Why COVID-19 Lingers

A top World Health Organization official is backpedaling on her comments over the role asymptomatic carriers play in spreading COVID nineteen. Maria van Kirkhove said on Monday that asymptomatic transmission of coronavirus is very rare. That comment revived a controversy over how the virus spreads. Today, she says she was referring specifically to two or three studies. New York City reached

a milestone today. It reported just one percent of its residents tested positive for the coronavirus for the first time since the beginning of the outbreak. The city had reached a high of seventy one testing positive in April. The city is now conducting more than thirty thousand tests a day, and much of the world continues to open up. The Eiffel Tower in Paris will reopen following its longest shutdown

since World War Two. France also unveiled a massive rescue plan for its struggling aerospace industry, and the European Union is considering a leader summit to discuss measures for speeding up a recovery. The United Nations says that the pandemic, combined with a global recession, is contributing to a worldwide food emergency. The organization released a policy brief that says these factors could set the stage for a health and nutrition crisis on a scale not seen for decades and

now our main story. Many survivors of coronavirus report feeling unwell weeks after they've supposedly beat the infection. That's raised questions about the long term consequences of COVID nineteen. Never in the modern scientific era have so many people been infected with this same virus in such a short period of time. As Bloomberg Senior editor Jason Gale reports, that could actually sent a unique opportunity to discover strategies for

preventing post COVID illness in the future. Anyone who's had shingles knows about the lasting effects of chicken pox. Many infections can cause secondary diseases. We only need to look at the rare multi system inflammatory syndrome reported around the world in children to see that the coronavirus can trigger some subsequent complications, some of them lethal. With millions of people afflicted by COVID nineteen, survivors and their doctors are

wondering what other persistent effects this illness might have. It's an important question, not just because of the sheer volume of people afflicted, but also because of the likelihood that many sufferers could be left with permanent damage to their lungs and other vital organs, requiring costly long term medical care and support. So, you know, we've taught for a long time that once you have and then you're done with it, that would be yet you know. This is

Dr RV. Nath. He's a physician scientist with the National Institutes of Health in Bethesda, Maryland, vous clinical director of the Institute of Neurological Disorders and Stroke and heads the section that looks at infections of the nervous system, tells of the patients now complaining of the fact that they have persistent symptoms that fewer goes away, and you know all the other symptoms, the carf and other things that now they're developing other those kinds of symptoms. The lingering

symptoms that COVID patients experience are fairly broad. V is interested in brain fog, malays tiredness symptoms reminiscent of myalgic encephalomyelitis or chronic fatigue syndrome, which he says is linked with a lot of viral infections. COVID, though has also been associated with some other neurological complications, including strokes as

well as brain bleeds and inflammation. These things are happening later in the course of the infection, suggesting that there's an immune component to it, so you know, the virus goes down and the immune system gets hyperactive, and it can cause a variety of different types of neurological symptoms. As unfortunate as these rare problems are obvious, says, they represent an opportunity to learn how and why these post viral syndromes occur their biological pathways, so that we might

be able to prevent them. For example, biological samples taken from patients at the start of their illness may reveal evidence of key aspects of the disease process, and oftentimes they by the time you see the patient, you don't really know what infection they had, and the virus has never figured out, and and it's too late to figure out what virus they have. Now that's not an excuse any longer. You know exactly what virus caused that, and you know exactly what the syndrome is, and you know

exactly what happened in between. So I think it's an unfortunate situation, but you can use it to get an advantage to try and understand these diseases that we haven't been able to for a long, long long time. Obviously, he and other scientists are preparing studies to understand what's different about the minority of people who don't recover normally

from their coronavirus infection. I haven't had the infection for long enough for us to know how long these things are going to persist, and sometimes it takes people a month or two to recover from it. Everybody's a little bit different. However, we are concerned that some of them may have plowing symptoms. The NAH has several research teams trying to unlock the secrets of these post viral illnesses. Another doctor I spoke with is investigating what's termed the

natural history of infection in dozens of COVID patients. My name is Anthony Superdidy. I'm a critical care physician. I work in the Critical Care Medicine department at the Clinical Center, which is the research hospital associated with the National Institutes of Health. Anthony began enrolling patients last week in a study that aims to follow patients for a year to track the impact it's had on their heart, lungs, and kidneys.

Uh the The study is composed of two cohorts patients who are acutely ill who would be followed from the time of the onset of their symptoms into out to one year, and then we will be getting patients from who have been treated at the outside hospitals who would be enrolled after their acute illness and to see again the consequences in terms of their cardiac their pulmonary function as well as their their their kidney function renal functions.

The participants are going to be given a thorough work up. Tests will include m RIS, ultrasounds and different types of CT scans on multiple organs. The images and blood and urine tests will be taken at various time points to track the progression of changes. Our hope is to get the m r S at least at three different time points.

One would be at the time of study entry, and that's across the board with people that are our patients who would be you know, relatively low symptom o asymptomatic or low symptom mode to those that are going to be hospitalized, and then we would get them at the recovery phase after they've cleared their virus and have improved, and then we would get them at convalescence in terms

of eight weeks to twelve months. Anthony will be comparing the results across a spectrum of COVID patients and we're really trying to enroll not just the critically ill patients. Were very interested and also the the young person who might have an infection. They lose their sense of smell and taste, they have a fever, they feel kind of like they've had a bad flu, and they get better. So those people are very interesting to look at simply

because what are the consequences, how do they get better? Uh, and how does that differ from from someone in a similar age group who doesn't get better and who deteriorates and requires an IC you admission. Doctors also need to disentangle the causes because they might be the direct result of the virus, the body's a immune response to it, and it could be the result of the treatment patients received.

One of the things that becomes complicated. However, there's many things we do in critical care that affect neurocognitive function, muscular recovery, even as things as simple as getting back to your work. A study in Canada that followed patients with a life threatening lung injury known as acute respiratory distress syndrome now many patients were suffering neurocognitive problems and

trouble sleeping a year later. Anthony says that might be a result of the type of sedatives sometimes you use so that patients will tolerate the intubation required for mechanical ventilation. We use benzo diazepines and they're very good on one hand. On the other hand, the recent data that has come out would suggest that that's associated with post traumatic stress disorder, among other things and so on. In the context of that,

many people try to avoid those drugs. However, if you if you looked at around the world right now, when people are really, really sick and they're really trying to make sure their loans don't get injured further with not just the information from the from the COVID, but from the from the support measures we used in terms of how we ventilate them on the mechanical ventilator UM, they're often pushed to the UH, to the situation where they have to use almost everything to keep the person sedated

to be able to tolerate the UH less injurious UH modalities of mechanical ventilation. So we're kind of stuck in a situation where we we may not have even defined the best ways of supporting people right now. Fortunately, there is a vast amount of research being published each week, much of it is informing ways to improve patient care. The other good news is that awareness of the secondary

effects of the coronavirus is growing. As a Vanette says, people should know that if they have persistent symptoms, they're not crazy. There may well be thing biologically wrong and that they should see a doctor about them. Identifying such medical concerns in real time could help solve the mystery of these post viral illnesses, prevent them in the future, and find better treatments for those who suffer from them, including post COVID nineteen patients. That was Jason Gale, and

that's our show today. For coverage of the outbreak from one bureaus around the world, visit Bloomberg dot com slash coronavirus and if you like the show, please leave us a review and a rating on Apple Podcasts or Spotify. It's the best way to help more listeners find our global reporting. The Prognosis Daily edition is produced by over foreheads Jordan Gaspore, Magnus Hendrickson and me Laura Carlson. Today's main story was reported by Jason Gale. Original music by

Leo Sidrin. Our editors are Francesca Levi and Rick Shine. Francesco Levi is Bloomberg's head of podcasts. Thanks for listening.