Saturday, January 23

The US healthcare system will have a hard time dealing with Covid’s ‘long distance carriers’ | Coronavirus


PPost-viral fatigue syndrome (PVFS) isn’t new, but that won’t stop the “long-term” Covid syndrome from collapsing an already unstable medical system. The symptoms faced by so-called long-distance carriers – Covid patients who don’t seem to make a full recovery, even months after infection – can be debilitating. Understanding the long-distance syndrome’s similarity to previous outbreaks (as well as the differences) should advise an incoming administration on the need for massive healthcare reform.

Post-viral fatigue syndrome has followed many viral outbreaks, such as the 1918 Spanish flu, 2002 SARS-CoV, 2009 influenza, and the 2014 Ebola outbreak, to name a few. PVFS is also frequently associated with the Epstein-Barr virus (EBV), which can cause infectious mononucleosis (mono, sometimes called “kissing disease”). Like Covid-19, EBV can present without symptoms, especially in children, but it has been linked to the activation of autoimmune disorders.

The threat of long distance syndrome is not its novelty, but its history. Post-viral fatigue is often classified with (and sometimes becomes) chronic fatigue syndrome (CFS), a disease that affects women at a rate four times higher than men and still eludes effective treatment. Current reports estimate that at least 10% of people allegedly infected with Covid-19 have developed long-distance carrier syndrome. As of Thanksgiving, the United States will have surpassed 12 million Covid cases. At 10%, we can anticipate a huge addition to the already staggering rate of chronic disease in the US – if our healthcare system doesn’t adapt, it’s likely to fail.

What exactly is long distance carrier syndrome? It is too early to tell. From now on, the phrase is a general diagnosis. It appears that long-haul carriers can be divided into two main groups: those who experience physical damage to their organs, and those who have symptoms without a clear physical explanation. The latter is more similar to classic PVFS, and the former appears to be a consequence of Covid’s role as a vascular disease, a novelty for a respiratory virus.

As a vascular disease, widespread inflammation caused by the immune response to Covid can inflame the inner lining of endothelial cells, which line our blood vessels. Simultaneously, when the virus enters cells through ACE2 receptors, it can cause exocytosis, basically causing the guts of the cells to spill out, further increasing systemic inflammation. Vascular injury triggers generalized clotting, which may explain many of the seemingly strange and unrelated symptoms of acute Covid. This circular reaction can have long-term consequences, such as tissue damage and scarring. Whether the injury is obvious or not, both groups of long-distance carriers can suffer long-term damage to the lungs, heart, brain, and immune system.

It is not uncommon for a virus to trigger autoimmunity when there is a predisposition. An overactive immune response (like the one seen in Covid) can cause autoantigens to attack a person’s own body. Autoimmune conditions such as diabetes, systematic lupus, rheumatoid arthritis, celiac disease, and multiple sclerosis have been linked to a viral stimulus.

We are also seeing systematic low-grade inflammation in patients recovering from Covid-19. Systematic inflammation has been linked to chronic fatigue, autoimmunity, type 2 diabetes, metabolic syndrome, cardiovascular disease, and obesity, among others.

The NIH estimates that 8% of the US population has an autoimmune disease. The national obesity rate is above 40%. Diabetes affects more than 10.5% of the population. In other words, the United States already has a population with chronic diseases, and Covid-19 will only make it worse. Economically, preventable chronic diseases account for nearly 75% of total healthcare spending in the US, or an estimated $ 5,300 per person per year, according to the CDC. Six out of 10 adults in the US have at least one chronic disease; four in 10 have two or more chronic diseases. We have been a sick nation for a long time, even before Covid-19. If anything, the long-term Covid syndrome sheds light on America’s chronic problem.

The current model of healthcare is not working. There is a need for more emphasis on lifestyle interventions with a broader understanding of integrative practice. The goal of these prevention strategies is to help Americans live longer, have a healthier life, and a cheaper life. Simply put, preventive health care saves lives and money. For example, researchers have recently discovered that type 2 diabetes can be reversed with early intervention. Advances have been made in the treatment of multiple sclerosis and lupus with immune treatments, as well as diet and exercise. Almost all chronic diseases can be prevented through inclusive practices and early intervention.

It should also be noted that chronic disease affects mental health, which manifests itself physically, increasing the risk of diabetes, sleep disorders, chronic pain and heart disease, among others.

At the same time, health care must be made more accessible, including preventive health care, which can no longer be seen as a supplement to traditional care. We know that some communities of color experience chronic disease at overwhelmingly higher rates. We know that autoimmunity affects women at surprisingly higher rates than men. We know that chronic diseases disproportionately affect people from lower socioeconomic groups. Health should not be a privilege of wealth, whiteness and gender. The cost is too high.

We are currently in the acute stage of a devastating pandemic caused by an invisible pathogen. On top of that, there is a second pandemic, the mental health costs of this virus. Then there is a third layer: a hyperpartisan political climate, which exacerbates the first two. When a medical mask becomes a sign of political division, we are in grave danger.

  • Jennifer Lutz is a science and health journalist who writes for the New York Daily News, BuzzFeed, and other publications. Jennifer most recently served as the director of the True Health Initiative (THI), an NGO dedicated to public health and lifestyle intervention. Dr. Richard Carmona, MD, MPH, FACS, was the 17th Surgeon General of the United States and is a Distinguished Professor of Public Health at Arizona State University. He also has faculty appointments as Professor of Surgery and Pharmacy.

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