High cholesterol, overweight and reduced physical stamina are long COVID sequelae in young adults

Authors: University of Zurich Summary: 6, 2022:Science Daily

As the Covid-19 pandemic evolves, the issue of post-infection consequences is growing in significance. Does Long Covid impact previously healthy young adults? Although this group is of great societal importance, representing the next generation and the backbone of the workforce, the intermediate-term and long-term effects of SARS-CoV-2 infections have scarcely been researched in this population. Available original research tends to focus on sufferers who were hospitalized, the elderly or those with multiple morbidities, or restricts evaluations to a single organ system.

Long Covid implications in young Swiss military personnel

A new study, funded by the Swiss Armed Forces, and conducted under the leadership of Patricia Schlagenhauf, Professor at the Epidemiology, Biostatistics and Prevention Institute of the University of Zurich (UZH), has now evaluated possible Long Covid implications in young Swiss military personnel. The study, published in the journal Lancet Infectious Diseases, was done between May and November 2021 with 29 female and 464 male participants with a median age of 21. 177 participants had confirmed Covid-19 more than 180 days prior to the testing day, and the control group was made up of 251 SARS-CoV-2 serologically negative individuals. Unlike other studies the novel test battery also evaluated cardiovascular, pulmonary, neurological, ophthalmological, male fertility, psychological and general systems.

Despite overall recovery also sequelae after recent infections remain

The findings show that young, previously healthy, non-hospitalized individuals largely recover from mild infection and that the impact of the SARS-CoV-2 virus on several systems of the body is less than that seen in older, multi-morbid or hospitalized patients. However, the study also provided evidence that recent infections — even mild ones — can lead to symptoms such as fatigue, reduced sense of smell and psychological problems for up to 180 days, as well as having a short-term negative impact on male fertility. For non-recent infections — more than 180 days back — these effects were no longer significant.

Specific constellation carries risk of developing metabolic disorders

For those with non-recent infections, however, the study — which had a long follow-up — provided evidence of a potentially risky constellation: “Increased BMI, high cholesterol and lower physical stamina is suggestive of a higher risk of developing metabolic disorders and possible cardiovascular complications,” says principal investigator Patricia Schlagenhauf. “These results have societal and public-health effects and can be used to guide strategies for broad interdisciplinary evaluation of Covid-19 sequelae, their management, curative treatments, and provision of support in young adult populations.”

Significant landmark study points the way

The study, conducted in collaboration with clinics at the University Hospital Zurich and Spiez Laboratory, is novel in that it quantitatively evaluated multi-organ function using a sensitive, minimally invasive test battery in a homogenous group of people several months after a Covid-19 infection. A valuable facet of the study was the control group, serologically confirmed to have had no SARS-CoV-2 exposure. “This combination of a unique test battery, a homogenous cohort and a control group make this a very powerful, landmark study in the evidence base on Long Covid in young adults,” says Schlagenhauf.

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Story Source:

Materials provided by University of ZurichNote: Content may be edited for style and length.


Journal Reference:

  1. Jeremy Werner Deuel, Elisa Lauria, Thibault Lovey, Sandrine Zweifel, Mara Isabella Meier, Roland Züst, Nejla Gültekin, Andreas Stettbacher, Patricia Schlagenhauf. Persistence, prevalence, and polymorphism of sequelae after COVID-19 in unvaccinated, young adults of the Swiss Armed Forces: a longitudinal, cohort study (LoCoMo)The Lancet Infectious Diseases, 2022; DOI: 10.1016/S1473-3099(22)00449-2

How COVID Could Screw You Worse With Each Reinfection

Authors: David Axe Tue, July 5, 2022

The more times you catch COVID, the sicker you’re likely to get with each reinfection. That’s the worrying conclusion of a new study drawing on data from the U.S. Veterans Administration.

Scientists stressed they need more data before they can say for sure whether, and why, COVID might get worse the second, third, or fourth time around. But with more and more people getting reinfected as the pandemic lurches toward its fourth year, the study hints at some of the possible long-term risks.

To get a handle on the health impact of reinfection, re-reinfection and even re-re-reinfection, three researchers—Ziyad Al-Aly from the Washington University School of Medicine plus Benjamin Bowe and Yan Xie, both from the V.A. St. Louis Health Care System—scrutinized the health records of 5.7 million American veterans.

Some 260,000 had caught COVID just once, and 40,000 had been reinfected at least one more time. The control group included 5.4 million people who never got COVID at all. Al-Aly, Bowe and Xie tracked health outcomes over a six-month period and came to a startling conclusion. “We show that, compared to people with first infection, reinfection contributes additional risks,” they wrote in their study, which hasn’t been peer-reviewed yet but is under consideration for publication in Nature.

Every time you catch COVID, your chance of getting really sick with somethinglikely COVID-related—seems to go up, Al-Aly, Bowe and Xie found. The risk of cardiovascular disorders, problems with blood-clotting, diabetes, fatigue, gastrointestinal and kidney disorders, mental health problems, musculoskeletal disorders and neurologic damage all increase with reinfection—this despite the antibodies that should result from repeat infections.

All of the conditions are directly associated with COVID or have been shown to get worse with COVID. “The constellation of findings show that reinfection adds non-trivial risks,” the researchers warned.

This risk could become a bigger deal as more people get reinfected. Globally, the death rate from COVID is going down, thanks in large part to growing population-wide immunity from past infection and vaccines.

But at the same time, non-fatal reinfections are piling up. Around half a billion people all over the world have caught COVID more than once, according to Al-Aly, Bowe and Xie’s study, citing data from the Johns Hopkins Coronavirus Resource Center. Many more reinfections, including “breakthrough” infections in the fully vaccinated, are likely as new variants and subvariants of COVID evolve to partially evade our antibodies.

The exact increase in risk from reinfection depends on the particular disorder in question—and whether you’ve been vaccinated and boosted. Broadly speaking, however, the likelihood of heart and clotting problems, fatigue and lung damage roughly doubles each time you catch COVID, Al-Aly, Bowe and Xie found.

Ali Mokdad, a professor of health metrics sciences at the University of Washington Institute for Health, offered one important caveat: time. “In general, one would expect that COVID will do more damage with a longer infection,” he told The Daily Beast. A short-lasting COVID infection followed by another short case of COVID should be less damaging than, say, back-to-back long illnesses.

The longer your infections drag on, the greater the stress on your organs. “These are two blows instead of one,” Mokdad said.

But it’s possible the worsening outcomes resulting from reinfection have little or nothing to do with the cumulative stress of successive long illnesses. According to Peter Hotez, an expert in vaccine development at Baylor College, the escalating risk could result from a poorly-understood phenomenon called “immune enhancement.”

A virus undergoes immune enhancement when a person’s immune system, after initial exposure to the pathogen, backfires during reinfection. Someone suffering immune enhancement with regards to a particular disease is likely to get sicker and sicker each time they’re exposed.

Immune enhancement could explain Al-Aly, Bow and Xie’s observation of escalating risk from COVID reinfection. “If the observation is true,” Hotez stressed. But it’s possible the observation is inaccurate. Hotez said he’s “not convinced that reinfection is actually more severe.”

Anthony Alberg, a University of South Carolina epidemiologist, told The Daily Beast he, too, is somewhat skeptical. Just how much more risk you might accumulate with each case of COVID is really hard to predict. And Al-Aly, Bow and Xie’s study is too cursory to totally settle the uncertainty all on its own.

The main problem, Alberg explained, is tied to a classic logical dilemma: causation versus correlation. Just because veterans got sicker with each COVID infection doesn’t necessarily mean COVID is definitely to blame, he pointed out. The vets in the study who came down with COVID more than once maybe tended to belong to groups with overall worse health outcomes whether or not they caught COVID twice, thrice or never.

The Massive Screwup That Could Let COVID Bypass Our Vaccines

“Compared with veterans who were infected once with SARS-CoV-2, those who were infected two times or more were more likely to be older [or] Black people, reside in long-term care, be immunocompromised, have anxiety, depression and dementia and to have had cerebrovascular disease, cardiovascular disease diabetes and lung disease,” Alberg said.

COVID, in other words, might be beside the point. It’s possible the worsening outcomes in Al-Aly, Bow and Xie’s study are due to the fact that the reinfected patients “were on average older and with much poorer health status than those with one infection,” Alberg said, “not because of having been infected more than once.”

Untangling causation and correlation in a study of this scale could be tricky. “More evidence [is] needed on this topic before definitive conclusions can be reached,” Alberg said.

In the meantime, it should be easy for us to mitigate the potential risk. Anyone who comes down with COVID a second time shouldn’t hesitate to take a course of paxlovid or some other antiviral drug that’s approved for the disease. “We should continue to focus on making sure people are aware of the benefits of early treatment,” Jeffrey Klausner, an infectious diseases expert at the University of Southern California Keck School of Medicine, told The Daily Beast.

Better yet, we could focus on developing “strategies for reinfection prevention,” Al-Aly, Bow and Xie wrote.

The top priority, of course, should be vaccinating the unvaccinated. Even the best COVID vaccines aren’t 100-percent effective at preventing infection or reinfection—and they’re getting somewhat worse as SARS-CoV-2 evolves for greater immune-escape.

But even with cleverer viral mutations, the jabs are still pretty effective. You can’t get sicker and sicker with reinfection… if you never get infected in the first place.

COVID-19: Understanding long COVID

Authors: Emory News Center

For some individuals, the road to recovery from COVID-19 is long. While most people recover from mild COVID-19 symptoms over the course of one to two weeks, “long-haul” patients can suffer from lingering symptoms for months on end. This syndrome, called post-acute COVID-19 or “long COVID,” can have devastating effects on the daily lives of millions of patients.

To discuss what we know about long COVID, Jodie Guest, PhD, professor and vice chair of the department of epidemiology at Emory’s Rollins School of Public Health, teamed up with Alex Truong, MD, co-director of the post-COVID clinic at Emory’s Executive Park. Truong is also an assistant professor in the Division of Pulmonary and Critical Care Medicine at Emory University School of Medicine.

Their conversation follows up on a previous discussion conducted in 2021 and is part of an online video series hosted by Guest, who leads the Emory COVID-19 Outbreak Response Team, answering questions related to the pandemic.

Q: What symptoms are associated with long COVID?

A: “A lot of our patients come in with very, very similar symptoms of brain fog, fatigue and shortness of breath,” says Truong. “It’s almost as if I can cut and paste one patient’s story to the next patient.”

“It’s very rare that someone comes in with a singular issue,” he continues. “It’s always a host of issues. Most of the time, patients are complaining that their brain fog and fatigue are the biggest limiters of their activities of daily living — their ability to get back to work, the ability to go back to school or take care of their kids. There’s a smaller population of patients who have had chronic pain syndromes and chronic shortness of breath syndromes that are often very challenging to figure out.”

Q: How many people who have COVID-19 will develop long COVID?

A: “That’s a really hard question to answer, because I think we are lacking the data,” Truong says. “I think, unfortunately, we aren’t at a place yet where we really know who’s at risk, and so we don’t know what the proportions are.”

Guest notes that current estimates for the risk of long-term symptoms range broadly from 15% to 80% of COVID-19 patients.

“That span of statistics, being all over the board, includes patients who are severely sick in the hospital and those who are not severely sick,” Truong adds. “If I had to guess, I would have to say it’s probably closer to the 15 to 20% range, depending on the population you’re looking at.”

Q: Is hospitalization due to severe COVID-19 associated with an increased risk of long COVID?

A: “A lot happens in the hospital and in the ICU that puts patients at risk for long-term outcomes, regardless of whether they have COVID or not,” Truong says, noting that survivors of any critical illness are prone to develop symptoms such as cognitive dysfunction, chronic fatigue and chronic pain.

“We have a syndrome called post-ICU syndrome that actually captures this collection of conditions that patients suffer from,” he says. “I think it’s difficult to separate what is post-COVID syndrome versus what is post-ICU syndrome. As we move forward in this diagnosis, this category of post-COVID folks will have to be better defined so that we can better separate it from the post-ICU folks.”

One key difference Truong does see between the two syndromes is that post-acute COVID patients generally report issues with attention, concentration and brain fog, while individuals with post-ICU syndrome often experience more memory loss.

Q: Is long COVID associated with damage to cells in the body caused by COVID-19?

A: “Initially, we thought of COVID as a lung infection virus. We do see a lot of patients in our post-COVID populations who have persistent lung inflammation, and some patients progress to scarring, representing that there is direct lung parenchyma damage,” Truong says.

“We’re also realizing that COVID is possibly a vascular problem,” he continues. “It will affect the blood vessels and can cause a whole cohort of symptoms that may be explained by decreased blood flow, such as brain fog and some of the cardiomyopathies that we may be having.”

Some of these symptoms, such as lung and heart inflammation, may be reversed with medication. Unfortunately, symptoms like brain fog are more difficult to resolve.

“We’re only at the very beginning steps of understanding how COVID affects the brain,” Truong says. “There are some data that suggest there are proinflammatory changes within the brain and movements of proinflammatory cells past the blood-brain barrier that may affect the limbic system, or the core systems of your brain that are responsible for things like mood, attention and memory.”

“We’re still in the process of trying to figure out what the importance of these different pathologies are,” he adds, noting that further research is needed to better understand these symptoms.

Q: Can people who fully recover from COVID-19 develop long COVID symptoms later?

A: “It was originally assumed that long COVID was associated with severe symptoms during your original infection, but now there seems to be some data that people are developing new issues after fully recovering from COVID-19,” Guest says. “Even people who didn’t have symptoms can experience some of these post-COVID-related health issues, which can present as a lot of different types and combinations of health problems and seem to range for a long period of time.”

Truong says the causes of post-COVID syndrome among this category of seemingly recovered patients are particularly frustrating to trace.

“We do get a population of patients who have very mild symptoms or in some cases don’t have any symptoms and just incidentally were found to have COVID, and then months later developed a syndrome of brain fog, fatigue and shortness of breath that isn’t explained by some pathology and the lung,” he says.

“I think that initially, there was a lot of conversation as to whether inflammation was playing a role in why patients are having post-COVID syndrome,” he continues. “The thought was the more severely sick you initially were, the more likely you are to have post-COVID. That has totally been blown out of the water. We do not see that signal whatsoever.”

Truong adds that post-COVID symptoms among these patients may potentially be explained by preliminary research regarding COVID-19 and autoimmunity.

“Patients who get infected with COVID may recover from the initial illness easily, but subsequently develop some sort of auto-antibody or auto-protein that the body does react to, and then manifests a lot of these other symptoms,” he says.

Q: How do you know whether a patient has long COVID or another condition?

A: “That’s been the big challenge in our clinic,” Truong says. “When patients come in with what sounds like post-COVID syndrome, the first step is always to make sure that there were confirmed COVID tests.” Patients can’t be diagnosed with post-COVID syndrome without having had a confirmed positive COVID-19 test.

Next, the clinic conducts several tests to rule out other diagnoses for patients who struggle with symptoms such as brain fog and fatigue.

“We do a whole slew of lab work that checks for thyroid levels, vitamin D deficiency, vitamin B12 deficiency, anemia and a bunch of other abnormalities,” he explains.

Easily treatable conditions like hypothyroidism and significant anemia are rarely diagnosed at the post-COVID clinic, and while vitamin deficiencies are common, Truong says patients often continue to experience symptoms even after those vitamins have been repleted.

“I think, unfortunately, we’re at the stage where if you have a COVID diagnosis and I can’t figure out other causes for your symptoms, then I’m blaming it on post-COVID syndrome,” he says. “That’s not very sexy or scientific, but at this point in the evolution of this syndrome, this is where we’re at.”

Q: When should people seek care for long-term symptoms after having COVID-19?

A: “I think that what patients should expect is that after their acute illness, in the next two to four weeks after they’ve been infected, they’re not going to feel well,” Truong says. “They’re going feel like they have brain fog, they’re probably going to have fevers and chills, body aches and fatigue.”

“If those symptoms last beyond four to six weeks from their initial infection and it’s affecting their lives and the ways that they do their job, or affecting how they’re functioning and activities of daily living, then I think that’s when it’s really important for them to come see us,” he continues.

“There is a population of patients who do have lingering symptoms past those four to six weeks after infection, and it’s just getting better on its own, but slowly,” Truong adds. “To those patients, I would say, wait and watch. But if it’s really affecting you, and it’s not improving at all, then please don’t wait too long to come see us.”

Q: Is the post-COVID clinic at Emory’s Executive Park still busy?

A: “Yes, we are very busy,” Truong says. “Interestingly, I was expecting a much bigger wave of new patients with the Omicron wave. I think that we’re still seeing patients who were of the previous waves right now.”

“I feel like we’re so much better at taking care of patients,” he adds, highlighting the progress the clinic has made since last year. “I think we have a little bit more data on our side, we have a lot more experience on our side, and I think we’re able to approach patients in a way that is much more systematic.”

Q: Where else can long COVID patients turn for support?

A: Many individuals with long COVID find support through social media. Online communities for people suffering from post-COVID symptoms have formed over platforms such as Facebook, Reddit and Twitter.

“There are several communities that actually have been really helpful,” Truong says. “Patients are passing information around, both for the good and bad. But I think right now, patients are finding the Internet is a really good resource for finding information on how to take care of themselves, as well as finding professionals who may be able to help them along with their journey.”

“That support system can be so good if the information is accurate,” Guest adds.

Q: Can children experience long COVID?

A: “Children can definitely get the long-haul or post-COVID syndrome. I think they tend to be less likely to have symptoms of shortness of breath and respiratory issues, and more likely to have a lot of the brain fog and fatigue issues that we’re seeing,” Truong says.

While Truong only treats adult patients at the post-COVID clinic, he says he hears about teenagers who have experienced long-haul symptoms for more than a year after initial infection. “They can’t get back to school and do the things that they need to do — most of which, again, centers around the brain fog and fatigue.”

Q: Does long COVID impact women more than men?

A: At the Emory post-COVID clinic, Truong sees about twice as many female patients as he does male patients.

“I think the data we have is that more women are showing up to the clinic than men are,” he says. “I have no idea whether that is because post-COVID syndrome is affecting women more than men, or if it is that they’re just seeking care and men are being stubborn and not seeking care.”

“I think in part it has to do with a selection bias, but I wouldn’t be surprised if the rates are truly a little bit higher in women than men,” he adds. “In similar syndromes such as chronic fatigue syndrome, we do see that those rates are slightly higher in women than men.”

Q: Does vaccination impact the risk of developing long COVID?

A: “The data we have so far have suggested that yes, indeed, it is helping protect you from having post-COVID syndrome if you get a breakthrough infection after you’ve had all three of your shots, which includes the booster,” Truong says. “I do have a small population of patients who have had post-COVID syndrome after they’ve been vaccinated, but it seems like those folks tend to have rather mild disease and tend to resolve a lot faster than my folks who have not been vaccinated and got COVID, and thus post-COVID syndrome, after.”“The safest way to keep from getting long COVID, or post-COVID syndrome, is certainly to make sure you keep from getting COVID-19,” Guest says. “The best way to do that is by getting vaccinated, getting a booster, making sure you protect those people who are around you, and when cases are still high out in the community, please wear a mask when you’re indoors in public spaces.”

SARS-CoV-2 mRNA Vaccination-Associated Myocarditis in Children Ages 12-17: A Stratified National Database Analysis

Authors: RALPH TURCHIANO    • 

Abstract

Establishing the rate of post-vaccination cardiac myocarditis in the 12-15 and 16-17-year-old population in the context of their COVID-19 hospitalization risk is critical for developing a vaccination recommendation framework that balances harms with benefits for this patient demographic. Design, Setting and Participants: Using the Vaccine Adverse Event Reporting System (VAERS), this retrospective epidemiological assessment reviewed reports filed between January 1, 2021, and June 18, 2021, among adolescents ages 12-17 who received mRNA vaccination against COVID-19. Symptom search criteria included the words myocarditis, pericarditis, and myopericarditis to identify children with evidence of cardiac injury. The word troponin was a required element in the laboratory findings. Inclusion criteria were aligned with the CDC working case definition for probable myocarditis. Stratified cardiac adverse event (CAE) rates were reported for age, sex and vaccination dose number. A harm-benefit analysis was conducted using existing literature on COVID-19-related hospitalization risks in this demographic. Main outcome measures: 1) Stratified rates of mRNA vaccine-related myocarditis in adolescents age 12-15 and 16-17; and 2) harm-benefit analysis of vaccine-related CAEs in relation to COVID-19 hospitalization risk. Results: A total of 257 CAEs were identified. Rates per million following dose 2 among males were 162.2 (ages 12-15) and 94.0 (ages 16-17); among females, rates were 13.0 and 13.4 per million, respectively. For boys 12-15 without medical comorbidities receiving their second mRNA vaccination dose, the rate of CAE is 3.7-6.1 times higher than their 120-day COVID-19 hospitalization risk as of August 21, 2021 (7-day hospitalizations 1.5/100k population) and 2.6-4.3-fold higher at times of high weekly hospitalization risk (2.1/100k), such as during January 2021. For boys 16-17 without medical comorbidities, the rate of CAE is currently 2.1-3.5 times higher than their 120-day COVID-19 hospitalization risk, and 1.5-2.5 times higher at times of high weekly COVID-19 hospitalization. Conclusions: Post-vaccination CAE rate was highest in young boys aged 12-15 following dose two. For boys 12-17 without medical comorbidities, the likelihood of post vaccination dose two CAE is 162.2 and 94.0/million respectively. This incidence exceeds their expected 120-day COVID-19 hospitalization rate at both moderate (August 21, 2021 rates) and high COVID-19 hospitalization incidence. Further research into the severity and long-term sequelae of post-vaccination CAE is warranted. Quantification of the benefits of the second vaccination dose and vaccination in addition to natural immunity in this demographic may be indicated to minimize harm.

Millennials Experienced the “Worst-Ever Excess Mortality in History” – An 84% Increase In Deaths After Vaccine Mandates

The most recent data from the CDC shows that U.S. millennials, aged 25-44, experienced a record-setting 84% increase in excess mortality during the final four months of 2021, according to the analysis of financial expert and Blackrock whistleblower, Edward Dowd,

Dowd, with the assistance of an insurance industry expert, compiled data from the CDC showing that, in just the second half of 2021, the total number of excess deaths for millennials was higher than the number of Americans who died in the entirety of the Vietnam War. Between August and December, there were over 61,000 deaths in this age group, compared to 58,000 over the course of 10 years in Vietnam.

In all, excess death among those who are traditionally the healthiest Americans is up by 84%.

Five months post-covid, Nicole Murphy’s heart rate is still doing strange things

Authors: Ariana Eunjung Cha February 21, 2022

The Washington Post
The Washington Post

Five months after being infected with the coronavirus, Nicole Murphy’s pulse rate is going berserk. Normally in the 70s, which is ideal, it has been jumping to 160, 170 and sometimes 210 beats per minute even when she is at rest — putting her at risk of a heart attack, heart failure or stroke.

No one seems to be able to pinpoint why. She’s only 44, never had heart issues, and when a cardiologist near her hometown of Wellsville, Ohio, ran all of the standard tests, “he literally threw up his hands when he saw the results,” she recalled. Her blood pressure was perfect, there were no signs of clogged arteries, and her heart was expanding and contracting well.

Murphy’s boomeranging heart rate is one of a number of mysterious conditions afflicting Americans weeks or months after coronavirus infections that suggest the potential of a looming cardiac crisis.

A pivotal study that looked at health records of more than 153,000 U.S. veterans published this month in Nature Medicine found that their risk of cardiovascular disease of all types increased substantially in the year following infection, even when they had mild cases. The population studied was mostly White and male, but the patterns held even when the researchers analyzed women and people of color separately. When experts factor in the heart damage probably suffered by people who put off medical care, more sedentary lifestyles and eating changes, not to mention the stress of the pandemic, they estimate there may be millions of new onset cardiac cases related to the virus, plus a worsening of disease for many already affected.

“We are expecting a tidal wave of cardiovascular events in the coming years from direct and indirect causes of covid,” said Donald M. Lloyd-Jones, president of the American Heart Association.

In February 2021, the National Institutes of Health launched an initiative to look at the causes and possible treatments for long covid, the constellation of symptoms from brain fog and exercise fatigue to heart-related issues that some people experience well past their initial infections. In addition, the American College of Cardiology has recognized the serious, longer-term effects of the coronavirus by preparing new guidelines, scheduled out in March, for monitoring and returning to exercise after infection. But many experts and patient advocacy groups say more is needed, and are calling on President Biden and other leaders for comprehensive changes in the health care system that would provide more funding for research and treatment, financial support for people who can no longer work and address the social and emotional consequences of illness in the decades to come.

Zaza Soriano, 32, a software engineer from Millersville, Md., who works for a NASA subcontractor, got covid right before Christmas despite being fully vaccinated and boosted, and since then, her blood pressure has remained very high with the bottom number, or diastolic pressure when the heart rests between beats sometimes as high as 110 when it should be lower than 80. She also has brain fog and her joints ache.

“It’s so frustrating we still know so little about why this is happening,” she said.

Ziyad Al-Aly, an assistant professor of medicine at Washington University and a Veterans Affairs physician who co-authored the Nature Medicine study, describes the pandemic as an earthquake. “When the earth stops shaking and the dust settles, we will have to be able to deal with the aftermath on heart and other organ systems,” he said.

“Governments around the world need to pay attention,” Al-Aly emphasized. “We are not sufficiently prepared.”

Heart disease is the planet’s No. 1 killer, responsible for 17.9 million deaths, or a third of the total each year before the pandemic, and there’s already growing evidence of the outsize impact the coronavirus is having on our long-term health.

Multiple studies suggest that Americans’ collective blood pressures has jumped since the crisis began. According to a December study in the journal Circulation, for example, the average blood pressure among a half-million U.S. adults studied from April to December 2020 went up each month for both of the numbers measured by monitors.

The Centers for Disease Control and Prevention as of this month had logged more than 1 million excess deaths or deaths since the start of the pandemic that are beyond what we would have expected in normal times. While most of those were directly caused by the virus, there were also an additional 30,000 deaths due to ischemic heart disease and nearly 62,000 additional deaths due to hypertensive disease.

When the coronavirus first hit the United States in 2020, doctors were surprised by the heart involvement in cases they saw: professional athletes with signs of myocarditis or hardening of the heart walls; patients dying from their illness with hundreds of tiny clots in major organs; children rushed to emergency rooms with an inflammatory reaction involving cardiac complications.

Many of those presentations turned out to be rare or rarely serious. But they led researchers to an important discovery: that SARS-CoV-2 could directly attack the heart and blood vessels, in addition to the lungs.

Myocarditis has mostly been a transient issue, impacting activity or becoming life-threatening in only a small minority of cases; the clotting is more widespread but something that usually can be controlled with blood thinners; and the pediatric inflammatory syndrome has affected only about 6,400 children out of millions of cases, as of January.

The idea that infections increase cardiovascular risk is not new. It has been documented in cases of influenza and other viruses as well. But in coronavirus, that impact seems “enhanced,” said Antonio Abbate, a professor of cardiology at the VCU Pauley Heart Center. And the early and obvious cases, he said, should serve “as a kind of warning” for the type of longer-term cases we may see into the future.

Indeed, as the months since their infections have turned into years, people who initially had mild or even some asymptomatic coronavirus cases are pouring into cardiology practices across the country.

At Memorial Hermann-Texas Medical Center in Houston, Abhijeet Dhoble, an associate professor of cardiovascular medicine, said they are seeing an increase in arrhythmia, an abnormality in the timing of the heartbeat, and cardiomyopathy, a heart muscle disease. The patients, who previously had covid, range in age from their 30s to 70s and many had no previous heart disease.

“We are seeing the same patterns at university clinics and the hospital,” he said.

Two different processes may be at play, according to David Goff, director of the National Heart, Lung and Blood Institute’s division of cardiovascular sciences. The virus may inflict direct damage to the heart muscle cells, some of which could die, resulting in a weaker heart that does not pump as well. Another possibility is that after causing damage to blood vessels through clots and inflammation, the healing process involves scarring that stiffens vessels throughout the body, increasing the work of the heart.

“It could lead over time to failure of the heart to be able to keep up with extra work,” he explained.

Blood vessels and fatigue

David Systrom, a pulmonary and critical care doctor at Brigham and Women’s Hospital in Boston, said he believes blood vessel damage may be responsible for one of the most common and frustrating symptoms of long covid — fatigue.

Systrom and his colleagues recruited 20 people who were having trouble exercising. Ten had long covid. The other half had not been infected with the virus. He inserted catheters into their veins to provide test information before putting them on stationary bikes and took a number of detailed measurements. The study was published in the journal Chest in January.

In the long covid group, he found that they had normal lung function and at peak exercise, their oxygen levels were normal even as they were short of breath. What was abnormal was that some veins and arteries did not appear to be delivering oxygen efficiently to the muscles.

He theorized this could be due to a malfunction in the body’s autonomic nervous system, which controls involuntary actions such as the rate at which the heart beats, or the widening or narrowing of blood vessels.

“When exercising, it acts like a traffic cop that distributes blood flow to muscles away from organ systems like the kidney and gut that don’t need it. But when that is dysfunctional, what results is inadequate oxygen extraction,” he said. That may lead to the feeling of overwhelming exhaustion that covid long haulers are experiencing.

The overall the message from providers is that “covid by itself is a risk factor for heart disease” like obesity, diabetes, or high blood pressure, according to Saurabh Rajpal, a cardiologist at Ohio State University Wexner Medical Center.

“This is a virus that really knocks people down,” agreed Nicole Bhave, a cardiologist with Michigan Medicine and member of the American College of Cardiology’s science committee. “Even young, healthy people don’t often feel very normal for weeks to months, and it’s a real challenge to distinguish what’s just your body slowly healing versus a new pathological problem.”

“People experiencing what appear to be heart issues should have a “a low threshold for seeing their primary care doctor,” she said.

Heart beats

Unexplained high blood pressure has been a common symptom after covid infection.

Lindsay Polega, 28, an attorney from St. Petersburg, Fla., had never had any medical issues before covid. She had been an all-state swimmer in high school and ran, swam or otherwise exercised an hour or more every day since. But after two bouts with covid, the first in early 2020 and the second in spring 2021, she’s been having what doctors call “hypertensive spikes” that result in shooting pains in her chest that make her shaky and weak. During those incidents, which sometimes occur a few times a day, her blood pressure has gone as high as 210/153 — far above the 120/80, that is considered normal.

One incident happened during a light Pilates class and she had to go to the emergency room. Other times, it has happened while walking. “Sometimes I’ll just be on the couch,” she said.

Each specialist she saw referred her to another — endocrinology, immunology, cardiology, neurology. Finally, she found herself at a long-covid clinic where the doctor theorized the issue may be with her adrenal gland. Scientists have documented that the virus can target the adrenal glands, which produce hormones that help regulate blood pressure among other essential functions. Polega was put on a heavy-duty blood pressure drug called eplerenone that’s typically used in patients after a heart attack, and it has helped to reduce but not eliminate the episodes.

The scariest part for Polega is that women taking eplerenone are cautioned against pregnancy due to research in animals showing low birth weights and other potential dangers. Polega and her boyfriend of six years had recently purchased a house together, and were talking about starting a family soon.

“That’s a big thing to have taken away at my age — my future,” she said.

Of all the symptoms of long covid, among the most baffling have been erratic heart rates and skipped heartbeats with no clear cause.

Tiffany Brakefield, a 36-year-old pharmacy tech from Bonita Springs, Fla., who had covid in June 2020, said the spikes are so unpredictable that she found herself having to sit down on the floor at Walmart during a recent shopping excursion.

“I felt like I was going to fall down, and all I could do was wait for it to calm down on its own,” she said. Her doctors had put her on a heart medication, metoprolol, but it has not helped.

Rick Templeton, a 52-year-old community college instructor in Lynchburg, Va., felt chest tightness along with a racing heart rate, but in his case it disappeared five to six months after his infection in September 2020, and doctors never knew why it happened because his test results were normal.

Rajpal, the cardiologist in Ohio, said a large majority of his post-covid cases are similarly vexing.

“The most common type of long haulers we are seeing have shortness of breath, chest discomfort, and fast heart rate. But when we investigate them for heart disease they come back as normal,” he said.

Goff, the NIH scientist, said the presentation looks similar to a condition known as POTS, or postural orthostatic tachycardia syndrome, in which symptoms such as lightheadedness and heart rate changes are related to reduced blood volume, typically worsened by changing positions. A body of emerging evidence suggests that for many people, it could be a post-viral syndrome.

He said the unstable heart rate for many post-covid patients “can be quite serious and debilitating, and can really interfere with ordinary day-to-day activities.” Doctors can use blood pressure medications to try to stabilize heart rates but because they depress blood pressures at the same time, they can be tricky to use.

Murphy, the Ohio long covid patient, said that when her heart rate soars, which happens several times an hour, she said “it feels like a hamster in my chest.”

Her troubles began on Sept. 5, when she and her teenage daughter tested positive for the virus. Her daughter got over her illness in a few days. Murphy was acutely ill for about three weeks, and many of her symptoms never went away.

The 44-year-old single mom says she’s extraordinarily weak and has trouble with her memory sometimes. Before she was infected, she worked 12-hour days as a day care provider, a waitress and a cashier. Now she’s lucky if she can last three to four hours at her job as a DoorDash driver.

She’s tried to stay active by taking walks but sometimes “when I take steps, it’ll be like stars.” When she saw the cardiologist, she passed out during the stress test on the treadmill.

“I constantly live in fear I’m going to have a heart attack or stroke,” she said.

After all her heart tests came back fine except for her EKG, which showed the jumping heart rate, her doctors referred her to the Cleveland Clinic’s long covid group. She hopes they will help her find answers.

Heart-disease risk soars after COVID — even with a mild case

Authors: Saima May Sidik 10 February 2022

Nature

Massive study shows a long-term, substantial rise in risk of cardiovascular disease, including heart attack and stroke, after a SARS-CoV-2 infection.

Even a mild case of COVID-19 can increase a person’s risk of cardiovascular problems for at least a year after diagnosis, a new study1 shows. Researchers found that rates of many conditions, such as heart failure and stroke, were substantially higher in people who had recovered from COVID-19 than in similar people who hadn’t had the disease.

What’s more, the risk was elevated even for those who were under 65 years of age and lacked risk factors, such as obesity or diabetes.

“It doesn’t matter if you are young or old, it doesn’t matter if you smoked, or you didn’t,” says study co-author Ziyad Al-Aly at Washington University in St. Louis, Missouri, and the chief of research and development for the Veterans Affairs (VA) St. Louis Health Care System. “The risk was there.”

Al-Aly and his colleagues based their research on an extensive health-record database curated by the United States Department of Veterans Affairs. The researchers compared more than 150,000 veterans who survived for at least 30 days after contracting COVID-19 with two groups of uninfected people: a group of more than five million people who used the VA medical system during the pandemic, and a similarly sized group that used the system in 2017, before SARS-CoV-2 was circulating.

Troubled hearts

People who had recovered from COVID-19 showed stark increases in 20 cardiovascular problems over the year after infection. For example, they were 52% more likely to have had a stroke than the contemporary control group, meaning that, out of every 1,000 people studied, there were around 4 more people in the COVID-19 group than in the control group who experienced stroke.

The risk of heart failure increased by 72%, or around 12 more people in the COVID-19 group per 1,000 studied. Hospitalization increased the likelihood of future cardiovascular complications, but even people who avoided hospitalization were at higher risk for many conditions.

“I am actually surprised by these findings that cardiovascular complications of COVID can last so long,” Hossein Ardehali, a cardiologist at Northwestern University in Chicago, Illinois, wrote in an e-mail to Nature. Because severe disease increased the risk of complications much more than mild disease, Ardehali wrote, “it is important that those who are not vaccinated get their vaccine immediately”.COVID’s cardiac connection

Ardehali cautions that the study’s observational nature comes with some limitations. For example, people in the contemporary control group weren’t tested for COVID-19, so it’s possible that some of them actually had mild infections. And because the authors considered only VA patients — a group that’s predominantly white and male — their results might not translate to all populations.

Ardehali and Al-Aly agree that health-care providers around the world should be prepared to address an increase in cardiovascular conditions. But with high COVID-19 case counts still straining medical resources, Al-Aly worries that health authorities will delay preparing for the pandemic’s aftermath for too long. “We collectively dropped the ball on COVID,” he said. “And I feel we’re about to drop the ball on long COVID.”

doi: https://doi.org/10.1038/d41586-022-00403-0

References

  1. Xie, Y., Xu, E., Bowe, B. & Al-Aly, Z. Nature Med. https://www.nature.com/articles/s41591-022-01689-3 (2022).PubMed Article Google Scholar 

‘We Made a Big Mistake’ — COVID Vaccine Spike Protein Travels From Injection Site, Can Cause Organ Damage

Authors:  Children’s Health Defense

COVID vaccine researchers had previously assumed mRNA COVID vaccines would behave like traditional vaccines. The vaccine’s spike protein — responsible for infection and its most severe symptoms — would remain mostly in the injection site at the shoulder muscle or local lymph nodes.

But new research obtained by a group of scientists contradicts that theory, a Canadian cancer vaccine researcher said last week.

“We made a big mistake. We didn’t realize it until now,” said Byram Bridle, a viral immunologist and associate professor at University of Guelph, Ontario. “We thought the spike protein was a great target antigen, we never knew the spike protein itself was a toxin and was a pathogenic protein. So by vaccinating people we are inadvertently inoculating them with a toxin.”

Bridle, who was awarded a $230,000 grant by the Canadian government last year for research on COVID vaccine development, said he and a group of international scientists filed a request for information from the Japanese regulatory agency to get access to Pfizer’s “biodistribution study.”

Biodistribution studies are used to determine where an injected compound travels in the body, and which tissues or organs it accumulates in.

“It’s the first time ever scientists have been privy to seeing where these messenger RNA [mRNA] vaccines go after vaccination,” Bridle said in an interview with Alex Pierson where he first disclosed the data. “Is it a safe assumption that it stays in the shoulder muscle? The short answer is: absolutely not. It’s very disconcerting.”

The Sars-CoV-2 has a spike protein on its surface. That spike protein is what allows it to infect our bodies, Bridle explained. “That is why we have been using the spike protein in our vaccines,” Bridle said. “The vaccines we’re using get the cells in our bodies to manufacture that protein. If we can mount an immune response against that protein, in theory we could prevent this virus from infecting the body. That is the theory behind the vaccine.”

“However, when studying the severe COVID-19, […] heart problems, lots of problems with the cardiovascular system, bleeding and clotting, are all associated with COVID-19,”  he added. “In doing that research, what has been discovered by the scientific community, the spike protein on its own is almost entirely responsible for the damage to the cardiovascular system, if it gets into circulation.”

When the purified spike protein is injected into the blood of research animals, they experience damage to the cardiovascular system and the protein can cross the blood-brain barrier and cause damage to the brain, Bridle explained.

The biodistribution study obtained by Bridle shows the COVID spike protein gets into the blood where it circulates for several days post-vaccination and then accumulates in organs and tissues including the spleen, bone marrow, the liver, adrenal glands and in “quite high concentrations” in the ovaries.

“We have known for a long time that the spike protein is a pathogenic protein, Bridle said. “It is a toxin. It can cause damage in our body if it gets into circulation.”

A large number of studies have shown the most severe effects of SARS-CoV-2, the virus that causes COVID, such as blood clotting and bleeding, are due to the effects of the spike protein of the virus itself.

A recent study in Clinical and Infectious Diseases led by researchers at Brigham and Women’s Hospital and the Harvard Medical School measured longitudinal plasma samples collected from 13 recipients of the Moderna vaccine 1 and 29 days after the first dose and 1-28 days after the second dose.

Out of these individuals, 11 had detectable levels of SARS-CoV-2 protein in blood plasma as early as one day after the first vaccine dose, including three who had detectable levels of spike protein. A “subunit” protein called S1, part of the spike protein, was also detected.

Spike protein was detected an average of 15 days after the first injection, and one patient had spike protein detectable on day 29 –– one day after a second vaccine dose –– which disappeared two days later.

The results showed S1 antigen production after the initial vaccination can be detected by day one and is present beyond the injection site and the associated regional lymph nodes.

Assuming an average adult blood volume of approximately 5 liters, this corresponds to peak levels of approximately 0.3 micrograms of circulating free antigen for a vaccine designed only to express membrane-anchored antigen.

In a study published in Nature Neuroscience, lab animals injected with purified spike protein into their bloodstream developed cardiovascular problems. The spike protein also crossed the blood-brain barrier and caused damage to the brain.

It was a grave mistake to believe the spike protein would not escape into the blood circulation, according to Bridle. “Now, we have clear-cut evidence that the vaccines that make the cells in our deltoid muscles manufacture this protein — that the vaccine itself, plus the protein — gets into blood circulation,” he said.

Bridle said the scientific community has discovered the spike protein, on its own, is almost entirely responsible for the damage to the cardiovascular system, if it gets into circulation.

Once in circulation, the spike protein can attach to specific ACE2 receptors that are on blood platelets and the cells that line blood vessels, Bridle said. “When that happens it can do one of two things. It can either cause platelets to clump, and that can lead to clotting — that’s exactly why we’ve been seeing clotting disorders associated with these vaccines. It can also lead to bleeding,” he added.

Both clotting and bleeding are associated with vaccine-induced thrombotic thrombocytopenia (VITT). Bridle also said the spike protein in circulation would explain recently reported heart problems in vaccinated teens.

Stephanie Seneff, senior research scientists at Massachusetts Institute of Technology, said it is now clear vaccine content is being delivered to the spleen and the glands, including the ovaries and the adrenal glands, and is being shed into the medium and then eventually reaches the bloodstream causing systemic damage.

“ACE2 receptors are common in the heart and brain,” she added. “And this is how the spike protein causes cardiovascular and cognitive problems.”

Dr. J. Patrick Whelan, a pediatric rheumatologist, warned the U.S. Food and Drug Administration (FDA) in December mRNA vaccines could cause microvascular injury to the brain, heart, liver and kidneys in ways not assessed in safety trials.

In a public submission, Whelan sought to alert the FDA to the potential for vaccines designed to create immunity to the SARS-CoV-2 spike protein to instead cause injuries.

Whelan was concerned the mRNA vaccine technology utilized by Pfizer and Moderna had “the potential to cause microvascular injury (inflammation and small blood clots called microthrombi) to the brain, heart, liver and kidneys in ways that were not assessed in the safety trials.”

Study Finds Teenage Boys Six Times More Likely To Suffer Heart Problems From Vaccine Than Be Hospitalized by COVID

Authors; Paul Joseph Watson via Summit News,

Research conducted by the University of California has found that teenage boys are six times more likely to suffer from heart problems caused by the COVID-19 vaccine than to be hospitalized as a result of COVID-19 itself.

“A team led by Dr Tracy Hoeg at the University of California investigated the rate of cardiac myocarditis – heart inflammation – and chest pain in children aged 12-17 following their second dose of the vaccine,” reports the Telegraph.

“They then compared this with the likelihood of children needing hospital treatment owing to Covid-19, at times of low, moderate and high rates of hospitalisation.”

Researchers found that the risk of heart complications for boys aged 12-15 following the vaccine was 162.2 per million, which was the highest out of all the groups they looked at.

This compares to the risk of a healthy boy being hospitalized as a result of a COVID infection, which is around 26.7 per million, meaning the risk they face from the vaccine is 6.1 times higher.

Even during high risk rates of COVID, such as in January this year, the threat posed by the vaccine is 4.3 times higher, while during low risk rates, the risk of teenage boys suffering a “cardiac adverse event” from the vaccine is a whopping 22.8 times higher.

The research data was based on a study of adverse reactions suffered by teens between January and June this year.

In a sane world, such data should represent the nail in the coffin for the argument that teenagers and children should be mandated to take the coronavirus vaccine, but it obviously won’t.

In the UK, the government is pushing to vaccinate 12-15-year-olds, even without parental consent, despite the Joint Committee on Vaccination and Immunisation (JCVI) advising against it.

Meanwhile, in America, Los Angeles County school officials voted unanimously to mandate COVID shots for all

Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis

PLOS

Abstract

Objective


We aimed to systematically identify the possible risk factors responsible for severe cases.


Methods

We searched PubMed, Embase, Web of science and Cochrane Library for epidemiological studies of confirmed COVID-19, which include information about clinical characteristics and severity of patients’ disease. We analyzed the potential associations between clinical characteristics and severe cases.


Results

We identified a total of 41 eligible studies including 21060 patients with COVID-19. Severe cases were potentially associated with advanced age (Standard Mean Difference (SMD) = 1.73, 95% CI: 1.34–2.12), male gender (Odds Ratio (OR) = 1.51, 95% CI:1.33–1.71), obesity (OR = 1.89, 95% CI: 1.44–2.46), history of smoking (OR = 1.40, 95% CI:1.06–1.85), hypertension (OR = 2.42, 95% CI: 2.03–2.88), diabetes (OR = 2.40, 95% CI: 1.98–2.91), coronary heart disease (OR: 2.87, 95% CI: 2.22–3.71), chronic kidney disease (CKD) (OR = 2.97, 95% CI: 1.63–5.41), cerebrovascular disease (OR = 2.47, 95% CI: 1.54–3.97), chronic obstructive pulmonary disease (COPD) (OR = 2.88, 95% CI: 1.89–4.38), malignancy (OR = 2.60, 95% CI: 2.00–3.40), and chronic liver disease (OR = 1.51, 95% CI: 1.06–2.17). Acute respiratory distress syndrome (ARDS) (OR = 39.59, 95% CI: 19.99–78.41), shock (OR = 21.50, 95% CI: 10.49–44.06) and acute kidney injury (AKI) (OR = 8.84, 95% CI: 4.34–18.00) were most likely to prevent recovery. In summary, patients with severe conditions had a higher rate of comorbidities and complications than patients with non-severe conditions.

Conclusion

Patients who were male, with advanced age, obesity, a history of smoking, hypertension, diabetes, malignancy, coronary heart disease, hypertension, chronic liver disease, COPD, or CKD are more likely to develop severe COVID-19 symptoms. ARDS, shock and AKI were thought to be the main hinderances to recovery.

For More Information: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250602

Histopathological observations in COVID-19: a systematic review

  1. Authors: Vishwajit Deshmukh1, Rohini Motwani, Ashutosh Kumar3, Chiman Kumari4, Khursheed Raza5
  2. Correspondence to Dr Rohini Motwani, Department of Anatomy, ESIC Medical College and Hospital, Sanathnagar, Hyderabad, Telangana, India; rohinimotwani@gmail.com

Abstract

Background Coronavirus disease-2019 (COVID-19) has caused a great global threat to public health. The World Health Organization (WHO) has declared COVID-19 disease as a pandemic, affecting the human respiratory and other body systems, which urgently demands for better understanding of COVID-19 histopathogenesis.

Objective Data on pathological changes in different organs are still scarce, thus we aim to review and summarise the latest histopathological changes in different organs observed after autopsy of COVID-19 cases.

Materials and methods Over the period of 3 months, authors performed vast review of the articles. The search engines included were PubMed, Medline (EBSCO & Ovid), Google Scholar, Science Direct, Scopus and Bio-Medical. Search terms used were ‘Histopathology in COVID-19’, ‘COVID-19’, ‘Pathological changes in different organs in COVID-19’ or ‘SARS-CoV-2’. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines were used for review writing.

Result We identified various articles related to the histopathology of various organs in COVID-19 positive patients. Overall, 45 articles were identified as full articles to be included in our study. Histopathological findings observed are summarised according to the systems involved.

Conclusion Although COVID-19 mainly affects respiratory and immune systems, but other systems like cardiovascular, urinary, gastrointestinal tract, reproductive system, nervous system and integumentary system are not spared, especially in elderly cases and those with comorbidity. This review would help clinicians and researchers to understand the tissue pathology, which can help in better planning of the management and avoiding future risks.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

For More Information: https://jcp.bmj.com/content/74/2/76