Don’t just look at covid-19 fatality rates. Look at people who survive
— but don’t entirely recover.
Emergency room doctors and nurses in protective gear at St. Joseph’s
Hospital in Yonkers, N.Y., on June 3.
Emergency room doctors and nurses in protective gear at St. Joseph’s
Hospital in Yonkers, N.Y., on June 3. (John Minchillo/AP)
<https://www.washingtonpost.com/people/megan-mcardle/>
Opinion by
Megan McArdle <https://www.washingtonpost.com/people/megan-mcardle/>
Columnist
Washington Post, August 16, 2020 at 8:00 a.m. EDT
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During the first few months of thecoronavirus
<https://www.washingtonpost.com/nation/2020/08/14/coronavirus-covid-live-updates-us/?itid=lk_inline_manual_1>pandemic
<https://www.washingtonpost.com/graphics/2020/national/coronavirus-us-cases-deaths/?itid=lk_inline_manual_1>,
the United States became a nation of novice hermits and amateur
epidemiologists. The former battened down the hatches; the latter
frantically tried to assess just how much danger we were hiding from.
Betweensourdough seminars
<https://www.vox.com/the-highlight/2020/5/19/21221008/how-to-bake-bread-pandemic-yeast-flour-baking-ken-forkish-claire-saffitz>and
Zoom meetings, Twitter PhD theses were composed and defended seeking to
pin down the “infection fatality rate”: the percentage of infected
people, including the undiagnosed, who died from covid-19.
In those early innings, good-faith estimates rangedas high as 3 percent
<https://institutefordiseasemodeling.github.io/nCoV-public/analyses/first_adjusted_mortality_estimates_and_risk_assessment/2019-nCoV-preliminary_age_and_time_adjusted_mortality_rates_and_pandemic_risk_assessment.html>andas
low as 0.1 percent
<https://www.bloomberg.com/opinion/articles/2020-04-24/is-coronavirus-worse-than-the-flu-blood-studies-say-yes-by-far?sref=JuZtaCVh>.
As we got more information, however, the plausible estimates narrowed,
and is probablyin the range of 0.5 to 1.0 percent
<https://www.who.int/news-room/commentaries/detail/estimating-mortality-from-covid-19>.
But with more data, something else has become clear: We’re focusing too
much on fatality rates and not enough on the people who don’t die, but
don’t entirely recover, either.
Anecdotal reports of these people abound. At least seven elite college
athleteshave developed myocarditis
<https://www.espn.com/college-football/story/_/id/29633697/heart-condition-linked-covid-19-fuels-power-5-concern-season-viability>,
an inflammation of the heart muscle that can have severe consequences,
including sudden death. An Austrian doctor who treats scuba divers
reported thatsix patients
<https://meaww.com/six-austrian-divers-permanently-damaged-lungs-recovery-mild-coronavirus-covid-19>,
who had only mild covid-19 infections, seem to have significant and
permanent lung damage. Social media communities sprang up of people who
arestill suffering
<https://www.sciencemag.org/news/2020/07/brain-fog-heart-damage-covid-19-s-lingering-problems-alarm-scientists>,
months after they were infected, with everything from chronic fatigue
and “brain fog” to chest pain and recurrent fevers.
Full coverage of the coronavirus pandemic
<https://www.washingtonpost.com/coronavirus/?itid=lk_interstitial_manual_8>
Now, data is coming in behind the anecdotes, and while it’s preliminary,
it’s also “concerning,” says Clyde Yancy,chief of cardiology
<https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=21219>at
Northwestern University’s Feinberg School of Medicine. A recentstudy
<https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916>from
Germany followed up with 100 recovered patients, two-thirds of whom were
never sick enough to be hospitalized. Seventy-eight showed signs of
cardiac involvement, and MRIs indicated that 60 of them had ongoing
cardiac inflammation, even though it had been at least two months since
their diagnosis.
If these results turned out to be representative, they would utterly
change the way we think about covid-19: not as a disease that kills a
tiny percentage of patients, mostly the elderly or the obese, the
hypertensive or diabetic, but one that attacks the heart in most of the
people who get it, even if they don’t feel very sick. And maybe their
lungs, kidneys or brains, too.
AD
It’s too early to say what the long-term prognosis of those attacks
would be; with other viruses that infect the heart, most acute,
symptomatic myocarditis cases eventually resolve without long-term
clinical complications. Though Leslie Cooper,a cardiologist
<https://www.mayoclinic.org/biographies/cooper-leslie-t-jr-m-d/bio-20053294>at
the Mayo Clinic, estimates that 20 to 30 percent of patients who
experience acute viralmyocarditis
<https://www.mayoclinic.org/diseases-conditions/myocarditis/symptoms-causes/syc-20352539#:~:text=Myocarditis%20can%20affect%20your%20heart,a%20more%20general%20inflammatory%20condition.>end
up with some sort of long-term heart disease including recurrent chest
pain or shortness of breath, which can be progressive and debilitating.
When I asked whether the risk of long-term disability from covid-19
could potentially end up being greater than the risk of death, Cooper
said: “Yes, absolutely.”
Those patients would, on average, be much younger than the ones who are
dying; the median age inthe German study
<https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916>was
49. These are patients with many years of life to lose, either to
disability or early death. And there are disturbing findings from much
younger patients; a study of186**children
<https://www.nejm.org/doi/full/10.1056/NEJMoa2021680>who hadMIS-C
<https://www.cdc.gov/mis-c/>, the (thankfully rare) inflammatory
syndrome that can occur with pediatric covid-19, showed 15 had developed
aneurysms of the coronary artery.
But you can’t generalize from such small studies, especially since
covid-19 is rapidly becoming the most-studied disease in human history;
if we regularly put patients with other viral infections through cardiac
MRIs, what might their hearts look like a few months in?
AD
We desperately need larger, more comprehensive studies, and, thankfully,
they’re in the works — one of the largest and the bestwill follow
<https://le.ac.uk/research/stories/phosp>10,000 British patients. But
these take time to set up, and as genetic epidemiologist Louise Wain, a
researcher on the British study, told me ruefully, “No one warned us a
year ago that we were going to have a pandemic.” She hopes to have the
1,000th patient enrolled by September, which is amazingly fast, but
still not quick enough for policymakers and individuals who have to
decide whether to leave our hermitages.
“All of us, me included, have tired,” says Yancy. And, in recent months,
our laser focus on fatality rates has offered at least the young and
healthy what seems like a beacon of hope. Without hard data, it has been
easy to dismiss reports of longer-term complications as anecdote,
hysteria or media hype. But at this stage, the absence of data isn’t
proof that those effects aren’t real.
Of course, even if the risks are higher than we thought, we still must
make trade-offs — crops must be picked and kids educated, pandemic or
no. But whatever your personal cost-benefit analysis was, it should
become more conservative with those potential long-term complications
factored in. At the very least, says Yancy, “Wear the mask. When you
think about all these ramifications, wear the mask.”
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