Complacency can be deadly - Pearls and Irritations

Downplaying the seriousness of the Covid-19 sequelae known as "Long Covid" is a serious mistake.

Last week much publicity was given to the suggestion from one team of researchers that the symptoms of "Long-Covid" were not significantly different from those that followed many viral infections and the term should be dropped. Long-Covid was just another example of "Post-viral syndromes" associated with prolonged physical and mental fatigue. To do so would be a serious mistake.

Twenty or more years of my research activities involved efforts to understand what was causing so many to suffer from what is called "Chronic Fatigue Syndrome" or CFS. Together with other immunologists on our team we studied many hundreds of patients with this condition. In the vast majority of patients (both adult and children) we could not identify a precipitating cause nor find an explanation for the severe mental and physical fatigue that so effected their quality of life.

We did see patients with the same symptoms who had clearly developed CFS after a documented viral illness e.g Influenza, the Epstein-Barr virus that causes "glandular fever" and Ross River virus. Logically enough, these were called "Post-viral fatigue syndromes". We were also interested that the side effects of treating a number of conditions with "Interferon," an immune system modulator, which produced very similar fatigue symptoms. The search for the cause of CFS and an adequate treatment continues with some progress but is a story for another day.

By definition "Long-Covid" is a "post viral syndrome" clearly precipitated by Infection with the SARS virus that causes Covid-19. For some patients the mental and physical fatigue is similar to that seen after other viral infections but the all important point is that in many patients who have experienced Covid-19, six or more months later they are still unwell, many severely, even life threatening complications are evident, complications that we do not see in patients with CFS.

COVID-19 itself can lead to various cardiovascular complications, such as heart muscle injury, rhythm irregularities, coronary artery disease and clots in veins that can break up and block blood vessels in the lungs. In addition elevated blood pressure and hypertension, as post-acute sequelae of COVID-19, have been reported in several studies. This suggests that COVID-19 could have long-term implications for cardiovascular health.

I recently saw a young tennis coach with Long-Covid effecting his heart. His pulse rate could drop suddenly to 40 beats per minute then suddenly jump to 180 beats per minute. This condition had require numerous "000" calls for emergency help.Recent global research has allowed us to observe that patients with Long-Covid tend to fit into one of four categories.

Heart, kidney, and circulatory problems; Lung conditions, sleep disorders, and anxiety; Muscle pain, connective tissue disorders, and nervous system disorders and digestive and respiratory problems.

While children are less likely than adults to suffer significant symptoms from a Covid-19 infection some do with Long-Covid manifesting itself as chronic tiredness or fatigue, trouble sleeping and concentrating, while muscle and joint pain and cough are also common associates. Rarely, exposure to the SARS virus results in children becoming vulnerable to what is called "multi-system inflammatory syndrome" which can be fatal. In the US since the Covid outbreak 400 children have died from this problem.

I know this reads like something from a medical text book but I describe these issues here to emphasise that Long-Covid can be a very serious complication of a Covid infection and that there are many severe problems that do not allow us to think of this disorder as "just another post-viral syndrome". Current estimates from a number of studies suggest that between 5 and 11% of people who experience Covid-19 will develop Long-Covid symptoms.

We need to develop strategies to minimise Covid infections and the long term suffering they can cause. It is almost certain that we will not rid the world of the SARS-CoV-2 virus. As is true with influenza viruses, the SARS virus can make anatomical changes to itself that allow it to evade elimination by the immune system of humans. The current predominant SARS variation sweeping Australia has made more than 16 changes to the section of the virus vaccine induced antibodies must attack.

The virus changes and we adapt our vaccines but we need to face the fact that we must live with this virus. Fortunately our vaccines while not perfect, greatly reduce the chances of serious consequences from infection particularly for the most vulnerable and significantly reduce the likelihood of suffering from Long-Covid.

So far more than 7 million people have died as a direct result of SARS-coV-2 infection. Some 800 million positive tests have been recorded but there would be many millions infected but not tested.

To live with SARS and no doubt the viruses in the wings that will have the potential to cause a further pandemic, we need to focus on two issues, viral surveillance and relevant vaccine developments and societal changes in the way we humans interact with each other. Normalising social distancing is an enormous topic for discussion another time but best use of vaccination needs urgent attention now.

This invaluable weapon is increasingly being held hostage to ignorant but vehement social media disparagement of vaccination.

Social media can amplify the dangerous nonsense proffered by public figures. The crazy (literally) anti-vaccine rantings of Robert Kennedy in the US are supported by 19% of the population. Governor DeSantis in Florida, deliberately appointed a chief medical officer who claims that non-existent DNA in vaccines will cause you irreparable damage. Vaccination rates for all infections have fallen drastically in the US and tragically five States are reporting outbreaks of Measles, an infection that can kill a child. Donald Trump is angrily promising that if he is re-elected not one penny of public money will go to public schools demanding childhood vaccinations pre-schooling.

We have plenty of anti-vaccination protagonists in Australia. My in box has been inundated for years by Anti-vaxxers. Remember we had a "January 6" moment here in Australia when 150 of us banged angrily on the doors of parliament house protesting mandatory vaccination for some workers.

Anti-vaccination sentiment may be part of the reason we are experiencing significantly and dangerously low levels of vaccination. Vaccination of our children, though still high by world standards, has fallen in each of the last three years. Really of concern are data showing that only 19% of people aged 65 and over had received a Covid booster shot in the last six months. For those aged 75 and over (by far the most vulnerable group), this figure is just 23%. This is really serious and our government is not doing nearly enough in the public domain to boost uptake.

The Federal Government has established a review process to report on what the Federal government (not the States) did right or wrong during the Covid pandemic. We are awash with data from here and abroad. It is application of that data that we urgently need. This should be the task of the promised Centre for Diseases Control (CDC) but is impossible as government policy sees this crucial infrastructure held hostage to a publicly admitted "hasten slowly" approach by government to its establishment.

Winter is approaching and without a high uptake of influenza and Covid vaccines in the next few weeks we are at risk again of having many infections and swamped hospitals. Complacency can be deadly!