Dr. Rae Duncan, a consultant cardiologist, explained concerns with Long Covid:
The interview is just 13 minutes, but here's the gist of it below, just a little cleaned up and without the interviewer's questions.
"It's interesting that there appears to be a slight disconnect between the boots-on-the-ground public perception of Covid is and what scientists are finding in research studies. Obviously at the beginning of the pandemic we were very concerned about acute deaths. We've had over 7 million people die globally [the WHO says 21 million, and The Economist calculated it at over 28 million]; we have over 65 million disabled by Long Covid. In the event of vaccination and new Omicron variant, what we tend to see now is that the acute infection appears to be milder and feel like a bad cold or flu, but what scientists are showing is that SARS isn't a cold, and if we think of SARS-CoV-2 in terms of just the acute infection, what we're only doing is looking at the tip of the iceberg. The bulk of the iceberg lies under the surface, and for SARS2, the bulk of the iceberg under the surface that we're concerned about is the fact that SARS-CoV-2 can produce long term health issues."
The interview notes that in Canada, if you've had three or more cases of Covid, you're sitting at a 38% chance of getting Long Covid.
"We also have published data from the states that came out a little while ago with ??? book showing that the more times you get repeated infection with SARS-CoV-2 increases the cumulative risk of getting Long Covid but not just Long Covid, it also increases the risk of cardiovascular disease, neurological disease, endocrine disease, and autoimmune disease as well.
There's still a lot we don't know about this virus or long term effects, but what we do know on a population basis, and these are from epidemiology studies, and we have many of them now, several large studies across multiple continents looking at millions of patients, all showing generally the same thing, that after SARS-CoV-2 infection, there is an increased incidence of cardiovascular disease including heart attack and stroke, and that there may be an increased incidence of cardiovascular death after 18 months. We have some indication that vaccination does somewhat reduce the risk of developing Long Covid and cardiovascular disease, but it doesn't get rid of it completely.
But what we also need to remember is that Covid is a spectrum, and Long Covid is just one end of that spectrum. And there is some very early emerging research now looking at individuals who had been infected and felt like it was a bad cold and felt like they fully recovered, and in some of the individuals studied, there is evidence of silent, underlying organ damage. There was a recent paper presented a couple months ago in North America using advanced MRI techniques to scan the brains of individuals who had developed Long Covid but also individuals who had Covid and felt fully recovered and comparing them to individuals who had never had Covid, and showing widespread structural changes in the brains of those who had been infected.
What we know so far is that some groups appear to be more at risk than others. We've seen increased Long Covid rates in certain occupations such as health care workers and teaching staff, but although there may be groups who are at increased risk that does not mean that if you're young and healthy that you have no risk and not going to get Long Covid. I run a clinic and see a lot of Long Covid patients who are 16, 18, 20, 26, 22, 25 who were completely fit and healthy, some of them amateur athletes, who have been severely affected by Long Covid. Some of my patients struggle to walk; some cannot stand for more than two minutes having previously been athletic individuals, some are in wheelchairs. I have patients who are completely bedridden, who can only sit up for 20-30 minutes at a time because the virus has damaged the autonomic nervous system, and they can no longer control their heart rates.
We don't have a cure for Long Covid, but there are some phenotypes [observable symptoms] that we can treat and we are treating, and we are seeing some of these patients making improvements, but this winter has just been devastating for some of my patients because so many are getting re-infected. All the hard work we've put into trying to get them better, get them back to work, get them back to school, it's just all been completely undone again.
There are issues in a lot of countries. I think we all need to start following the science. And I think all countries really have to start listening to the WHO's advice on this. [She means their new advice, not the old stuff when they denied that it's airborne for years.] Dr. Tedros very clearly and very publicly stated in April last year that approximately 1 in 10 infections - not 1 in 10 people - 1 in 10 infections will result in Post Covid Condition, suggesting that if we do not get a handle on the high transmission rate from this virus - and it's still here; Covid's not gone anywhere unfortunately - that hundreds of millions were going to require longer term care. And some of this is avoidable. We already have the data to suggest that public health protections like putting in clean air and HEPA filters in schools and nurseries have already been shown in several studies now in Italy, in Belgium, in Finland, and in the U.K., to reduce Covid outbreaks in schools, to reduce sickness absences, to improve school attendance rates. But clean air in schools and hospitals have got other benefits as well because they protect us from other airborne pathogens.
I think we are too laissez-faire about Covid. I'm very concerned about the long term implications. We already have economic modelling data for the UK from Joseph Kwon that Long Covid alone may be costing the UK economy $3.3 billion per annum. That's just Long Covid and not including the increased incidence of cardiovascular disease, increased incidence of neurological disease, immune dysfunction, autoimmune disease, and there's a lot we don't yet know. Phenome center in Australia from Professor Jeremy a Jullian. and their team -- they haveve taken blood samples from thousands of individuals who have been infected with Covid from around the world, and they are looking at metabolic pathways and have shown that Covid has affected metabolic pathways. And one of the pathway we've seen in particular is cardio metabolic pathways. These are pathways and blood markers of cardiovascular disease and cardiovascular disease risk. And what they're seeing is that after SARS-CoV-2 infection, these cardiovascular disease markers are going up, and in some individuals they're not coming back down even a year after infection. And they're seeing this in children as well as in adults, which is obviously quite concerning.
I think there's a lot we can do. I wouldn't call them public health restrictions because we're beyond that. We're not talking lockdowns here. This virus is ubiquitous now. We have to learn to live with it, but we have to learn to live with it safely. So things that we could be doing, for example, for a start, would be putting clean air into schools and hospitals."
The interviewer then spoke about a crew member who had Long Covid for two years, was getting better, got Covid again, and is right back where he started.
The frustrating thing with Dr. Duncan's interview is that, even when the interview explicitly asked, she wouldn't suggest wearing masks. It is the single most effective way to reduce the spread, but it has become so political that very few people will suggest it. HEPA filters reduce spread by 20-30%, which is great, but N95s reduce spread by 99% if everyone wears them!! And even the WHO is actually on this now, shifting away from "it's not airborne" to encouraging masks, and posting messaging that makes it very clear that the pandemic is still here, and using "loud letters" in January:
"Reported deaths averaged approx 2400/week through Q4 of 2023, which is unacceptable when WE CAN PREVENT them. . . . What is driving circulation is an evolving virus that is reinfecting people in all countries, limited or no public health and social measure used to limit exposure. . . . Covid-19 is still a global threat, and we can't wish it away. What to do: Limit your exposure as much as you can. Test, mask, ventilate, get boosted/vaccinated. If you get (re)infected: limit contact with others, mask, ventilate to prevent onward spread."
The part missing is a call for a global coordinated scheme to stop shifting the burden to individuals, like mandating 10 ACH in all public places and mandating N95s for everyone at least in all healthcare facilities, schools, and public transportation -- places where people can't avoid going.
I know masks are annoying (hot tip: N95 are far less bothersome than surgical masks - I wore them 8 straight hours to teach every day for years!), but maybe think of it this way:
I know a lot of people who quit smoking because they didn't want to get cancer. They heard of the risk, and they made a huge lifestyle change to prolong their own life and well being. Some of them - like me - loved smoking, but they wanted to be healthier longer. Each Covid infection is like chaining back Marlboros for a few years for what it does to your body. It's like we're forcing our kids to smoke. We really need to stop the spread. At the very least, when you're in a public building that other people can't avoid (schools, hospitals, grocery stores, public transportation), throw on an N95. The life you save could be your own.
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