Long Covid

 On 4 March, Los Angeles County lifted its indoor mask mandate for covid. This was after California had lifted its state mandate. Margan and I went to REI today for some hiking shoes. We were masked and I estimate that about ½ to ⅔ of the people we saw inside were also masked – leaving a high proportion who were not. The national data and the LA County data all show falling numbers of cases, hospitalizations, and deaths, with numbers among the lowest troughs seen during the pandemic. However, the BA.2 omicron variant represents ever more of the cases seen, likely because it is more transmissible than the BA.1.1 variant and immunity from vaccines and prior infections wanes with time. The WHO reports BA.2 is now the dominant variant worldwide at 85% of isolates sequenced. Wastewater surveillance shows many communities have BA.2 being shed into sewage nationwide. 

At the same time, uptake of vaccines has fallen to very low levels in the United States – less than 160,000 doses daily. This leaves a questionable “immunity wall” given the dominance of the BA.2 variant. No one is certain of whether or not we will see another covid wave in the short term. Some experts say no but others are skeptical we will escape a BA.2 wave in the near future. 

What all of this does not address is what we currently call long covid. Long covid occurs in a proportion of people who become infected, survive, but go on to develop a wide variety of symptoms (hundreds have been described per this Lancet paper). For a layperson, I recommend reading Katherine J. Wu’s recent article in The Atlantic. Wu makes it clear long covid is here to stay but we don’t yet have a way to even define it, let alone prevent or cure it. The bewildering number of signs and symptoms seem meant to challenge an Osler. Below are two diagrams from the General Accounting Office that may help you visualize the broad outlines of what we are seeing:

Covid-19 can affect any organ system. It causes damage to the brain with changes that can be demonstrated via imaging and direct neuropathology study. 65% of patients report “brain fog” with long covid. Acute and chronic renal damage is reported with covid-19. The risk of heart disease increases dramatically after covid-19 and can persist, with heart failure. The litany expands with every new study. 

Perhaps the most sinister problem is brain involvement with cognitive impairment. Will Covid-19 cause an increase in dementia? Might this occur in younger people? How will our fractured healthcare system deal with this? These are questions without answers. As one of the people Wu interviewed for her article stated, long covid will be the pandemic after the pandemic.

Regardless of whether we will see another wave in the near future with BA.2, yours truly will continue to mask in indoor public settings. The FDA is expected to approve a second booster (really, a 4th dose) of mRNA vaccine in the next few days for those age 50 and above. I will be first in line to receive it. As my wife and I say, we don’t want this bat virus in our brains (or hearts or kidneys or whatever). As with HIV and AIDS, I believe there is a silver lining in this terrible cloud if we can learn more about what long covid is, how it is triggered, and how to treat and prevent it. That story is being written. Meanwhile, stay safe, Mask. Ventilate. Vaccinate. Boost. Be wise.