients who have recovered from the disease, but continue to have lingering symptoms at least three months after onset of the disease, according to the Harvard Medical School, which provides a nice summary here: https://www.health.harvard.edu/blog/the-tragedy-of-the-post-covid-long-haulers-2020101521173

People are post-COVID—they have “recovered”—when tests no longer detect the virus in their bodies. According to published studies and surveys conducted by patient groups, Dr. Anthony Komaroff of Harvard writes, 50 to 80 percent of patients continue to suffer from symptoms.

Post-COVID syndrome is somewhat analogous to surviving the horrors of war only to experience a lifetime of post-traumatic stress. With COVID-19, however, there is insufficient clinical history to know how long symptoms might last or even to predict their duration.

But post-viral symptoms, such as those that occur in patients who formerly had Epstein-Barr, Ebola, or severe acute respiratory syndrome (SARS), are a well-known phenomenon. One condition manifested by these patients is myalgic encephalomyelitis, sometimes called chronic fatigue syndrome, ME or ME/CFS.

(I knew someone who had post-polio syndrome. She recovered from polio as a child, only to be stricken decades later by debilitating symptoms that affected her leg muscles, causing them to atrophy and disabling her mobility.)

Coincidentally, CBS’s “60 Minutes” will be featuring a segment on post-COVID syndrome tonight at 7 on channel 10. We only found out about this report during the Washington Football Team’s game this afternoon, after we started writing this post.

A distressed young woman, in the 25-to-49 age group, appeared on one “60 Minutes” promotion talking about a “viral tornado.”

It is long past time to bring this syndrome to the public’s attention. 

LINGERING SYMPTOMS

The CDC alerted physicians in May to a life-threatening COVID-19 “multisystem inflammatory syndrome” in children—remember the Kawasaki-like syndrome?—but it has been slow to respond to the gathering clinical evidence about post-COVID in adults.

The most common symptoms suffered by post-COVID long haulers are fatigue, body aches, shortness of breath, difficult concentrating (“brain fog”), headaches, inability to exercise, and trouble sleeping, according to our research sources.

The full constellation of symptoms also includes chills, sweats, pain, fever, difficulty regulating blood pressure and heart rate, and a variety of others, depending on which organ systems the virus attacked.

There is no definitive set of symptoms to define long-haul COVID-19, nor is there yet a defined duration.

Harvard’s Dr. Komaroff divides long-haulers into two groups:

  1. Those who experience some permanent damage to their lungs, heart, kidneys, or brains that may affect their ability to function; and
  2. Those who continue to experience debilitating symptoms like those described above despite there being no detectable damage to organs.

Myalgic encephalomyelitis, aka chronic fatigue, is associated with the second group.

Three people with post-viral ME write movingly about their chronic condition and reach out to COVID-19 long-haulers in The Washington Post article, “With Long-Haul COVID-19, Important Advice for Patients, Doctors, and Researchers,” at https://www.washingtonpost.com/health/long-haul-covid-patients/2020/10/23/ab7c5324-0712-11eb-9be6-cf25fb429f1a_story.html

Clinical research that we read online shows that both people only mildly affected by COVID-19 as well as those who were severely ill can have post-COVID syndrome.

Typically, it takes less than two weeks to recover from a mild case, and about four to six weeks to recover from a severe case.

Dr. Komaroff says that lingering symptoms are “more likely to occur in people over age 50, people with two or three chronic illnesses, and people who became very ill with COVID-19,” but we view this as a tentative assessment.

He also does not define the “chronic illnesses.” Obvious illnesses are hypertension and diabetes, but a vitamin D deficiency, according to one report we read, also could be a chronic illness.

One COVID-19 news website cites asthma as the most common co-morbidity in long-haulers, even though people with asthma are less likely to contract COVID-19 than non-asthmatics.

Various hypotheses about the cause of post-COVID have been proposed: They include a severe inflammatory response, venous blood clotting, and oxygen deprivation.

Dr. William Petri, a medical professor at the University of Virginia, reportedly hypothesized that the virus remains in “immune privileged cells” of post-COVID sufferers and cannot be cleared or detected. Some of these so-called IPCs are in hair follicles, which could explain why long-haulers are reporting hair loss!  

We will not cite any firm conclusions here. Science is often uncertain. Clearly, further clinical studies and information about long-term recoveries are needed.

Here are some other articles for your edification:

Commentary: What We Know So Far About Post-COVID Syndrome – Merck Manuals Consumer Version

Post-Covid Syndrome: What It Is, Causes, Similarities to Chronic Fatigue Syndrome (ME/CFS) | Berkeley Wellness

Post-COVID syndrome: Mayo Clinic studying symptoms affecting some long after infection – Twin Cities

Wikipedia even has an entry under “Long Covid,” in which more symptoms are reported.

We plan to watch “60 Minutes” tonight. Stay tuned.

UPDATE: The “60 Minutes” segment featured patients and their treatment at the Center for Post-Covid Care at Mount Sinai Hospital in New York. It was very sketchy. Long-haulers at Mount Sinai were characterized as young people in their 20s to their 40s who had mild cases of COVID-19 and were never hospitalized, but months later have debilitating symptoms.

The lingering symptoms described by the profiled patients included profound fatigue, severe headaches, hand tremors, tachycardia (rapid heat beat), heavy limbs, ataxia (a lack of muscular movement coordination), and peripheral pins-and-needles pain. They were all women.

One cause offered by a physician for the post-COVID syndrome was the severe inflammatory response that we mentioned. For some reason, the immune system goes into overdrive and continues to fight the virus even after the virus has been vanquished, killing healthy cells.  

This same physician called the syndrome a mystery.   

Ann G. Sjoerdsma, 11/22/20

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