The comedian Jackie Mason used to joke “death is not the end – there’s still the fight about the estate.” What will be the “estate” left by Covid-19? Mass personal and economic devastation, surely. Yet already Covid-19 is causing a series of chronic diseases of the mind, brain, lungs, heart, kidney, and other organs that hits a far greater number than those counted dead. The cost of this legacy will wreck lives, careers, and the economy for a long time. Having the president call the disease “99% harmless” disregards carnage whose increasing cost we must begin to tote up.
Most of the time, Covid-19 attacks through the nasopharynx and thence to the lungs. The infectious pneumonias often lead to a drop in lung compliance, making them stiff. The lungs fill with so much fluid they become like soggy wood. At that point, ventilators are often necessary. A sizable portion of those people will die.
Yet the rest will also continue to suffer. Already many describe severe fatigue and difficulties breathing. Pulmonary doctors and nurses tell me many will develop lung fibrosis afflicting the rest of their lives.
Chronic shortness of breath is horrifying to live through. The studies have just started, but at the least, tens of thousands in this country will eventually know the terror and anxiety of not getting enough air.
Even the asymptomatic may not escape. Many blood clots also form in the lungs, and autoimmune pneumonia can develop weeks later, as happened to Peter Piot, one of the discoverers of Ebola virus.
Unlike many infectious illnesses, Covid-19 is not a “one and done” affair. Witness the Covid related increase in diabetes type 1- generally considered an autoimmune disease – in young kids.
A recent paper showing MRI heart inflammation in 78 out of 100 people months after the illness, including asymptomatic patients, has a lot of physicians worried. It may help to explain the strange heart attacks, and the folks who now walk around with heart rates of 105 and often feel dizzy, plus those with bizarre, unexpected strange arrhythmias. Like many other Covid caused illnesses, much of Covid-19’s ultimate effect on the public health may come from its capacity to exacerbate underlying conditions. Most of us get heart disease of some sort as we age.
Covid-19 is also causing vasculitides, autoimmune damage of arteries and veins often weeks after infection. Perhaps the most striking version is the Kawasaki like syndrome seen in children, now known as Multi-Inflammatory Syndrome in Children (MIS-C,) where children feel their legs and arms “burn up.”
Viruses go everywhere, and the chronic kidney disease that Covid-19 will cause is so far underestimated. A study at Mt. Sinai in NY of 4,000 Covid patients found 46% sustained acute kidney injury, of which 17% required dialysis. In some cohorts, up to 50% of Covid patients going into ICU will suffer kidney failure.
What will be the size of the Covid-19 chronic kidney disease epidemic? We should know more in the next year, but the costs to the medical care system are already high.
Several studies now show unusual brain inflammation with Covid-19, with British reports of high case numbers of acute disseminated encephalomyelitis, where our immune system starts digesting the myelin sheath surrounding nerve cells. Many Covid-19 patients also suffer stroke.
What appears more widespread is “brain fog,” generally seen in those with chronic fatigue syndrome. The brain fog seen so far with Covid-19 is subtly different, as the ravages of autoimmune can strike sharply and unexpectedly. So far patients have told me their brain fog is lasting months, though it is not present all the time. They complain bitterly that “mental steel wool” forces them to stop work or productive activity.
Covid-19 always causes many strokes through clotting. This appears to have killed one physician friend of mine, who could not be weaned off the ventilator after six weeks. As the virus and immune system can and do go anywhere, clotting can occur in many organs with Covid-19.
PTSD, Depression, and Anxiety
Most of the public does not know that after 3-4 days the large majority of ICU patients become psychotic. Most of the time this is organic delirium; the body is under such severe assault the cortex can no longer function. Paranoia and terror often ensue, especially when people are intubated and left socially isolated outside of medical staff.
Many patients who survive Covid-19 have been intubated for more than a month. Often they spend those weeks terrified and insane.
Many of them fully remember the horror.
Their recurrent flashbacks and nightmares are now causing clinicians to review standard treatments of PTSD. A mounting toll of depression and anxiety is also afflicting survivors.
That’s what happens to people who get very sick with Covid-19. The National Center of Health Statistics notes a four fold increase in self-described anxiety amongst American adults over the past year, to over one-third.
Covid-19 does far more than kill. It also leaves many who are too ill to function and work and others who will never recover the pleasures of their former lives. If we recognize through the less politically manipulable number of excess deaths that over 200,000 Americans have died as a result of Covid-19, we may see three to four times that number eventually developing chronic disease and disability. That means American Covid-19 “casualties” may already have reached 800,000 to a million.
With the high viral reservoir continuing in the population, a substantial increase in those numbers is already baked in.
Many studies are underway, but national reviews of what Covid-19 is doing to chronic disease, disability, and economic dislocation are warranted now.
Denial is not a strategy, but a catastrophe. The effects of Covid-19 will continue to prove far-reaching.