#sequelae

Long-Term Long Covid - by Eric Topol

Unfortunately, what was seen at 6 months largely continues out to 2 years. 

... [New paper at] Nature Medicine addresses what happened 2 years later to nearly 140,000 people who had Covid, compared with almost 6 million people non-infected controls.

... in the non-hospitalized group a substantial proportion— about 30%— of the 80 sequelae, including GI and neurologic, remained significantly elevated. 

... I’d like to point out the data analyzed in this study was enormous, as I tried to capture with one of the supplemental tables below, representative of many others. The authors took on many advanced analytic approaches with weighting, conditional modeling, and sensitivity analyses that I’m not going to review here.

... While this is the first comprehensive and systematic study of Covid at 2 years, it unfortunately is within a highly skewed population. The demographics of nearly 90% men, with a mean age 61 years, is far different than the prototypic person with Long Covid who is more apt to be female and age 30-39 years. Furthermore, to get 2 year follow-up it meant studying a population who had Covid early in the pandemic, before vaccines or the marked evolution of the virus with new variants, including Delta, which was more virulent that the ancestral or Alpha strains that preceded it. So please keep this in mind—the results are important but they may well not be representative of the real world, broader population, of Covid and Long Covid. That’s already a major hole in our knowledge base since there is no other report yet to systematically address a more representative population.

...

Summary

"Those of you who have watched The #Sandman may not realize that the epidemic mentioned early on in the show, where over a million people were affected by a strange sleeping sickness, encephalitis lethargica, was a real thing. …

It didn’t all happen overnight. The first cases were diagnosed in 1917, and the incredibly odd disease continued to turn up in nations around the world over the following decade. Over 500,000 people are thought to have died from the disease over that period …

But dying wasn’t what really marked out the strangeness of the disease. Many of those affected were trapped in a kind of half-life, neither fully awake nor wholly asleep. They could get up and walk, if assisted. But without intervention would sit silently for days. …

The cause of this disease is still unknown. Because it overlapped the massive flu pandemic, many have suspected that lethargica might be a “sequelae,” an after effect of infection by the 1918 flu virus. This theory has fallen out of favor lately, but remains a possibility. …

Like COVID-19, we largely think of flu as a respiratory disease. However, like COVID-19, flu actually effects a number of organs and systems. A sharp increase in heart attacks coming years, and even decades, later, have been connected to the 1918 flu. …

There is even evidence of decreased life expectancy among children born to infected parents. That’s on top of the millions of infants who died as a direct result. The associated health issues generated economic patterns that could still be detected over 50 years later. …

In addition, just as with COVID-19, “long flu” was common. Many people took years to recuperate from their encounter with that flu. Many never did. Again, there are patterns of poverty that are detectable as a direct result. …

What kind of sequelae will COVID-19 generate, and how will they effect not just individual lives, but our socioeconomic future? Absolutely no one knows. What we do know is that 210,000 Americans have already died from COVID-19 *this year*. Millions are experiencing long COVID. …

In absolutely no sense is this pandemic over. As schools start up in America, everyone seems to be, sadly, shockingly, unforgivably left to make their own decisions. Just remember, what we do now will be with us into the next century.

Oh, and I left out that Encephalitis lethargica had its own sequelae: a worldwide increase in Parkinsonism. This was not a kind disease, whatever its origin."

Src: @DevilsTower on Twitter