Hi, Everyone,
The largest study yet on #LongCovid has just been published in the Lancet, and the results aren’t pretty.
Six months after the participants got out of the hospital:
- 76 percent still had one or more symptoms
- 63 percent had fatigue/muscle weakness
- Insomnia, anxiety, and depression were common
- A significant number of participants still had lung abnormalities visible on computed tomography scan
- 13 percent had abnormal kidney function
This study looked only at what happened long-term to people who were hospitalized with COVID-19, and whose average age was 57 years old. So it might be tempting to assume that #LongCovid only affects people who had a severe infection and/or people above the age of 40.
However, previous research has shown that the likelihood of developing #LongCovid is not related to the severity of symptoms and that it’s more common in the young than the old.
While we don’t yet fully understand the mechanisms behind #LongCovid, some disturbing new research suggests that autoimmunity and nervous system dysfunction may play a role.
For example, a study of 52 patients with a recent history of severe or critical COVID-19 found that 44 percent had a positive anti-nuclear antibody (ANA) test result and 19 percent had a positive rheumatoid factor (RF) antibody test result. ANA antibodies are observed in patients with conditions like lupus and Sjögren’s syndrome, and RF antibodies are observed in patients with conditions like rheumatoid arthritis—all of which are autoimmune. Fifty-nine percent of patients with a positive ANA test result had at least one other autoimmune antibody present.
Another study found that patients with severe COVID-19 experience a shift from B-cell activation in germinal centers to extrafollicular B-cell activation. Fully explaining the significance of this would require an advanced lesson in immunology. The tl;dr is this: extrafollicular B-cell activation is more likely to lead to autoimmunity.
Other investigators have linked #LongCovid to postural orthostatic tachycardia syndrome (POTS). POTS leads to changes in involuntary nervous system functions, like heart rate and blood pressure—most often when moving from a seated or prone to standing position.
None of this is good news. It seems that there’s a common misconception now that COVID is a serious threat only for people who are either elderly or who have pre-existing conditions.
That is simply not the case.
While the young and healthy are far less likely to have a severe infection or suffer from acute complications, they seem to be just as likely—if not more so—to develop #LongCovid, which, as we are now seeing, can have debilitating and lasting effects.
What’s more, young people may have been affected by the acute effects of COVID more than previously believed. A recent study found that July 2020 was the deadliest month for young American adults in modern history.
The purpose of this email isn’t to scare you. It’s to keep you informed. As I’ve argued all along, when faced with a crisis, cultivating “realistic optimism” is the most fruitful approach to navigating it.
Unfortunately, the dominant narratives about COVID that we see on social media are lacking in nuance and complexity. I see one side consistently downplaying and underestimating the risks that COVID presents. And I see the other side occasionally exaggerating or mischaracterizing the risk. Neither of these polarized perspectives serves us.
We need a perspective that is informed by the latest and best evidence, and that is as free from political agendas as possible.
I hope to continue to play whatever small part in contributing to that perspective that I can.
In health,
Chris
