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Infection preventionists and other health care professionals once again on the frontlines battling a COVID-19 surge need be wary of “mild” symptoms that could haunt them in the long run.
Sometimes lost among the evidence that the Omicron variant of COVID-19 might be a way to, ironically, end the pandemic–mild symptoms and high infectivity might get us to herd immunity—is this question: What about long COVID? That’s especially pertinent to infection preventionists (IPs) and other health care professionals who find themselves yet again on the frontlines of another surge.
According to the Centers for Disease Control and Prevention (CDC), long COVID “is a range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if their illness was mild, or if they had no symptoms.”
Linda Spaulding, RN-BC, CIC, CHEC, CHOP, a member of Infection Control Today®’s Editorial Advisory Board (EAB), says that she’s “seen athletes in their 20s on the wait list for double lung transplants because of long COVID. That’s something that has long-term consequences. Some people talk of COVID fog. They just can’t put their thoughts together.”
In addition, even the treatments for those with long COVID can put toll on a patient’s body.
IPs and other health care workers on the frontlines are also in danger of contracting long COVID. “If health care workers have to give up their careers, then what comes next?,” says Spaulding, adding that the financial consequences of long COVID on the health care system could last “forever.”
A preprint study by Oxford University investigators on the medRxiv website, compares brain scans for SARS-CoV-2 infections in 394 COVID-19 patients who tested positive for the infection against 388 patients in a control group. “We identified significant effects of COVID-19 in the brain with a loss of grey matter in the left parahippocampal gyrus, the left lateral orbitofrontal cortex and the left insula,” the study states. “When looking over the entire cortical surface, these results extended to the anterior cingulate cortex, supramarginal gyrus and temporal pole.”
As noted by Kevin Kavanagh, MD, another member of ICT®’s EAB, a core difficulty in society’s attempt to guide COVID-19 from pandemic to endemic is that COVID is not just a respiratory virus. Kavanagh wrote in October that SARS-CoV-2 is similar to HIV because it can “silently spread throughout the host’s body and attack almost every organ.”
IPs and other health care workers are not immune to long COVID, but they are not always believed when they complain of symptoms, as reported in the Atlantic in November. The author writes that he “interviewed more than a dozen … health professionals from the United States and the United Kingdom who have long COVID. Most told me that they were shocked at how quickly they had been dismissed by their peers.”
Monica Gandhi, MD, MPH, an infectious disease expert and a professor at the University of California, San Francisco, has been saying throughout the pandemic that COVID-19 will devolve into a seasonal nuisance like the common cold and influenza. She told ICT® in a Q&A in September that “if you study the history of infectious diseases … there has not been a single infection that we have not been able to get through if they don’t infect the immune system or if we have an adequate vaccine. If you develop an effective vaccine for an infection, even in the face of vaccine hesitancy, lack of vaccine uptake, you are going to get there because immunity is the only thing that gets you through the pandemic.”
About Omicron, Gandhi recently told Bloomberg that “we’re now in a totally different phase. The virus is always going to be with us, but my hope is this variant causes so much immunity that it will quell the pandemic.”
On the other hand, some health care professionals warn that the system should brace itself for an onslaught of long COVID cases in February, after the current Omicron surge subsides, as many experts predict.
Bruce Patterson, MD, who works for the Chronic COVID Treatment Center, says it is too soon to determine whether Omicron can cause long COVID, but believes it will follow the same route as Delta in that regard. He tells the Deseret News in Utah that “I mean, given what we’ve heard and what we’ve seen, and Omicron just infecting everybody under the sun, we’ll see the same thing with an abundance of kids and adults.”
Kavanagh writes for ICT® that “much of the abandonment of public health measures has been spurred by a massive disinformation campaign which has successfully convinced a relatively large portion of our population that as long as one lives through COVID-19 all will be well. The young and healthy have especially embraced this narrative.”
It is a false narrative, Kavanagh warns, because “the premise that mild infections do not carry significant risks is false. In part this belief is driven by those who have not died from COVID-19 being counted as ‘recovered’ as opposed to ‘survived’. SARS-CoV-2 causes a system infection and is commonly detected in the heart and brain, exemplified by the loss of smell from brain tissue destruction and loss of cardiac function from myocarditis. Even those who develop ‘mild’ COVID-19 can develop long COVID-19 which in many cases lasts for a year or longer.”
Everybody but everybody hopes that this pandemic will end, but experts like Kavanagh point out there’s a difference between hoping and wishful thinking. In terms of evolutionary survival, viruses have billions of years of a head start on humans. And just as the world focuses less on Delta and more on Omicron, yet another variant has been spotted.
B.1.640.2 is so new that it doesn’t have an official name yet, but it’s being called the IHU variant because investigators with IHU Mediterranee Infection discovered it. Their study, also on medRxiv, states that the IHU variant contains “46 mutations and 37 deletions resulting in 30 amino acid substitutions and 12 deletions” and affects parts of the brain that control taste and smell, a point made by Anthony Harris, MD, in a recent Q&A with ICT®. “The reason why very likely you lose your sense of smell and taste is not from the virus infecting your nerves—the actual peripheral nerves here for the sense of taste and smell—but it affects the centers in your brain,” Harris said.
The IHU study states that the “data are another example of the unpredictability of the emergence of SARS-CoV-2 variants, and of their introduction in a given geographical area from abroad.”
The late comedian Gilda Radner, one of seven original cast members of Saturday Night Live, used one of her catchphrases for the title of her book chronicling her battle with cancer: It’s Always Something.
That seems to be the case with the COVID-19 pandemic, as well.