I know we're all tired of the pandemic, but this morning, I read that Canada's top doctors are warning of yet another wave of COVID predicted for this fall, if not sooner. Programs to promote vaccines and boosters are being dropped by provincial politicians. Reporting of numbers of cases is scarce, so most of us don't even notice the surge, although in the past few weeks I've been hearing about more cases amongst friends and family than ever before... We don't want to pay attention to any of this, but we should!
Last week I saw reports with bright red maps of the US, demonstrating so colourfully how the virus is on the increase there too. I'm hearing top American doctors begging people to get their vaccinations and boosters, just as they are here in Canada!
As for me, right now, I'm due for my 4th booster but could only get an appointment next week. They're only being given in pharmacies now in our province, usually on special "clinic days", and pharmacists seem to be having trouble keeping up with the demand, even though the number of people getting vaccinated are down. Our regular pharmacy is short-staffed and not giving any shots, and another pharmacy where we've often gone for flu shots is booked weeks ahead. I made quite a few calls and finally found an opening sooner...
They know immunity drops within 4 to 5 months, but we are only allowed to get boosted after at least 5 months here. If I'm like the average of those whose immunity has been tested, I probably have only 5% immunity left. I know I could easily be joining the ranks of the infected in my province. This week, New Brunswick has the highest positivity rate for PCR tests in the country (over 30%). The positivity rate gives an estimate how much virus spread is occurring, given that many cases detected with home tests are not reported any more.
But there's long COVID to think about too...
One of my greatest worries, at least now that the current variant of COVID seems to be causing less severe symptoms, is getting long COVID. Doctors say this can occur even after a mild case of the virus. And, the extreme shutdowns in China and North Korea (where the new variants Omicron BA-4 and BA-5 are spreading) make me suspect these strains might be causing more severe symptoms... and more severe COVID is associated with higher rates of long COVID.
And, now that we're over 2 years since the pandemic started, doctors are reporting patients who have had continuing unexplained symptoms for months and even years, some severe enough to interfere with their ability to function and continue working. Shrinkage in brain mass after COVID has been measured, as have decreases in IQ. I don't know about you, but I don't relish the thought of losing my ability to think...
At least researchers are finally finding time to study long COVID, also called post-COVID syndrome (PAS), looking for answers to what exactly it is (a definition of the syndrome), how often it occurs, what causes it, and what can be done to treat this condition.
What is long COVID, anyway??
Part of the problem of learning about this syndrome has been the fact that we don’t have a set clinical definition of what should be called “long COVID”. The CDC in the US defines it as new, returning, or ongoing health problems related to a COVID infection in people who are at least four weeks past the initial acute infection. The WHO (World Health Organization), however, defines long COVID as symptoms similar to the above, but at least 3 months after the initial diagnosis and lasting for over 2 months. There are over 200 reported symptoms that include things like fatigue, shortness of breath, memory difficulties, brain fog, digestive symptoms, and many others involving multiple organ symptoms.
How often it develops depends both on how severe the initial infection was, and what definition of long COVID is used. Amongst those who were hospitalized for the initial infection, long COVID can occur in up to 50% of those who recover (30% if the looser definition of long COVID is used). In those who had mild or even no symptoms initially, it can occur in 5 to 30%, depending on which definition is used. Either way, though, considering the millions who have caught the SARS-CoV-2 virus, it’s affecting a lot of people. As one Mayo Clinic expert has stated, it is not considered a rare condition.
Lots of theories...
However, as yet, researchers don’t have a solid answer as to what’s causing long COVID. One theory is that persistent virus or leftover bits of killed off virus in body tissues could be triggering chronic inflammation.
Another hypothesis is a disruption of the immune system, where it becomes revved up by the infection but, instead of shutting down afterward, it stays active, attacking healthy tissues in the body (an autoimmune process).
A third theory proposes dysregulation of the gut microbiome (note that the gut microbiome plays an important role in regulating the immune system), or reactivation of latent (sleeping) viruses like EBV (Epstein Barr virus). Although these are 3 top theories right now, many other hypotheses have been suggested and need to be investigated.
Tiny microclots have also been detected in many long COVID patients and are suspected of contributing to this syndrome, but they are not found in routine tests. So, another difficulty in diagnosing long COVID is that blood tests often come back as normal, even when something is clearly wrong. This can result in doctors deciding the symptoms are psychological—”all in your head”—and this is very frustrating for patients.
What's the good news?
One encouraging sign is that some patients have reported their long COVID symptoms improved after receiving an immunization against the virus. This seems to support the theory that the SARS-Co-V2 virus could be hiding in the body, with the targeted immune response to the vaccine helping the immune system to win the game of hide-and-seek.
Because there are many possible mechanisms for long COVID that researchers need to explore, finding definite answers will likely take time. Of course, it’s always better to treat the cause rather than just the symptoms... but what do you do when the cause isn’t known? You treat the symptoms.
Some clinics have noted good improvement over time with rehabilitation services, including occupational and physical therapy. It’s not a quick solution, however, and part of the improvement is likely through learning how to cope with the limitations imposed by the condition.
Interestingly, I read that those affected by chronic fatigue, another health problem that is not well understood, are hoping that research into long COVID may find answers for them too. Like COVID, this syndrome is often triggered by a viral infection, and sufferers are plagued by fatigue and brain fog.
My bottom line...
All this just makes it more important to me to do my best to avoid even a mild case of COVID. With summer coming here in Canada, we’ll be spending lots of time—especially social time—outdoors where air circulation is best. And, in spite of mask mandates being mostly removed, I’ll still be wearing the best one I can find whenever I am in a crowded public building. It quite amazes me that we were able to fly to Spain and back without contracting COVID. I credit strict mask-wearing, good airplane ventilation, and protective airline policies for our continuing good health!
So, what about you... do you plan to hang onto your masks for a while longer? Or maybe dig them out again during flu season? Let me know in the comments!
And, if you're not vaccinated with up to date boosters, there are so many reasons to get that free shot as soon as possible, before the predicted next wave this fall. Pandemics don't stop just because we want them to, or because politicians say we're back to normal (or the "new normal").
Virus pandemics don't disappear easily. Remember the 1918 flu (Spanish flu) pandemic? It was caused by the same H1N1 virus that came back to bite us again just a few years ago, and that's still included in current flu shots.
The bottom line is, you'll have much less to worry about if your immunization is up to date. So, book your appointment now to avoid the effects of waning immunity, surges in virus counts, potential for worse symptoms with future variants, and to avoid long COVID!
References:
Akiko Iwasaki, PhD, on the latest long COVID-19 research—American Medical Association
Could microclots help explain the mystery of long COVID?—The Guardian
Mayo Clinic Minute: Learning more about long-haul COVID-19—Mayo Clinic
We need answers to these four long COVID questions—Charlie McCone, The Guardian
N.B. has highest COVID-19 test-positivity rate in the country: Public Health Agency of Canada--CTV Atlantic News
COVID-19 in the U.S.: How do Canada's provinces rank against American states?--CTV News
Another wave of COVID-19 is coming. Why isn’t Canada preparing to beat it?--Editorial, Globe and Mail
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