Vincent Li, Class of 2022
As we sit squarely in the third month of shelter-in-place after its initiation by Governor Gavin Newsom on March 19, 2020 (1), the toll of the pandemic, both emotionally and physically, continues to increase. According to the Johns Hopkins CSSE (as of April 3, 2020), the United States alone has recorded 1,851,520 confirmed cases and 107,175 dead (2). It was not until an official order was released on May 7, 2020, that stage 2, in which lower-risk businesses and public spaces would begin incrementally re-opening, would start on May 8, 2020 (1). Though the confirmed case numbers are still rising, the renewal of businesses in non-essential industries calls into attention two primary concerns: how are we to address the possibility of a second wave, and what are the longer-term implications to the health of those who were infected and may be in the future?
To avoid speculation, let’s look at the latter. The symptoms of COVID-19 are already well-documented: fever, cough, shortness of breath, muscle and body fatigue, and various gastrointestinal problems (3). However, if we consider the possibility of the virus becoming endemic and seasonal like the common flu, we must examine the reality beyond the immediate symptoms.
SARS-CoV-2, or the name of the virus, primarily attacks the respiratory system of individuals unfortunate enough to acquire the virus. As previously mentioned, the disease manifests itself similarly to what one would expect of pneumonia and the flu. Per early reports on March 16 with a sample size of 4,226, approximately 80% of the cases are mild, with relatively trivial symptoms that do not debilitate the affected individuals (4). Of the remaining percentage of the population of confirmed cases, 12 percent required hospitalization, and 3 percent of patients were admitted to the ICU (4). More recently, the overall case-fatality rate of COVID-19 has been observed at 5.8% in the United States (5).
Though these percentages suggest that all but a small minority fare extremely well with the virus, there have been reports of there being a “potentially large population with post-viral problems” (6). Among some of these health complications include: higher rates of blood vessel blockages, leading to clots, strokes, and embolisms; chronic inflammation of heart muscle and cardiovascular damage implicated in increasing probabilities of heart attacks; lung scarring that reduces overall lung capacity permanently; and neurological deficiencies like impaired senses and consciousness (8). Given the lack of temporal distance from the pandemic, it is not yet possible to accurately discern the full impact of the disease, and as such, only time will tell.
In addition to the detection of damage in the lungs, heart, and so forth, there are also concerns over the possibility of SARS-CoV-2 causing myalgic encephalomyelitis/chronic fatigue syndrome (ME/FS). ME/FS is characterized by incessant muscle and body fatigue, cognitive issues, chronic inflammation, and persisting post-viral fatigue syndrome that lasts longer than six months (6). Although we are yet to be in a position to comment on the rate of ME/FS present in COVID-19 patients, the data from SARS helps contextualize the scope of the possibilities. In a follow-up study performed in December 2009, researchers found that 27.1% of respondents (survivors of SARS) qualified for chronic fatigue syndrome under the CDC’s criteria (7). It would be inappropriate to extrapolate that same proportion to those affected by COVID-19 given the discrepancies between their severity and fatality rates, but citizens should be cognizant of the potential thousands of patients who may suffer lifelong health effects in addition to those who have unfortunately passed away.
In addition to the health outcomes, it is pertinent to consider how certain risk factors beyond that of age and comorbidities affect survival and disease prognosis. A recent study performed by Wu, et al., has implicated air pollution as a major contributor to COVID-19 deaths, stating that “an increase of only 1 microgram/m2 in PM2.5 is associated with an 8% increase” in the mortality rate (9). PM2.5 is defined as particulate matter that is less than 2.5 microns in width, often in the form of droplets or fine particles (10). Exposure to this typically causes respiratory irritation and, if long-term, conditions such as chronic bronchitis, lung cancer, and heart disease (10). The severe weakening of lung tissue by persistent air pollution likely contributes to a more lethal outcome in COVID-19 patients.
The future of COVID-19’s fate is uncertain. With the continuous influx of new data, we must remain vigilant and not treat the disease flippantly even as we begin the process of reopening society. Eventually, the untold economic and health burdens the disease has incurred will become more apparent in the coming months and years.
References:
(n.d.). Retrieved from https://abcnews.go.com/US/warmer-weather-slow-coronavirus/story?id=70612437
Brian Vastag, B. M. (2020, May 30). Perspective | Researchers warn covid-19 could cause debilitating long-term illness in some patients. Retrieved from https://www.washingtonpost.com/health/could-covid-19-cause-long-term-chronic-fatigue-and-illness-in-some-patients/2020/05/29/bcd5edb2-a02c-11ea-b5c9-570a91917d8d_story.html
Cases in the U.S. (n.d.). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
Marco Ho-Bun Lam, F. (2009, December 14). Mental Morbidities and Chronic Fatigue in Severe Acute Respiratory Syndrome Survivors: Long-term Follow-up. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415378
Mortality Analyses. (n.d.). Retrieved from https://coronavirus.jhu.edu/data/mortality
Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12–March 16, 2020. (2020, March 26). Retrieved from https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
Symptoms of Coronavirus. (n.d.). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
Picture: https://commons.wikimedia.org/wiki/File:COVID19CTPneumonia.jpg
To avoid speculation, let’s look at the latter. The symptoms of COVID-19 are already well-documented: fever, cough, shortness of breath, muscle and body fatigue, and various gastrointestinal problems (3). However, if we consider the possibility of the virus becoming endemic and seasonal like the common flu, we must examine the reality beyond the immediate symptoms.
SARS-CoV-2, or the name of the virus, primarily attacks the respiratory system of individuals unfortunate enough to acquire the virus. As previously mentioned, the disease manifests itself similarly to what one would expect of pneumonia and the flu. Per early reports on March 16 with a sample size of 4,226, approximately 80% of the cases are mild, with relatively trivial symptoms that do not debilitate the affected individuals (4). Of the remaining percentage of the population of confirmed cases, 12 percent required hospitalization, and 3 percent of patients were admitted to the ICU (4). More recently, the overall case-fatality rate of COVID-19 has been observed at 5.8% in the United States (5).
Though these percentages suggest that all but a small minority fare extremely well with the virus, there have been reports of there being a “potentially large population with post-viral problems” (6). Among some of these health complications include: higher rates of blood vessel blockages, leading to clots, strokes, and embolisms; chronic inflammation of heart muscle and cardiovascular damage implicated in increasing probabilities of heart attacks; lung scarring that reduces overall lung capacity permanently; and neurological deficiencies like impaired senses and consciousness (8). Given the lack of temporal distance from the pandemic, it is not yet possible to accurately discern the full impact of the disease, and as such, only time will tell.
In addition to the detection of damage in the lungs, heart, and so forth, there are also concerns over the possibility of SARS-CoV-2 causing myalgic encephalomyelitis/chronic fatigue syndrome (ME/FS). ME/FS is characterized by incessant muscle and body fatigue, cognitive issues, chronic inflammation, and persisting post-viral fatigue syndrome that lasts longer than six months (6). Although we are yet to be in a position to comment on the rate of ME/FS present in COVID-19 patients, the data from SARS helps contextualize the scope of the possibilities. In a follow-up study performed in December 2009, researchers found that 27.1% of respondents (survivors of SARS) qualified for chronic fatigue syndrome under the CDC’s criteria (7). It would be inappropriate to extrapolate that same proportion to those affected by COVID-19 given the discrepancies between their severity and fatality rates, but citizens should be cognizant of the potential thousands of patients who may suffer lifelong health effects in addition to those who have unfortunately passed away.
In addition to the health outcomes, it is pertinent to consider how certain risk factors beyond that of age and comorbidities affect survival and disease prognosis. A recent study performed by Wu, et al., has implicated air pollution as a major contributor to COVID-19 deaths, stating that “an increase of only 1 microgram/m2 in PM2.5 is associated with an 8% increase” in the mortality rate (9). PM2.5 is defined as particulate matter that is less than 2.5 microns in width, often in the form of droplets or fine particles (10). Exposure to this typically causes respiratory irritation and, if long-term, conditions such as chronic bronchitis, lung cancer, and heart disease (10). The severe weakening of lung tissue by persistent air pollution likely contributes to a more lethal outcome in COVID-19 patients.
The future of COVID-19’s fate is uncertain. With the continuous influx of new data, we must remain vigilant and not treat the disease flippantly even as we begin the process of reopening society. Eventually, the untold economic and health burdens the disease has incurred will become more apparent in the coming months and years.
References:
(n.d.). Retrieved from https://abcnews.go.com/US/warmer-weather-slow-coronavirus/story?id=70612437
Brian Vastag, B. M. (2020, May 30). Perspective | Researchers warn covid-19 could cause debilitating long-term illness in some patients. Retrieved from https://www.washingtonpost.com/health/could-covid-19-cause-long-term-chronic-fatigue-and-illness-in-some-patients/2020/05/29/bcd5edb2-a02c-11ea-b5c9-570a91917d8d_story.html
Cases in the U.S. (n.d.). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
Marco Ho-Bun Lam, F. (2009, December 14). Mental Morbidities and Chronic Fatigue in Severe Acute Respiratory Syndrome Survivors: Long-term Follow-up. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415378
Mortality Analyses. (n.d.). Retrieved from https://coronavirus.jhu.edu/data/mortality
Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12–March 16, 2020. (2020, March 26). Retrieved from https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
Symptoms of Coronavirus. (n.d.). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
Picture: https://commons.wikimedia.org/wiki/File:COVID19CTPneumonia.jpg
Proudly powered by Weebly