“Shared expectations lead to predictability.”

600.  This will be the final edition of the FAQ Column.

         Q:  Why continue this column when Covid-19 is not seen by many as a problem?

         A:  That is a valid criticism!  Covid-19 is no longer in the forefront of people’s minds.  This in spite of public health experts’ concerns over not being prepared for future surges or new mutations.  Also, in spite of the growing concerns over what is called “long-Covid,” the morbidity and mortality that Covid-19 might be causing long after the infectious disease has been resolved.

To wrap up what highlights do exist during the last week of November 2022, the following is offered before we cease publishing routine weekly updates:

• Updated vaccinations and booster shots are the most effective way to stay safe from contracting Covid-19 and long covid consequences. Have you individually had all your recommended shots?
• The political hesitancy over Covid vaccinations has created a reduction of many to get other vaccinations. Fewer numbers of people are getting their flu shots this year than before.  The prevalence and number of seriously ill flu patients this year is very high.  Have you individually had your flu shot this year?  Did you know that Covid-19 and flu shots can be taken at the same time?
• The CDC recently did another study highlighting the risk of contracting one of 14 different long-Covid chronic conditions up to two years after infectious Covid-19 has been resolved.
  • Of the patients ages 18-64 who have recovered from Covid-19, 35.4% have come down with one or more of these chronic conditions. For those over age 64, 45.4% have displayed long-Covid.
  • The most common condition is fatigue (84%) and the least common is breathing difficulties (42%).
  • While most of these conditions eventually disappear, many don’t and become lifetime chronic conditions.
  • Some of these Covid-related conditions have first emerged after a delay of months and years.
• Researchers are now finding evidence that many of these chronic conditions can be considered correlated with Covid-19, and early treatment can be important in resolving the conditions earlier.
  • The October 2022 issue of Consumer Reports magazine identifies many specialists one can turn to for managing some of these post-Covid conditions in their early stages.
  • The same magazine also identifies there are post-covid clinics becoming available for multi-specialty treatment of multiple condition.
  • There are many such specialized clinics in Connecticut. However, each requires a referral from your primary care physician.  Many people who do not have a primary care physician currently are having trouble finding one.  The Hartford HealthCare System, for one, has a center to call to find and quickly book an appointment for an available primary care physician.  Other healthcare systems may have similar resources available.
• China has begun releasing the public from severe restrictions as part of its “Zero Covid Policy.” But large outbreaks have occurred slowing their “return to normal.”  Many experts feel this is due to a lack of natural immunity from large numbers recovering from the disease.  This makes the remaining population highly vulnerable for future outbreaks.  The economic impact probably will continue long into the future.
• Many experts predict that in the coming months there will be another surge of Covid-19 cases. And many also agree the currently available preparations are not adequate to overcome the public’s perceptions that all is well.  It is anticipated that further restrictions will be hard if not impossible to be publicly acceptable.
• More federal funding is needed to continue to provide at no cost to the public the vaccines, therapeutics, patient care and research into long-Covid. Because of the Republican control of Congress after January 1, 2023. The lame duck Congress is now striving to approve the $9.25 billion needed.  Also at risk is the restocking of the National Strategic Stockpile with personal protective equipment (gowns, gloves and masks) and other supplies to quickly respond to any future public health emergency.
• Finally, going forward, always keep your Covid and influenza shots up to date.

 

 

 

 

 

 

 

“Shared expectations lead to predictability.”

599. Rapid changes in research and science have created public health confusion.

         Q:  Why is guidance about what to do to prevent getting Covid-19 so confusing?

         A:  In an opinion article in last Sunday’s Hartford Courant, two epidemiologists at the University of Connecticut School of Medicine were quoted as saying, “Over the past two years of the Covid-19 pandemic, the recommendations from the US Centers for Disease Control and Prevention (CDC) have changed frequently.  These changes have resulted in 60% of Americans feeling ‘confused,’ and 56% feeling less confident in public health officials’ recommendations as a result.”  Hank Weinstock, MPH, and David Banach, MD, MPH recommend that the CDC should consider measuring wastewater for the presence of the Covid-19 virus as the more reliable method of surveillance.

It is true that the CDC has changed its guidance over the course of the disease.  An example is the traditional public health measure of calculating the positive rate of Covid tests given to predict the risk of future infections in a given population.  The World Health Organization had established an international standard that if a given number of tests given daily shows an increasing percentage of positive tests reaching 5%, restrictive measures such as masking should be imposed.  And then science developed the take-home testing capability.  Over the past year, tens of thousands of people using these tests found they were positive and sought medical care.  None of these home test results were centrally recorded, so a positive test ratio could not be determined.  The more reliable PCR laboratory tests were given, but not to everyone.  So, the percent positive of these tests was not useful as an assessment of risk.  The positive test ratio disappeared.

One of the new CDC guidelines that replaced it was to evaluate how the number of Covid-19 patients filled local hospital bed capacity.  The authors correctly point out that this measure is heavily influenced by the larger number of beds in major medical centers instead of the concentration of Covid patients in the adjacent communities.

The recommendation they offer – surveillance of wastewater to assess risk – suffers from similar characteristics, the complexity of the disease and the technology that surrounds it.  While measuring wastewater is a valid measure of future risk in communities that have centralized wastewater management, this cannot become a national CDC standard for everyone.  It would not be feasible to periodically sample and evaluate wastewater in thousands of individual septic tanks.

The conflict appears to remain with us, at least for a while – the need for simple answers to complex problems as defined by improving technology.

“Shared expectations lead to predictability.”

598.  A conflict in grant funding is slowing school ventilation improvements in CT.

         Q:  Why aren’t more schools improving their ventilation systems?  Isn’t there any funding?

         A:  We at UUS:E easily remember the months spent after the Covid-19 surge had climbed back down from last winter’s surge as we defined and decided to complete the temporary modifications to our Heating, Ventilation and Air Conditioning (HVAC) system.  Many indoor venues including restaurants, schools and churches have ventilation systems that only circulate indoor air around within a room.  Modifications that bring outdoor air into the system, exhausting some of the indoor air to the outside, help to reduce the concentration of Covid-19 virions available to infect new patients.

In a recent Hartford Courant article, reporter Alison Cross explained how a bureaucratic snafu is now preventing schools in Connecticut from beginning to improve their HVAC systems to make them safer, preventing contagious infections among students and staff.  Governor Lamont announced the “Connecticut Public Schools HVAC Indoor Air Quality Grant Program” in September.  This program made $150 million available in public school grants with a deadline to apply for individual project support by December 1.  These grants, authorized by the state legislature, require local matching funds to be allocated.

In the meantime, the U. S. American Rescue Plan Act has also made available federal funding for local communities to improve school ventilation systems.  Several state-wide community organizations including The Connecticut Conference of Municipalities, the Connecticut Association of Public School Superintendents, and the Connecticut Association of Boards of Education have issued a joint statement advocating for the repeal of the restriction in the state program that prohibits the use of federal funds to support the state funding for these projects.

It has taken a long time for many school officials to recognize the priority value of improving their HVAC systems.  With a late start for many, it has required lengthy discussions to plan for individual school redesign specifications leading to accurate cost estimates.  And for those districts that are ready, requiring local funds for this HVAC program may just not be available.  At the very least, state officials are urged to postpone the deadline allowing for more meaningful planning to implement the program properly.  The Connecticut Conference of Municipalities executive director and CEO Joe DeLong stated his concern, saying that when talks of a grant program for HVAC was starting, there was no consideration of any restrictions for matching funds.  “If you don’t have enough grant applications that come in to utilize all the funds, it could be perceived that the need isn’t as great as people thought,” DeLong said.  “That’s certainly not the case.  We know there’s a tremendous need.”

“Shared expectations lead to predictability.”

597.  The first anticipated new method of being vaccinated is now used in China.

         Q:  Many people hate getting vaccinated with a shot.  Is there another way?

         A:  China has one of the strictest regimens in place attempting to eliminate the Covid-19 pandemic.  But not unlike in other countries, many Chinese citizens resist getting injections and being compliant with government rules.  For what may be the first international example of an alternative to providing injected Covid vaccines, the Chinese city of Shanghai last week began to offer booster vaccines by inhalation.  Vaccinations are administered by breathing in the vaporized medication through the mouth.  Scientists and government officials hope to prove that vaccines that are inhaled will be more effective in areas with fragile health care systems and where people are unwilling to get shots in their arms.  The public health goal in China is to get a greater percentage of the population protected with booster doses before they relax their strict and cumbersome restrictions in place throughout the pandemic.

The one-shot vaccine used in China was developed by CanSino Biologics, Inc., China’s bio-pharmaceutical company.  This product is also distributed for use in Hungary, Pakistan, Malaysia, Argentina, and Mexico.  Regulators in India have approved a nasal vaccine, but this has not yet been distributed for use.  Many other nasal or vaporized vaccines are currently being tested, and in the future this method will probably be commonly available.

“Shared expectations lead to predictability.”

595.  The number of people getting booster shots is not adequate to prevent a surge.

         Q:  Are the booster shots working to get rid of Covid?

         A:  The data base Covid Act Now shows that less than half of the people eligible to receive the latest bivalent booster shots have done so.  This data shows that 95.0% of Connecticut citizens have received only one vaccine shot, while 81.8% have taken both of their Pfizer or Moderna shots or their single Johnson and Johnson shot.  This contrasts with only 44.3% of those eligible having had a booster shot.

In an article in the Saturday, October 22 issue of the Manchester CT newspaper Journal Inquirer, Eric Bednar pointed out that this is now happening “as cases once again surge in Europe and Asia setting up a potential spike in the United States in the wake 0f the upcoming holiday travel season and the pending flu season,”

The newest booster shot has been created to focus on reducing new infections from the Omega variants, but also to lessen the disease from developing more serious outcomes.

Have you received your up-to-date booster shot?

596.  New Covid-19 variants are coming.

         Q:  Are there new mutations of Covid on the horizon that could cause a surge here?

         A:  Jonathan Wolfe last week published an article in the New York Times addressing the emergence of this anticipated problem.  Several new Omicron subvariants have been steadily gaining ground in the U.S., setting off alarm bells ahead of fall and winter.  These variants include BQ.1 and BQ.1.1, which currently account for 11 percent of cases in the U.S., up from about 3 percent two weeks ago. Other Omicron offshoots are also growing steadily, including BA.4.6, BF.7 and XBB, which has been spreading quickly within in Singapore.

All these variants are new versions of Omicron, which initially showed up here almost a year ago.  Some of these mutations are actually able to get around the immunity that people may have received from being infected by the previous varieties of coronavirus.

Many people have decided for themselves that the pandemic is over, resulting in a lot less wearing of masks. On top of that, the immunity that people may have is waning over time.

Importantly, there’s no evidence that these new variants cause more severe disease. But the Omicron surge last winter showed us that if a so-called mild variant infects a huge number of people, hospitalizations surge. On the other hand, if there were a totally new variant that came out that could raise people’s odds of ending up in the hospital and of dying, that would be a lot worse.

It’s important that people get vaccinated. And if they haven’t gotten their booster shots, they need to do so as soon as they can.

 

 

 

“Shared expectations lead to predictability.”

 593.  The U.S. has extended its Covid-19 state of emergency another 90 days.

          Q:  Is federal money still available to help pay for the care of patients with Covid-19?

          A:  Kanishka Singh has reported in Reuters News last week that the United States has extended the COVID-19 pandemic’s status as a public health emergency for another 90 days, thereby preserving measures like high payments to hospitals and expanded Medicaid.  The extension was announced by U.S. Health Secretary Xavier Becerra.

The toll of the COVID-19 pandemic has diminished significantly since early in Biden’s term when more than 3,000 Americans per day were dying, and as enhanced care, medications and vaccinations have become more widely available.  But hundreds of people a day continue to die from the coronavirus in the United States, according to the U.S. Centers for Disease Control and Prevention.

Biden has asked Congress for $22.4 billion more in funding to prepare for a potential case surge.

594.  The number of Covid-19 cases is rising in Europe, as demonstrated in England.

         Q:  Is there a surge of new Covid-19 cases anywhere in the world?

         A:  Several western European countries are reporting an increase in new cases.  The Guardian newspaper has reported a rise in level across most of the UK with 1.7 million people recently infected.  In England, about one in 35 people – 2.8% of the population – had Covid in the week ending October 3, according to the Office of National Statistics.  This incidence of Covid-19 cases was a 31% increase over that of a week earlier.

In England, increases in infection levels were recorded for all regions except the northeast in the most recent week, and for all age groups except those aged two years to school year 11 (aged 15-16). The highest levels of infection were seen for people aged 70 and over, with about 3.7% of this age group having had Covid in the most recent week.

Sarah Crofts, the deputy director for the Covid-19 Infection Survey, described the rise in infections amongst older age groups in England and Wales as “notable.”

However, National Health Service data suggests the rate of increase in Covid hospital admissions has slowed. In the seven days from 4-10 October there were 8,198 admissions, a 4% rise from 7,904 the week before.

The latest wave of infections appears in part to be caused by the BA.5 sub-variant of Omicron, and early relatives, including BA.5.2. However, new forms of Covid are emerging from BA.5 with some already making up a sizeable proportion of infections. As a result, experts have warned this winter is likely to involve a range of variants, akin to an “Omicron soup.”

Professor John Edmunds, an epidemiologist at the London School of Hygiene and Tropical Medicine, said genomic surveillance was expensive and had been scaled back significantly, but it appeared some sub-variants were increasing faster than BA.5, while the increase of BA.5 in its many forms was of interest.

While some have said the current wave could be worse than the last, Edmunds suggested the dominance of BA.5 meant there was cause for optimism.  “My tentative guess would be that this BA.5 second wave will not be very large, as the decline in population immunity since the BA.5 peak in July is likely to be relatively modest,” he said.

 

“Shared expectations lead to predictability.”

591.  China is not living with “Covid,” but living with “zero Covid.”

         Q:  Is the whole world dealing with Covid-19 like we are?

         A:  Since the initial onset of Covid-19 in China, the national government has dictated it will manage the disease by totally eliminating it.  They have imposed a “zero Covid policy.”

The pandemic has generally allowed changing of former rituals around the world, but in China, the continuation of their extreme measures makes a stark contrast.

Vaccinations are available and required.  But the effectiveness of the Chinese vaccine is far lower than the shots given in the U.S.  China under “zero Covid” is a web of digital codes. At the entrance to every public space — restaurants, apartment complexes, even public restrooms — is a printed-out QR code that people must scan with their phones to log their visit.  Everyone also has a personal health code, which displays test results and location history to assign a color. Green is good. Yellow is denied entry to a public space, or red when you may be sent to quarantine.

Testing is mandatory.  One test daily if you leave your residence, and repeated testing each time you enter specified buildings and areas.  Testing sites are ample, since the government has ordered they be within a 15-minute walk in cities. They usually have a line, which can grow to be blocks long during lunchtime or after work. On hot days, people wait sometimes for 30 minutes, face masks plastered to their skin by sweat.

There are “temporary quarantine areas” where anyone deemed a potential health risk while in public can be deposited until medical care arrives.  Some of these are roped off areas on sidewalks.

When a person is tested and found to be yellow – restricted from entering a designated public space or store – or red – infected – they are taken to a secured location where they are held without the ability to leave for days.  If enough residents in a city block are found to test red, the entire block is declared to be in lockdown.  All residents are quarantined, and fencing is placed around the buildings to prevent anyone from leaving.  Most people routinely buy groceries to store at home in quantity.  They are now prepared for when their lodgings might be suddenly declared to be in lockdown.

The economic effects of the restrictions have been harder to ignore. People caught in several lockdowns can make them unable to work for weeks. Jobs are scarcer anyway, as fewer people were buying products or clothing.

Reports have been published identifying that most people find impossible to get used to is the pervasive, and utter arbitrariness. You’re under lockdown, until someone decides you’re not.  You can take all the required tests, and be perfectly healthy, but your health code can still turn yellow.  For many Chinese, the past few years of the pandemic have stirred the spectrum of emotions from anger to frustration to grief. But the first word many people reach for, when asked how they feel, is “helplessness.”

The epidemiology of this infectious disease leads to the conclusion that when the world-wide pandemic is finally controlled, one area will remain with the greatest number of people without immunity – China.  By eliminating the disease, the population of China will remain highly vulnerable – unless these draconian measures continue.

592.  While Covid-19 is allegedly controlled, long-covid remains as a pandemic.

         Q:  If Covid-19 is under control, what’s all the fuss over long-Covid all about?

         A:  The consensus of many experts is that once the prevalence of the initial Covid-19 infections was being reduced by vaccinations, the population began to react to its fatigue over the many preventive restrictions imposed and demanded a “return to normalcy.”  Long-Covid conditions are often separated by time from when symptoms of Covid-19 emerged.  Long-covid physical signs and symptoms are dissimilar from those of Covid-19 and from other people with different conditions.  This leads to the consideration by the public they are different illness not caused by the same coronavirus agent.

Currently in the U.S., for people aged 65 and over, 92.6% have completed their initial vaccination series   But for this same group, only 45.2% have received at least two of their available booster shots.  After the vaccination program began, the percentage of people in this same age group who have died from Covid has risen by more than 5-fold.

A recent opinion article published by Bloomberg News has addressed this situation by considering Covid-19 and long-Covid as being parallel diseases.  (This article was reprinted in the October 5, 2022 issue of the Hartford Courant.)   The editorial posits that while Covid-19 is considered under control, long-Covid is still a pandemic.  “Even with good vaccinations and treatments, this year’s U.S. death toll is already many orders of magnitude higher than that of the other virus that circulates each year, the flu.” The editorial states that even if this winter’s surge is controlled and fewer people contract Covid-19 than last year, at the current death rate, “another 150,000 lives could be lost over the next 12 months.

As clearly stated by the Bloomberg editorial board: “The federal government needs to be considering how to end the emergency phase of the Covid-19 pandemic without putting solutions for long-Covid further out of reach.”  The roadblock to this happening is the strategy deeply opposed by most people – keeping vaccinations and booster shots up to date.

“Shared expectations lead to predictability.”

590.  “Brain fog” is a disabling and not well understood long-COVID condition.

         Q:  What, exactly, is “brain fog”?

         A:  Long-COVID continues to dominate the current reports on research of COVID-19.  Among the more common conditions being discussed are neurological conditions, including severe headaches and “brain fog.”  In a recent article published by National Geographic, long-COVID headaches are contrasted with migraine attacks.  One author stated, “if migraine headaches can be rated as “9 out of 10 in severity, many people have long-COVID headaches that are “20 out of 10.”  In other words, these can become totally debilitating.  Research is underway exploring the changes in the vascular, chemical, and neurologic changes COVID-19 causes leading to this resulting condition.

Ed Yong is a staff writer at The Atlantic.  He won the Pulitzer Prize for Explanatory Reporting for his coverage of the COVID-19 pandemic. On September 22, he published an article entitled,”One of Long-COVID’s Worst Symptoms Is Also Its Most Misunderstood.”  He explained that “brain fog isn’t like a hangover or depression. It’s a disorder of executive function that makes basic cognitive tasks absurdly hard.”  Executive functions are the set of mental abilities that includes focusing attention, holding information in mind, and blocking out distractions. These skills are so foundational that when they crumble, much of a person’s cognitive edifice collapses. Anything involving concentration, multitasking, and planning—that is, almost everything important—becomes absurdly difficult.

Brain fog is by far one of the most disabling and destructive of long-COVID conditions.  Ed states, “It’s also among the most misunderstood.  From 20% to 30% of patients report brain fog three months after their initial infection, as do 65% to 85% of the long-haulers who stay sick for much longer. It can afflict people who were never ill enough to need a ventilator – or any hospital care.  And it can affect young people in the prime of their mental lives.”

Several examples are cited when health workers with brain fog seek care for themselves.  They find that physicians – even those who have treated COVID-19 patients – often fail to recognize this condition.  Patients are diagnosed as having clouded thinking like that which accompanies hangovers, stress, or fatigue.  But, in reality, brain fog involves real changes to the structure and chemistry of the brain. It is definitely not a mood disorder.

In some severe cases, people have to stop driving – suddenly, they can’t remember where they were going.  One case was cited where a woman couldn’t unload her dishwasher because she couldn’t associate the objects inside with where to place them in the cupboard.

Memory suffers, too, but in a different way from degenerative conditions like Alzheimer’s. The memories are there, but with executive function malfunctioning, the brain can neither choose the important things to store nor retrieve that information efficiently.

Most people with brain fog are not so severely affected and gradually improve with time. But even when people recover enough to return to work, they can struggle with minds that are less nimble than before.

The same constellation of problems in the brain also befalls many people living with HIV, after seizures from epilepsy, after seizures, cancer patients experiencing so-called “chemo brain,” and people with several complex chronic illnesses such as fibromyalgia. It’s part of the diagnostic criteria for myalgic encephalomyelitis, also known as chronic fatigue syndrome, or ME/CFS.  Brain fog existed well before COVID, affecting many people whose conditions were often stigmatized, dismissed, or neglected.  But with the large number of cases associated with COVID-19, scientists are now encouraged and focusing on researching this condition seeking its characteristics, its cause, and perhaps its cure.

At UUS:E President Peggy Webbe’s request, Jim Adams prepared the following summary of the Meetinghouse ventilation status. He expressed his willingness to discuss this issue further with interested persons …

The UUS:E Building & Grounds committee (B&G) has implemented various measures to improve the indoor air quality within the Meetinghouse. These measures help to reduce the risk of COVID-19 transmission through a combination of fresh air (ventilation, best choice) and filtration (air purifiers, acceptable alternative). Note that these measures, while providing significant improvements do not eliminate the virus transmission risk inherent with indoor spaces. Also, any such measures can never make the air quality equivalent to being outside.

Transmission of viruses, like COVID-19, is inherently higher risk in an enclosed space or building where the exhaled breath of an infectious person can be transported in the air and remain aloft for hours. Bringing fresh outdoor air into a room (ventilation) can dilute and/or displace any present airborne virus, reducing the risk of infecting others. Where increased ventilation is not possible, the use of HEPA air purifiers is an alternative means of removing the virus from the air. None of these measures completely eliminate the viral risk.

Experts agree that improved air quality should be incorporated as part of a layered defense against COVID-19. It is recommended that this be done using outside air ventilation and/or air purification, targeting a combined 4 – 6 air changes per hour (ACH) though a combination of these approaches. ACH is a simplified way of quantifying the amount of ventilation or filtration flow relative to the size of the space involved. For example, if your ventilation systems flows 4000 cubic feet of fresh air per hour into a 1000 cubic foot room, that equates to 4 ACH (4000/1000). However, due to the mixing involved during that hour, this does not mean that all air in the room is replaced 4 times per hour. In fact, due to mixing, it would take approximately 45 minutes to replace 90% of the room air with a flow level of 4 ACH. As and mentioned previously, these levels of air flow can never make an indoor space equal to outdoors, where air replacement around a person(s) occurs within seconds with even the slightest breeze.

A major component of the air quality improvements is provided by existing features of the building heating and air conditioning (HVAC) system. The HVAC system includes 3 heat recovery ventilators (HRV) which introduce fresh air into the building when required. Up to now, these HRVs were controlled by wall mounted CO2 sensors, and only provided fresh air when enough people were present in a space to bring the CO2 levels up to uncomfortable levels (which was rarely the case). B&G recently made changes to the HVAC control system (aka “new thermostats”) to allow the HRVs to now be used on demand. A large HRV now provides 4 ACH of fresh air to the sanctuary, and the 2 smaller HRVs provide 1 ACH of fresh air to the remaining common spaces and offices upstairs, and all areas on the Garden Level except for the classrooms. To achieve the target 4 ACH in these common spaces and offices, air purifiers with the required flow have been put in place throughout the building. All bathrooms utilize motion detector actuated vent fans for these low occupancy spaces.

The RE classrooms all have their own wall mounted HVAC unit, which provide heating and cooling. However, they unfortunately do not have any fresh air capability. Therefore, each classroom space has been provided with special ventilation window fans which provide at least 4 ACH of fresh air for these spaces, year-round. Testing was conducted by B&G to confirm the fans provide the required 4 ACH, and that the HVAC units are able to maintain comfortable temperatures in the room during winter.

For all of the improvements to work, they must be turned on properly when spaces are occupied. Instructions have been placed above each thermostat describing how to turn on the HRV ventilators, and instructions are in each classroom describing how to utilize the window fans. Air purifiers should be turned on manually when people are present for significant time in the other spaces.

 

“Shared expectations lead to predictability.”

589. Australian studies show a variety of immunity factors may link to long-covid.

         Q:  Is immunity a factor for those who contract long-covid syndromes?

         A:  A continuing worldwide concern continues over Covid-19 as we try to learn more about the causes and manifestations of long-Covid.  Long-Covid is the continuing chronic presence of debilitating illness affecting a variety of different organ systems in the body.   It doesn’t affect everyone who is infected by the Covid-19 virus, but some authorities have estimated that as many as 1 person will develop long covid in every group of 20 who were infected.  A recent report out of Australia looked at how Covid-19 affects the immune system.  The Australian affiliate of the ABC network reported that when you catch a virus, there will be one of three outcomes:

1. Your immune system clears the infection and you recover (for instance, with rhinovirus, which causes the common cold.)
2. Your immune system fights the virus into “latency,” and you recover with a virus dormant in your body (for instance with the virus that causes chickenpox, that later can emerge as causing shingles.
3. Your immune system fights, and despite best efforts the virus remains “chronic,” replicating at very low levels.  This can occur for the hepatitis C virus.

But international evidence suggests changes to our immune cells after Covid-19 infections may have other impacts. It may affect our ability to fight other viruses, as well as other pathogens, such as bacteria or fungi.

Research in Australia has found Covid-19 alters the balance of immune cells up to 24 weeks after clearing the infection.  There were changes to the relative numbers and types of immune cells between people who had recovered from Covid compared with healthy people who had not been infected.

Another study focused specifically on dendritic cells — the immune cells that are often considered the body’s “first line of defense.” Researchers found fewer of these cells circulating after people recovered from Covid. The ones that remained were less able to activate white blood cells known as T-cells, a critical step in activating anti-viral immunity.

Other studies have found different impacts on T-cells and other types of white blood cells known as B-cells (cells involved in producing antibodies).

After Covid-19 infections were cleared, one study found evidence many of these immunity cells had been activated and “exhausted.” This suggests the cells are dysfunctional and might not be able to adequately fight a subsequent infection. In other words, sustained activation of these immune cells after an infection may have an impact on other inflammatory diseases.

One study found people who had recovered from Covid-19 have changes in different types of B-cells. This included changes in the cells’ metabolism, which may impact how these cells function. Given B-cells are critical for producing antibodies, we’re not quite sure of the precise implications.

Having a healthy immune system and being vaccinated are critically important to have the best chance of fighting any infection, according to the CDC.

What impact will these changes have?  One of the main concerns is whether such changes may impact how the immune system responds to other infections, or whether these changes might cause or worsen other chronic conditions.

It is reassuring to know that scientists are working on a better understanding of long-Covid syndromes.  It is concerning to know how complicated the causes between a viral infection and the possible subsequent emergence of different chronic conditions.  It is also frustrating not being able to link the causation between Covid-19 and the subsequent possible development of chronic conditions.  A person diagnosed with diabetes weeks or months after recovering from Covid-19 can easily assume these two events are not related.

In the absence of scientific evidence, most experts advise continuing caution when gathering in groups (masks, social distancing and ventilation), The popular feeling of security may not actually be representing reality by failing to recognize the possibility of long-Covid.