LONG COVID

New controversies

As omicron has replaced all previous variants of SARS-CoV2 across the world, we have fewer hospitalizaions and deaths than with earlier variants. There remains pressure from the medical establishment for vaccines and now increasing concern about “Long COVID”. Two recent articles typify the controversies related to this condition. An excellent article by Pereira and coauthors in The Lancet Regional Health Europe compared outcomes in a large group of COVID patients and a control group associated with other viral respiratory infections. The study shows that both groups had progressively less chronic symptoms as they were evaluated over time. There were ZERO distinguishing characteristics that marked post-COVID patients from those who had other infections. This study really undermines the largely anecdotal descriptions of post-COVID symptom complexes.

In an even more recent publication, deaths related to Long COVID were described in a paper from the National Center for Health Statistics. 3500 deaths were attributed to Long COVID. The problem with this study is that death certificates were the primary data from which this conclusion or correlation was discerned. I have written before about the problem of relying on death certificates. During my career of 40+ years, I had hundreds of patients die but death certificates were generally filled out by the physicians who were attending them at death as opposed to physicians most familiar with the patient. There are no reviews of the accuracy of the information filled out. The key blanks on the death certificate to fill in include “cause of death” and “contributing factors” associated with death. Long COVID has been defined in varying forms of exactitude and there are no controlled studies demonstrating which ingredients are most accurate. Thus, a physician for an 80 year old who had COVID pneumonia three months ago who dies of an underlying acute or chronic condition might be inclined to mention Long COVID in the contributing factors leading to death. I would submit that this data is highly subjective.

Is there any scientific daf suggest that the spike protein or the virus itself might cause widespread and persistent immunologic responses that could affect health. All of these studies are interesting and need further study.

The bottom line is that SARS-CoV2 is a virus that has led to a worldwide pandemic. It has caused millions of deaths and has carved a biologic and immunologic pathway through humanity that is unique compared to well-known respiratory viruses. The import in the short- and long-term remain uncertain. It may persist in human biology from this point forward. It has inspired the interests and investigations of scientists and clinicians. Sadly, it has also inspired the interests within the political realm. It will take time and energy to sort out facts from fiction, reality from imagination, truth from conspiracy. I look forward to learning and sharing perspectives with my friends, family and readers.