Emergence of a Deadly Coronavirus

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ASPartOfMe
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10 May 2023, 10:03 pm

The COVID public health emergency ends this week. Here's what's changing

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On Jan. 31, 2020, with six confirmed cases of a new coronavirus in the U.S., a group of federal health officials gathered somberly at the lectern at the White House and declared a public health emergency.

"Beginning at 5:00 p.m. EST Sunday, February the 2nd, the United States government will implement temporary measures to increase our abilities to detect and contain the coronavirus proactively and aggressively," announced then-Health and Human Services Secretary Alex Azar.

"COVID 19 is still a significant problem, but emergencies can't go on forever," observes Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. "I think we're living in a place where we're treating COVID similar to flu."

Concrete changes coming
In the early months of the pandemic, for a brief time, there was remarkable bipartisan unity in quickly marshaling federal resources to fight the new virus. That included major investments in vaccine development, new laws that allowed people to stay on public insurance programs without interruption, and free tests and vaccines for all. Those rules allowed for things like drive-through mass vaccination campaigns, where no one asked for your insurance card, and free curbside COVID-19 testing kiosks.

What is left of many of those programs are now being dismantled. Here's what's changing and what's staying the same, for now.

Vaccines and tests no longer free — now covered by health insurance
The federal government will no longer buy up tests or vaccine doses or treatments to give out to the American public for free. The health insurance system will take over — patients will have to go to the doctor, get a prescription, perhaps pay a copay when it comes to COVID tests and treatments, just like they do for all other illnesses.

It's important to note vaccines will still be free for practically everyone. People who are insured are required to get vaccines with no cost sharing because of the Affordable Care Act. The White House says people without insurance will still be able to get free COVID-19 vaccines — and treatments like Paxlovid — through 2024.

COVID data tracking gets scaled back
For people used to relying on data from the Centers for Disease Control and Prevention for guidance on how much virus is circulating in their community, there are big changes ahead. The CDC announced it will sunset some of its COVID data tracking efforts, including tracking and reporting new infections. It will continue to track COVID-19 hospitalizations and deaths, do genetic analysis to identify worrisome variants, and monitor spread through wastewater surveillance.

"We will continue to keep our eye on the COVID-19 ball," Dr. Nirav Shah, the CDC's principal deputy, told reporters last week. He pointed to a recent CDC analysis of the new approach showing it will be effective.

Telemedicine access to remain in place
Some popular changes to health care brought by the COVID-19 pandemic will remain in place, at least for a time, including more flexibility with telemedicine, access to controlled substances and hospital-at-home programs. The Drug Enforcement Administration has not said how long it will allow telehealth prescribing of controlled substances, but most of the other measures have been extended to at least the end of next year.

Vaccines, tests and treatments emergency use can continue
Another thing that won't change for now is access to numerous COVID-19 vaccines and tests and treatments that were allowed for emergency use by the Food and Drug Administration. That authority comes from a different declaration, which hasn't ended yet — the timing of that is up to Health and Human Services Secretary Xavier Becerra.

The great Medicaid unwinding
A key provision in one of the first COVID relief laws gave states extra federal funding for Medicaid — the public health insurance program for low income people — but required states not to disenroll anyone for as long as the public health emergency was in effect.

Liz Adams, a stay-at-home mom in Plant City, Fla., says it was very important to her and her family to know they had Medicaid throughout the pandemic without having to worry about getting recertified. "It was there — you knew it was there," she says. "I didn't have to worry. I could take my kids to the hospital when they got sick and not have to stress it."

Medicaid grew to be bigger than it's ever been, with an estimated 95 million beneficiaries, which is more than 1 in 4 Americans. This provision actually ended a bit ahead of the public health emergency — states could start disenrolling people as of April 1.

Although the head of the health agency in charge of Medicaid, Chiquita Brooks-Lasure, has said many times that federal officials are "laser focused" on helping ensure that people who are eligible don't lose coverage, a recent estimate from health research group KFF suggested that as many as 24 million people could lose Medicaid, including millions who are still eligible but fall through administrative cracks.

Will we be prepared for future threats?
The end to America's public health emergency declaration comes on the heels of the World Health Organization making the same determination last week.

In the U.S., the bipartisan willingness to marshal resources for the pandemic began to fall apart as the years wore on. The White House and federal health agencies have requested more funding to continue managing COVID-19 and prepare for the next pandemic threat, but Congressional Republicans questioned the need for it.

"One of my biggest worries is that we are losing time in preparing for the next pandemic," Dawn O'Connell, the head of the Administration for Strategic Preparedness and Response told senators last week.

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ASPartOfMe
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10 May 2023, 10:05 pm

Millions of people have long COVID brain fog — and there's a shortage of answer

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As the Biden administration ends the COVID-19 public health emergency, millions of Americans who contracted the disease continue to suffer from symptoms associated with long COVID.

Neuropsychologist James C. Jackson says people with long COVID can suffer from symptoms like exhaustion, shortness of breath and disturbed sleep. Some of the most troubling symptoms are neurological: struggling to remember things, to focus, even to perform basic daily tasks and solve problems.

These symptoms can lead to a loss of employment, income and important relationships. Jackson, who is a research professor at Vanderbilt University, says that while long COVID was initially associated with people who became critically ill with COVID-19, he's seeing an increasing number of patients for whom the initial illness was relatively mild.

"This is a little bit of a mystery," Jackson says. "Many people with mild cases are profoundly debilitated [with long COVID], and some people with quite severe cases are doing fairly well."

Jackson's new book, Clearing the Fog, is a practical guide for long COVID patients and their families, giving advice on how to find help, and information on treatments and strategies for dealing with symptoms.

He notes while the scientific community rallied in response to COVID-19, there's been less urgency in the response to long COVID, leaving patients and families on their own to find solutions.

Interview highlights
On the number of people who have long COVID
There's a range of estimates that people report. In the book, I talk about the number 200 million [worldwide]. That's a huge number of people, and that's an estimate that is widely quoted. I think there's some debate among experts about whether it's more than that, about whether it's less than that. I think the worldwide piece is important because this isn't a United States problem, particularly. This is very much a global problem. And indeed, some of the resources that could be used effectively to treat long COVID, those are even less available in some developing countries than in the United States.

On the type of cognitive impairment associated with long COVID
So the thing that people talk about the most is they talk about "memory problems." ... So often they have memory problems, but more typically the problems are with processing speed. That has to do with how quickly you can process information and with attention and with this thorny thing that we call executive functioning. And I say "thorny thing" because executive functioning is associated with ability to function in so many areas.

People with executive dysfunction ... they have problems driving. They can't manage their money. They have a hard time managing their medication. They can't plan for the future. So executive dysfunction, processing, speed, inattention and some deficits with memory. And if you put it together — because often people have all of that — it's a really toxic cocktail. And what it means for people is they have a hard time functioning in the workplace. They often aren't functioning well socially. They're not reading social cues, they're disinhibited.

On the mental health issues that often accompany long COVID
There's no question that mental health issues are tremendously important in the context of long COVID, and why wouldn't they be? If you've lost your job, you're socially isolated, you've lost a lot of hope. In that context, it's really normal, I think, to feel depression, to feel anxiety, to develop PTSD in some cases, because it's hugely traumatic. ... In some cases, for people to have worsening OCD, increased suicide and suicidal ideation is another thing we're concerned about. It's a topic we engage in our support groups all of the time.

Many people are really, really reluctant to have a conversation with their provider about a mental health issue because for some of them they worry, I think, that that provider will say, "See, I told you so. It's only depression. It's only anxiety." ... Patients worry that if they say, "I'm a little anxious," people will say, "It's all in your head."

On why it's important to redefine "brain injury" in the context of long COVID
Unfortunately, physicians — thoughtful and well-meaning, excellent clinically, etc. — they have a certain notion about what constitutes a brain injury: A brain injury is a stroke; a brain injury is you fall off a ladder and you crack your skull on the driveway. That's too often what is defined as a brain injury – and of course, it is.

The problem is there are a lot of other ways to get brain injuries. You can be in the ICU on a ventilator. You can have not enough oxygen get to your brain, something called hypoxia, that can be a brain injury. You can be delirious, which is deleterious to your brain, that can cause a brain injury. And you can have long COVID. That, too, can basically be a cause of a brain injury.

It's not only that you're in Iraq and you survive an IED explosion. It's not only that you're on the football field and have a concussion. There's a medical route to a brain injury, but no one, almost no one gets referred for rehab.

On how social isolation may worsen long COVID
[People with long COVID] feel like other people don't really understand them and they feel like the overtures they have made to try to connect with people ... are often met with negative sorts of things. That is, they engage with people, they're wearing masks. People look at them with a side eye. They feel embarrassed. Often people don't get how impaired they actually are because they don't look impaired. So often they've tried to connect socially, that has not gone necessarily very well. They often recede into this hermit-like existence. Often their fatigue is very confining. Couple that with fears about getting COVID again, their world gets smaller and smaller and smaller.

And the problem with that, I think, as a point of fact, we know that the more social support people have, the better they do; the less social support they have, the less well they do. As people recede into that house or that apartment, sometimes that room, they lose those social connections, and, not surprisingly, they get more and more depressed.

On how to ask for help with long COVID, especially if you lose your job or can't work
Social Security, short-term disability, long-term disability, for some people, there are a range of options that are available, but people need to be aware first of what is available. They need to think of how to ask for it. ... If you're cognitively impaired, you're obviously less good at filling out complicated forms. You're less good at advocating for yourself.

That's where family members come in. That's where friends come in. Asking for help is one of the things we work on in our support groups ... the right and wrong ways to ask for help. The research says that if you ask someone for help, whether it's to take you to the store, whether it's help in filling out a form, if you ask them directly, they'll almost always help. If you send them an email, they often won't. So learning to ask for help, it's an important skill and it's one that people with long COVID unfortunately need to learn.

kitesandtrainsandcats
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10 May 2023, 10:41 pm

Long covid is an issue, that is for sure. I have escaped having it, but I already had ME/CFS, fibromyalgia, and a neurological autoimmune disease, which were already causing similar symptoms.

I know 2 people who have long covid and 1 who may well have it.
And they are in 3 different countries, here in the US midwest, India, England.

Looking at that, "Unfortunately, physicians — thoughtful and well-meaning, excellent clinically, etc. — they have a certain notion ..."
All I have to say is that from 30 years of experiences of the people having what I have, the thing we would be most likely to say is,
"Physicians? Thoughtful physicians? Well-meaning physicians? Clinically excellent physicians?
ROFLMFAO!! ! What alternate reality fantasyland did YOU just fall to Earth from?"
:roll: :lol: :evil: :roll: :lol:

:arrow: So, what happens when a covid doctor gets long covid?
https://www.medscape.com/viewarticle/983069

Quote:

I was of course familiar with these symptoms, as professor and chair of the Department of Rehabilitation Medicine at the Joe R. and Teresa Lozano Long School of Medicine at University of Texas Health Science Center San Antonio. I developed a post-COVID recovery clinic to help patients.

So I knew about postexertional malaise (PEM) and postexertional symptom exacerbation (PESE), but I was now experiencing these distressing symptoms firsthand.

Clinicians really need to look for this cardinal sign of long COVID as well as evidence of myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). ME/CFS is marked by exacerbation of fatigue or symptoms after an activity that could previously be done without these aftereffects. In my case, as an All-American Masters miler with several marathons under my belt, running 5 miles is a walk in the park. But now, I pay for those 5 miles for the rest of the day on the couch or with palpitations, dizziness, and fatigue the following day. Busy clinic day full of procedures? I would have to be sitting by the end of it. Bed by 9 PM was not always early enough.
Becoming a Statistic

Here I am, one of the leading experts in the country on caring for people with long COVID, featured in the national news and having testified in front of Congress, and now I am part of that lived experience. Me — a healthy athlete, with no comorbidities, a normal BMI, vaccinated and boosted, and after an almost asymptomatic bout of COVID-19, a victim to long COVID.

You just never know how your body is going to react. Neuroinflammation occurred in studies with mice with mild respiratory COVID, and could be happening to me. I did not want a chronic immune-mediated vasculopathy.

So, I did what any other hyperaware physician-researcher would do. I enrolled in the RECOVER trial — a study my own institution is taking part in and one that I recommend to my own patients.

I also decided that I need to access care and not just ignore my symptoms or try to treat them myself.

That's when things got difficult. There was a wait of at least a month to see my primary care provider — but I was able to use my privileged position as a physician to get in sooner.

My provider said that she had limited knowledge of long COVID, and she hesitated to order some of the tests and treatments that I recommended because they were not yet considered standard of care. I can understand the hesitation. It is engrained in medical education to follow evidence based on the highest-quality research studies. We are slowly learning more about long COVID, but acknowledging the learning curve offers little to patients who need help now.

This has made me realize that we cannot wait on an evidence-based approach — which can take decades to develop — while people are suffering. And it's important that everyone on the front line learn about some of the manifestations and disease management of long COVID.

I left this first physician visit feeling more defeated than anything and decided to try to push through. That, I quickly realized, was not the right thing to do.

Quote:

Those without clear biological explanations of their post-viral symptoms due to COVID sometimes experience gaslighting from the very people who are assigned to be their helpers. Whenever an illness has hard-to-understand symptoms, such as those that affect people with ME/CFS, some experts are too quick to patronize and even undermine efforts to cope with their illness. In a sense, these patients are twice victimized, first by having debilitating symptoms and then by the reaction of others to their illness. With long COVID, particularly where the symptoms persist without easy-to-recognize organic damage, some health professionals have engaged in gaslighting, stigmatizing, and denying the serious nature or legitimacy of their illness.

Gaslighting occurs when patients with long COVID are seen by their primary care healthcare professionals, and when clear biological damage in cardiac or other areas is not uncovered, an all too common reaction is disbelief that their symptoms have continued past the viral infection.

Not much has changed since this in 2020,
https://jamanetwork.com/journals/jama/f ... le/2771111

Quote:

An intriguing idea is taking shape. During the July webinar, Fauci noted that some long haulers’ symptoms like brain fog and fatigue are “highly suggestive” of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

New York–based psychiatrist Mady Hornig, MD, a member of Columbia University Medical Center’s epidemiology faculty, has long studied the role of microbial, immune, and toxic factors in the development of brain conditions such as ME/CFS, whose etiology and pathogenesis are unknown. Now she’s looking at these relationships not only as a physician and scientist but also as a long hauler.

Hornig wrote off a throat tickle and cough in March as allergies. And she assumed that walking around her home shoeless caused the chilblains that later developed on her toes. It wasn’t until a 4 am fever awoke her on April 24 that she suspected she had contracted COVID-19. Although she takes 650 mg of aspirin daily for another condition, the fever persisted for 12 days, a longer stretch than any she had experienced since she had her tonsils removed at age 14, nearly 50 years ago.

Despite all the indicators, Hornig’s April 27 nasal swab test was negative for SARS-CoV-2. That’s likely because it was performed either too soon or too late—depending on whether the late April fever or the earlier cough or “COVID toes” were the first sign.

Her doctors told her they didn’t have a better explanation than COVID-19 for her symptoms, which have also included oxygen saturation levels as low as 88% and 8- to 10-minute tachycardia episodes that still send her heart rate to 115 to 135 beats per minute at least once a day and leave her breathless, even if she’s sitting down. Before COVID-19, Hornig was used to working 12- to 14-hour days. For weeks after becoming ill, tachycardia would leave her so fatigued that “I felt like I could not do anything further—my brain was just empty,” she said in an interview.

ASPartOfMe wrote:

Millions of people have long COVID brain fog — and there's a shortage of answer

Quote:

On the type of cognitive impairment associated with long COVID
So the thing that people talk about the most is they talk about "memory problems." ... So often they have memory problems, but more typically the problems are with processing speed. That has to do with how quickly you can process information and with attention and with this thorny thing that we call executive functioning. And I say "thorny thing" because executive functioning is associated with ability to function in so many areas.

People with executive dysfunction ... they have problems driving. They can't manage their money. They have a hard time managing their medication. They can't plan for the future. So executive dysfunction, processing, speed, inattention and some deficits with memory. And if you put it together — because often people have all of that — it's a really toxic cocktail. And what it means for people is they have a hard time functioning in the workplace. They often aren't functioning well socially. They're not reading social cues, they're disinhibited.

On the mental health issues that often accompany long COVID
There's no question that mental health issues are tremendously important in the context of long COVID, and why wouldn't they be? If you've lost your job, you're socially isolated, you've lost a lot of hope. In that context, it's really normal, I think, to feel depression, to feel anxiety, to develop PTSD in some cases, because it's hugely traumatic. ... In some cases, for people to have worsening OCD, increased suicide and suicidal ideation is another thing we're concerned about. It's a topic we engage in our support groups all of the time.

Many people are really, really reluctant to have a conversation with their provider about a mental health issue because for some of them they worry, I think, that that provider will say, "See, I told you so. It's only depression. It's only anxiety." ... Patients worry that if they say, "I'm a little anxious," people will say, "It's all in your head."

On why it's important to redefine "brain injury" in the context of long COVID
Unfortunately, physicians — thoughtful and well-meaning, excellent clinically, etc. — they have a certain notion about what constitutes a brain injury: A brain injury is a stroke; a brain injury is you fall off a ladder and you crack your skull on the driveway. That's too often what is defined as a brain injury – and of course, it is.

The problem is there are a lot of other ways to get brain injuries. You can be in the ICU on a ventilator. You can have not enough oxygen get to your brain, something called hypoxia, that can be a brain injury. You can be delirious, which is deleterious to your brain, that can cause a brain injury. And you can have long COVID. That, too, can basically be a cause of a brain injury.

It's not only that you're in Iraq and you survive an IED explosion. It's not only that you're on the football field and have a concussion. There's a medical route to a brain injury, but no one, almost no one gets referred for rehab.

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jimmy m
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12 May 2023, 10:21 am

Perhaps Long Covid is a known condition that has been around for a long time. It might actually go by another name Transient ischemic attack (TIA) or for short a Mini Stroke.

A transient ischemic attack (TIA, or mini-stroke) can have symptoms that last for months or years afterward. Many healthcare providers think these symptoms are rare or at least short term, but a 2013 survey from the UK Stroke Association showed otherwise. Seventy percent of respondents reported long-term after effects such as cognitive difficulties or poor mobility. And sixty percent had emotional changes after the incident.

A transient ischemic attack is a passing vascular blockage (clot) that eliminates or reduces blood flow to some part of the brain. “Transient” refers to how long it lasts: typically less than one hour, but occasionally longer. An ischemic stroke refers to being caused by a clot rather than blood vessel breakage. The episode ends when the clot breaks up and allows blood flow to resume.

TIA does not cause widespread, permanent damage, but it may result in small pockets of dead brain cells. It is often called a “warning stroke” because it precedes 12% of all strokes, and 9-17% of TIA patients have a stroke within 90 days. That means it’s extremely important to seek medical attention and follow-up care because of your higher risk of a stroke.

Symptoms of a TIA appear suddenly and may disappear just as quickly. People often mistake them for a migraine or a pinched nerve. Other stroke symptoms include numbness or tingling on one side of the body, memory loss, and confusion.

Take these signs seriously. It’s better to go to the ER or a local hospital’s stroke clinic for a false alarm than to have an undiagnosed TIA or full stroke. Work with your doctor to identify your stroke risk factors (such as high blood pressure, atrial fibrillation, or family history), take any needed preventative medications (such as statins or antiplatelet meds), and make recommended lifestyle changes to decrease your risk of future stroke (such as diet and exercise).

Long-term effects of TIA:

* Memory problems.
* Difficulties with executive functioning.
* Emotional symptoms (such as irritability or anxiety).
* Brain fog, trouble concentrating, and word-finding struggles.
* Visual difficulties.
* Mildly slurred speech.
* Arm and limb weakness or numbness.

While these symptoms may resolve with time, if they’re still present three months after your TIA, they probably won’t go away on their own. You’ll need appropriate therapy to help them resolve.

Source: Emotions, Memory, and More: The After Effects of Transient Ischemic Attack (TIA or Mini-Stroke)

So perhaps this condition called Long COVID is really a known condition called Transient ischemic attack. As a result of the pandemic that has lasted for the past 3 years, many people have changed their lifestyles. Many have stayed home rather than working. This has produced changes such as less exercise and poorer eating habits. Many have gained some excess weight. This has made us more vulnerable to TIA.

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SabbraCadabra
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12 May 2023, 2:04 pm

jimmy m wrote:

Perhaps Long Covid is a known condition that has been around for a long time. It might actually go by another name Transient ischemic attack (TIA) or for short a Mini Stroke.

TIA does share some of the same symptoms, and it could possibly be a co-morbid (since Covid causes micro-clots all throughout the body), but Long Covid encompasses massive damage throughout every area of the body. It also tends to reactive other dormant viruses, such as EBV, which cause additional damage.

There are plenty of other conditions that have similarities to LC, just look at almost any auto-immune disease.

BTW, suggesting that people with LC just need to "eat better and get exercise" is rather insensitive.

While a low-histamine diet can vastly improve many LC symptoms, I've seen nothing to suggest that overweight people are more likely to become Long Haulers. In fact, most people I see in the support groups were incredibly physically active in their previous life; marathon runners, weight lifters, mountain climbers, hikers, etc. Current studies seem to suggest that overexertion during illness could be one piece of the puzzle, and other studies confirm that trying to force yourself through PEM does far more harm than good. Due to several factors, the blood literally cannot supply enough oxygen.

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ASPartOfMe
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12 May 2023, 5:45 pm

Is not a mini-stroke something you can see with an MRI?

kitesandtrainsandcats
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12 May 2023, 6:02 pm

jimmy m wrote:

So perhaps this condition called Long COVID is really a known condition called Transient ischemic attack.

Except there are the people who have long covid and have had brain scans and have no sign of TIA.

And there are those like me and my father who have had the similar looking ME/CFS for a decade or three and have had the brain scans and have no sign of TIA.

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16 May 2023, 8:07 am

SabbraCadabra wrote:

BTW, suggesting that people with LC just need to "eat better and get exercise" is rather insensitive.

While a low-histamine diet can vastly improve many LC symptoms, I've seen nothing to suggest that overweight people are more likely to become Long Haulers. In fact, most people I see in the support groups were incredibly physically active in their previous life; marathon runners, weight lifters, mountain climbers, hikers, etc. Current studies seem to suggest that overexertion during illness could be one piece of the puzzle, and other studies confirm that trying to force yourself through PEM does far more harm than good. Due to several factors, the blood literally cannot supply enough oxygen.

Actually I do not believe I am reacting rather insensitive. You see I did not suffer a mini stroke. I suffered a massive stroke. It was a life ender experience. I lost my vision on my right side. But in addition I suffered an extreme form of Aphasia (I lost all my knowledge of spoken words along with my ability to read. That was two years ago and I have made some improvements.

When you suffer a stroke, your body dies. The heart stops beating and your body starts to self destruct. But in some of us, a spark of energy flashes and your bodies heart begins to beat again. But the damage is already done. Because the cells in the body contain many serial combinations, a small breakdown puts a block in a large line. A loss of 2 percent of your cells means that around 20 percent of your brain cells are broken. Most people cannot recover from such a loss.

So when you discuss long covid, I see a very small piece of what I experienced. But there are similarities. Diet and exercise is one of the tools that I use to keep alive and repair the damage. My stroke was a long time in developing. It was over several decades in the making. Many people buried themselves in their homes during COVID and long covid may be part of the result.

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17 May 2023, 9:44 am

I came across an article on Long COVID and thought I would pass it on.

A Critical But Neglected Aspect of the Pandemic: Long COVID

Long COVID burdens tens of millions of Americans and the nation's healthcare system, but our response to it has been fragmented and chaotic. We need to address it without delay, with more research and better access to treatment.

This article tries to define the condition and takes a quantitative approach.

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18 May 2023, 6:40 pm

New Guidance Focuses on Neurological Symptoms for Long COVID Patients

Quote:

Long COVID has disrupted the daily lives of millions of people and even disabled some. A medical society representing physicians and others who work with people with disabilities, the American Academy of Physical Medicine and Rehabilitation, published a guidance statement Tuesday on what clinicians should look out for when screening and treating patients with long COVID, specifically in terms of their neurological conditions.

The guidance, which is part of a multidisciplinary series on other types of long COVID symptoms, such as fatigue and breathing problems, takes aim at earlier evaluation, diagnosis and management in order to improve outcomes for patients. The authors also lay out some neurological "red flags" that draw an important distinction between common long COVID-19 symptoms like headaches and brain fog, and medical emergencies that require immediate attention. (In addition to "long COVID," the medical community now sometimes refers to the condition as "post-acute sequelae of SARS-CoV-2 infection," or PASC for short.)

The guidance statement from the AAPMR doesn't appear to break any new major research into medical treatments or completely new symptoms of long COVID that haven't already been noted by medical organizations like the US Centers for Disease Control and Prevention or research on causes of long COVID outlined in science journals, such as the hefty review published in Nature Reviews Microbiology earlier this year. But the AAPMR statement does call for a careful look into how clinicians and doctors should be screening patients, so as not to brush a serious neurological sign under the rug as a "typical" long COVID symptom.

It also draws on existing information that there's no single test for long COVID, and that it depends instead on a holistic view of your health pre- and post-COVID-19.

Sleep problems, headaches and other common neurological symptoms
Research has shown that the neurological and cognitive symptoms of COVID-19 are among the most common patients deal with, and they can affect the way people are able to get through daily life. Some of the common neurological symptoms doctors are still seeing in 2023, outlined in AAPMR guidance statement, are:

Impact to cranial nerves (nerves that help you taste, smell, see and more)
Headaches
Neuropathic pain or neuropathies (numbness, tingling, etc.)
Sleep disturbances
Muscular pain, weakness and tremors

In a media briefing Tuesday, physician and co-author in the guidance Dr. Monica Verduzco–Gutierrez called COVID-19 "ignitor fluid" for other things that may have been going on in your body pre-COVID-19. This can be true for sleep disturbances, she said, causing a baseline sleep issue (like trouble falling asleep at night) to become much worse and warrant a sleep study.

The authors of the guidance note that symptoms of a disrupted sleep cycle overlaps with common cognitive symptoms long COVID patients often report, including having a hard time concentrating or problems with memory. Similar to the other neurological symptoms outlined in the guidance, patients with long COVID or COVID-19 should be given a detailed sleep screening and follow up with the appropriate treatment, some of which is also outlined in the guidance.

Spotting a 'red flag' long COVID symptom
Drawling a line between "red flag" long COVID symptoms (which are really symptoms that require immediate medical attention) and common long COVID symptoms is especially important given the vagueness of long COVID as a disease and the prevalence of medical gaslighting among the people who suffer from it.

For example, headaches may be one of the most common neurological symptoms of long COVID patients, but a severe or "thunderclap" headache that comes on suddenly means you should seek medical care immediately.

"Identifying patients with progressive or ominous 'red flag' neurological symptoms is essential for emergent triaging," Dr. Leslie Rydberg, co-author of the guidance statement, said in a news release Tuesday. "These symptoms may be due to long COVID versus another medical condition, but a history and physical examination is essential."

Below are a few neurological "red flags" that require attention, according to the guidance. Keep in mind that these are only neurological warning signs, and that you should seek medical care any time something feels concerning or out of the ordinary.

Progressive weakness: Some people have experienced numbness or tingling from COVID-19, but weakness in your body that's getting worse (especially if it's getting worse fast) could be a sign of a stroke or health condition.

Sensory changes, like changes to your smell or taste suddenly, can be signs of a stroke and require attention.
Impaired bowel or bladder control: Unexplained incontinence, or even constipation, can be a sign something is impacting the brain or spinal cord, per the guidance.

Loss of consciousness may mean you're experiencing a seizure or there's another cause that requires follow-up. This is different from feelings of fatigue people many people with long COVID experience.

Hallucinations or reduced awareness are some neuropsychiatric symptoms that require medical attention.

Extreme headaches that feel like the worst of your life or come on suddenly can signal a problem in the brain.

Other symptoms like pathologic reflexes or your pupils dilating suddenly. Unexpected dilated pupils can be a sign of something more serious and you should seek care.

underlining=mine

Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of neurologic sequelae in patients with post-acute sequelae of SARS-CoV-2 infection (PASC)

SabbraCadabra
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19 May 2023, 8:19 pm

https://twitter.com/luckytran/status/16 ... 5942353923

Quote:

The CDC has finally published guidance for cleaning indoor air and is recommending wearing masks in schools.

Why wait until after the end of the public health emergency? The government always knew about the science needed to save lives. But they didn't want to pay for it.

Quote:

For everyone asking "why now?"

Basically CDC couldn't "recommend" this during the emergency because then the government would be obligated to pay for part or all of it. Employers who failed to achieve this standard could also be held liable for workplace injury caused by covid.

I guess it should come as no surprise, but it's still pretty disgusting.

jimmy m wrote:

Diet and exercise is one of the tools that I use to keep alive and repair the damage.

Exercise is a bad idea for Long Covid, overexertion will only make the condition worse

jimmy m wrote:

Many people buried themselves in their homes during COVID and long covid may be part of the result.

Most Long Haulers caught Covid in March 2020, which was before any lockdowns in the US.

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21 May 2023, 8:17 pm

Another variant of COVID has appeared. This one is called XBB.2.3. Current data seems to show that around 3.5 percent of cases in the U.S. are this variant. It is very active in India at the moment. There are many offshoots to this variant so it is still evolving. At this point it does not appear to be very deadly. Here is what we know.

Federico Gueli, independent researcher from Italy, closely tracking SARS-CoV-2 variants fold TOI, "The current surge in India is mainly driven by XBB.1.16 that has replaced every other lineage with the exception of XBB.2.3. Looking at the numbers, I see a co-circulation scenaria. It is likely that this surge may be prolonged by the presence of new "blooms" descending from XBB.2.3. As of now, I am seeing more ongoing evolution for XBB.2.3."

At the moment in India, there are several different variants which include XBB.2.3.2, XBB.2.3.4 and XBB.2.3.5. So essentially this particular variant is in an evolutionary stage that may produce a wide array of new variants.

Source: XBB.2.3 sublineage under experts' lens as caseload increases in India

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25 May 2023, 10:38 am

FDA grants full approval to Paxlovid to treat Covid in high-risk adults

Quote:

The Food and Drug Administration on Thursday granted full approval to Pfizer’s Covid antiviral pill, Paxlovid, for adults who are at high risk of getting severely sick with the virus.

Paxlovid is specifically advised for the treatment of mild to moderate Covid in adults older than 50 and people who suffer from certain medical conditions that place them at a higher risk of ending up in the hospital or dying from Covid.

That includes those who have diabetes, heart conditions, cancer or a weak immune system.

As many as three-quarters of adults in the U.S. are at high risk of severe Covid.

The FDA first made Paxlovid available in December 2021 under emergency use authorization for high-risk individuals ages 12 and up. Under that designation, the FDA quickly approved the treatment based on preliminary clinical trial data.

The FDA’s latest decision means there is now extensive clinical data indicating Paxlovid is safe and effective.

The treatment consists of two medications: nirmatrelvir, which blocks a key enzyme that the Covid virus needs to replicate, and ritonavir, which boosts the first medication’s ability to fight the infection.

Both Pfizer and the FDA view the treatment as an important complementary tool to vaccination that can help high-risk Americans manage their Covid infections and ultimately save lives.

FDA researchers estimated, based on Covid rates in January, that Paxlovid could “lead to 1,500 lives saved and 13,000 hospitalizations averted each week” in the U.S.

But it’s unclear what uptake will look like later this year.

The U.S. has 1.1 million courses of the treatment available for free nationwide. Once that runs out, the government will shift the distribution of Paxlovid to the commercial market.

That means Pfizer will sell Paxlovid directly to healthcare providers at a price the company hasn’t disclosed. Paxlovid is priced at about $530 per course now.

major safety concerns were identified in the trial, the review said, though the agency flagged 137 medications that may lead to serious adverse reactions if they interact with Paxlovid.

The FDA said the most common drugs that caused safety issues were immunosuppressants, which are often used to treat HIV and organ transplant patients.

The FDA’s office of surveillance and epidemiology recorded 271 reports of serious adverse events potentially related to drug interactions with Paxlovid, including 147 hospitalizations and six deaths, as of late January.

FDA staff said those events could potentially be avoided by adjusting the dose of certain drugs, increasing patient monitoring and ensuring that product labeling informs prescribers and patients of potential drug interactions.

For some doctors, another area of concern is Paxlovid “rebound cases.” That’s when patients who take the treatment see their Covid symptoms return or test positive shortly after they initially recover.

Reports of those cases cropped up not long after Paxlovid first entered the market.

Both President Joe Biden and his former chief medical advisor Dr. Anthony Fauci seemingly recovered from Covid after taking the antiviral cocktail but tested positive again soon after recovering.

An FDA review of Pfizer’s clinical trials found overall rates of rebound ranged from 10% to 16%, “with no evidence of a higher rate of symptom rebound or moderate symptom rebound” in patients who received Paxlovid compared with patients who received a placebo.

Those results also held regardless of patients’ risk of severe disease, or whether the omicron variant or an earlier strain of the virus was dominant, according to the FDA review.

China faces a new Covid wave that could peak at 65 million cases a week

Quote:

China is bracing for a new wave of Covid infections that could see as many as 65 million cases per week by the time the surge peaks at the end of June.

The surge comes about six months after the country dismantled its sprawling infrastructure for dealing with Covid, including harsh lockdowns, mass testing, stifling quarantines and strict mask requirements.

“People feel differently about this wave,” said Qi Zhang, 30, who works at a finance company in the northern city of Tianjin. “The last time, everyone was terrified, but now they don’t think it’s a big deal,” she told NBC News on Thursday.

The new wave's data was revealed by respiratory disease specialist Zhong Nanshan at a medical conference this week in the southern city of Guangzhou. According to state media, he told the audience that the wave that started in late April was “anticipated,” and that his modeling suggested China could be approaching 40 million infections per week. By the end of June, he said, the weekly number of infections will peak at 65 million.

The United States, by comparison, was reporting more than 5 million cases a week at its peak last January. Like the U.S., China stopped providing weekly case updates this month, making it difficult to know the true extent of the current outbreak.

The State Department said the U.S., which imposed a testing requirement on travelers from China in January before lifting it in March, was discussing China’s second Covid wave with allies and partners but declined to say whether travel restrictions were under consideration.

During China’s first omicron wave in December and January, a different omicron variant was infecting millions of people every day, overwhelming hospitals and crematoriums in cities across the country. Store shelves were emptied of fever medications and schools were shut down.

About 80% of China’s 1.4 billion people were infected during that wave, Wu Zunyou, chief epidemiologist at the Chinese Center for Disease Control and Prevention, said in January. But immunity may have waned in the months since, raising the risk of reinfection.

Zhong said at the medical conference that the government had given preliminary approval to two vaccines aimed at the XBB subvariants, which are already circulating in the U.S., and that others could be approved soon.

Joey Wang, 24, a student in Hebei province, said many people were finding Covid symptoms less severe this time around. But public fears also seem to have been eased by the change in government messaging.

Zhang, the finance employee, said colleagues who recently tested positive were choosing to come to work anyway, contrasting it with the first wave when everyone spent long periods working from home.

“When I look back to such strict Covid measures, it feels like a dream,” she said. “It makes me doubt if all those strict lockdowns were right if we ended up here anyway.”

We are going to find out if the pandemic is over or has just been on pause. All the media here have been describing the pandemic in the past tense. Percentage of positives cases are ticking up here but the sample size is minuscule so we are flying blind.

I got my second OMICRON booster last week and my KN95 masks are at ready.

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25 May 2023, 11:09 am

ASPartOfMe wrote:

There is an active disability and incurable illness community on Tumblr and a good portion of them are not the least bit convinced the pandemic is over.

Posts saying, "He guys, look at this data here, the pandemic is not over" get reblogged far and wide.
So do posts criticizing the media and even the government.

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25 May 2023, 6:50 pm

ASPartOfMe cited an article that gave a glimpse of what is happening in China.

About 80% of China’s 1.4 billion people were infected during that wave, Wu Zunyou, chief epidemiologist at the Chinese Center for Disease Control and Prevention, said in January. But immunity may have waned in the months since, raising the risk of reinfection.

Zhong said at the medical conference that the government had given preliminary approval to two vaccines aimed at the XBB subvariants, which are already circulating in the U.S., and that others could be approved soon.

Like in the U.S. they have decided to stop counting. ASPartOfMe wrote that he received the latest COVID booster shot. I also took mine today. The government has decided COVID is over and will no longer provide these booster shots. You can probably still get one but I suspect that you will pay an arm and a leg to receive one in the future.

At this point I believe that the variants that are out there are very mild versions of what came before. The variants in 2019 and 2020 were killers.

Yesterday I went swimming at the YMCA pool and I met a man who had COVID 3 times already. As a matter of fact many people have had COVID 3 times. Each time they get it the impact gets smaller and smaller.

I do not know if some deadly strange new variant will come out of the blue in China and then spread throughout the world. In old days, transportation was by horses and pandemics moved from one country to others over several years. But in our world, one can fly around the world in hours. Infections can travel very quickly and warnings are gone. Everything is instantaneous.

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25 May 2023, 7:22 pm

Still dodging it, so is bio-mom.
We’re Novids.
https://www.bu.edu/articles/2023/are-yo ... clues-why/

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