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Cardiovascular MRI in Patients Recently Recovered from Covid-19 (jamanetwork.com)
83 points by pama 49 days ago | hide | past | favorite | 50 comments

I’ve never understood why the long term effects of Covid-19 have seemingly been ignored by the people who say this isn’t a big deal, deaths aren’t significant, and it mostly effects old people.

Normal flu can cause long term cardiovascular effects in some people and Swine flu even more so. Given the severity of the effects of Covid-19 on peoples lungs, serious long term seems likely.

There's a large group of people in the US especially who believe (perhaps subconsciously) that saying something loudly enough can make it be true.

It's millions of people who literally believe they can ignore the virus away.


At least for me and many people I've talked to, it's less about ignoring, but more about how to deal with it in a feasible manner. This includes taking into account economic affects, long term feasibility, effectiveness of lockdowns, government overreach, and media fear mongering.

Daily deaths have been very low in Sweden since July 11. No more 2 more weeks.



Just for perspective Sweden has 5000 deaths, Norway 255, Denmark 615 and Finland 329. Adjusted for population, the Swedish death rate is higher than the USA. It is not a poster child for success.

Agree that at the moment Sweden seems to have done the wrong thing compared to its neighbours, Norway, Denmark, etc. However Anders Tegnell's strategy was to aim for the best long term outcome, not necessarily minimizing deaths in the short term.

Sweden, a country of 10.1 million people, in which annual all-cause mortality is around 93,000, is currently reporting a total of 5,743 "COVID-19 deaths" (using a very broad counting standard whereby anyone who dies within 30 days of a COVID-19 diagnosis is counted as a "COVID-19 death," irrespective of the actual cause of death). Of those 5,743 "COVID-19 deaths":

Almost 90% (89.1%) were over the age of 70 Over two-thirds (67.6%) were over the age of 80 Only 71 deaths (1.2%) were under the age of 50 Only 1 death was under the age of 20 [1]

In the US, around 80.3% of deaths have been individuals aged 65 or older whereas in Sweden, around 89.1% of deaths have been individuals aged 70 or older. [1]

In the US, only around 2.64% of deaths have been individuals under age 45 whereas in Sweden only around 1.26% of deaths have been individuals under age 50. [3]

Sweden is currently reporting an overall death rate of 556 deaths / 1 M population which is higher than the current US figure of 433 deaths / 1 M population. But Sweden's population is older. Around 20% of Swedes are 65+ versus only around 15% for the US. The size of a country's 65+ population is a reasonable proxy for the size of its vulnerable population in view of the fact that the vast majority of deaths have come from individuals 65 or older. If we calculate total deaths (any age) / 1M 65+ population for both countries, we get 2886 for the US vs. 2780 for Sweden. Sweden's death rate / elderly population is actually lower than than that of the US, and the US should only be expected to fall further behind in this metric as time passes in view of the fact that Sweden is further along its curve than the US.

[1] - https://www.statista.com/statistics/1107913/number-of-corona...

[3] - https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-...

You’re focusing exclusively on deaths, which is only proving the parent’s point. What about all the people who don’t die, but sustain chronic, potentially permanent damage as a result? Economies recover, but it’s less clear whether organs affected by COVID-19 do the same.

There are widespread reports indicating that surviving COVID-19 doesn’t mean you’re in the clear, regardless of your age. Yet a significant number of people continue to focus exclusively on death rate.

To reiterate the parent’s question: why are you, personally, focused exclusively on the death rate? Presumably, you’re young, and your risk of dying from COVID-19 is low. Why aren’t you more concerned about non-fatal but irreversible damage to your body, since that’s a more likely outcome for you? This is a perspective that people like the parent and myself genuinely don’t understand. What is your thought process?

The article here doesn't say the damage is irreversible, or that it hugely impacts quality of life. Which has been a pattern when I've researched long-term effects. There was a study getting passed around showing that 84% of sufferers had persistent neurological symptoms - certainly scary, even if they're not permanent! But if you poked in further, they were mostly composed of headaches, muscle aches, and dizziness, which are entirely normal and unsurprising consequences of recovering from a serious disease.

More generally, chronic and potentially permanent damage is a fact of life. If the long-term nonfatal consequences of the coronavirus don't pass the scale or severity of, say, carpal tunnel syndrome, I'm comfortable rounding that off as "not a big deal in the scheme of things".

>mostly composed of headaches, muscle aches, and dizziness,

I think you are imagining the most mild manifestations that could be categorized as those things. Those terms could cover a range from trivial to debilitating/life destroying.

It's like when you read that someone isn't or no longer is in "critical condition". It sounds good, it's antiseptic, but it could conceal unimaginable horror.

There are still a concerning number of much more serious chronic complications reported by low-risk young adults. Many report that the symptoms continue months after recovering from COVID-19, with no end in sight. Even though there isn’t much in the way of formal research at this point, it should at least raise some eyebrows.

Less that, then at some point we have to move on and live life.

How many years of shutdown can we handle?

Nearly every person I know is beyond stressed out. I’ve seen work people break down on calls. Remote just isn’t for everyone.

There is a period where you allow time for doctors to figure out best treatment. Maybe we’ll get a vaccine.

How many people are going start dying from sitting and watching tv all day.

I mean bill mitchell does literally believe it. The man is a complete lunatic.

Rona is the #3 cause of death in the US right now.

I question how much of quarantine angst is actually real. In most states it's barely a thing... You stand in line at the grocery store and eat outside at restaurants. That's not a substantive difference. The only real thing is that people haven't been going into an office, which honestly... Harden up, or at least find coping mechanisms that can handle the slightest disruption.

Imo quarantine is exposing a lot of social rot and forcing confrontations with chronic unhealthy behaviors. Work should not be a crutch for your social life, and you should be able to handle being with your children.

The effects of Covid-19 have never been considered by those people because it is irrelevant since they are pushing an agenda.

From the beginning, a bunch of people decided what the effect of Covid-19 should be and they simply kept pushing for it. It was never well thought, they just kept saying stuff as long as they could get away with it. It was only the flu, It was under control, it was already spread out and the test were detecting only the few and all this will be over in May so on and so on. There was even an Oxford study produced and used to support these claims[0].

These propaganda wars are taking victims now.

[0]: https://news.ycombinator.com/item?id=22697163

Just dive into the online activity history of the people who spread these things, it's a fascinating world of pushing for edge cases that never materialise but they keep pushing it anyway.

"Worldwide, the rate of infection with herpes simplex virus—counting both HSV-1 and HSV-2—is around 90%" [0] That virus might be a contributor to Alzheimer's and other neurological problems.

Serious, long term health problems are a pretty normal part of the human condition. Serious long term damage is not actually an automatic call for action upending everyone's lifestyle. There needs to be a more precise explanation of what the problem is for it to be meaningful. Background risk for disease is already very high; as you point out normal flu is already threatening and most people basically ignore it.

[0] https://en.wikipedia.org/wiki/Epidemiology_of_herpes_simplex

How do you expect people to respond to this comment exactly?

"Oh, okay, lots of people have herpes and herpes infections have unanticipated consequences. I guess COVID-19 is no big deal."

I'm not sure why you're being so aggressive about it. The original comment asked why the long-term effects of COVID-19 were seemingly being ignored, and your parent comment responded with an explanation of why some people are comfortable ignoring them.

Herpes has serious long term health implications and it is no big deal. Covid having serious long term health implications does not, in and of itself, mean it is a big deal. Long term health problems are a fact of life.

If people are going to argue it is a big deal, they need to articulate their concerns more precisely.

We don't see health care systems collapsing due to herpes infections.

Look at what's happening in Florida, Texas, Arizona with COVID-19.

Health care systems are furloughing workers because there are not enough patients.

> Health care systems are furloughing workers because there are not enough patients.

Sure, for routine care because people are avoid healthcare environments because of the risk of COVID-19. At the same time, the same systems are unable to deal with critical needs because ICU beds and other related critical resources that COVID-19 puts a high demand on are exhausted in some localities and nearly exhausted statewide in the worst hit areas.

It is a sociological problem, not medical or technological.

Colleagues at wife's work (TX) believe it is a democratic hoax.

I’ve never understood why the long term effects of Covid-19 have seemingly been ignored by the people who say this isn’t a big deal

Since antibiotics became a thing, it seems like it has mostly fallen out of fashion to associate long-term, permanent issues with a one-time infection. It used to be normal to think of infection in terms of permanent impairment.

Scarlet fever could do permanent heart damage. Polio could leave you unable to walk again.

But antibiotics and vaccines have helped create a mindset that if it's serious, you see a doctor, you get good drugs and it's a short-term issue, not something that will maim you for life. The world used to more routinely think in terms of a single infection maiming you for life.

Covid-19 possibly marks the end of an era in that regard. With antibiotic resistant infections on the rise and what not, we may see a return to those mental models of infection.

>isn’t a big deal, deaths aren’t significant, and it mostly effects old people.

The pattern here is denial, for which dismissing long term consequences is just a continuation.

It's hard to be sympathetic when you are 27, out of work for 6 months, and can't see friends because people in nursing homes are dying of a corona class virus effecting the elderly.

It's not only effecting the elderly though. Elderly people are parents and grandparents and have many loving relationships. Their suffering and passing before their time will have devastating effects on many young people.

At the same time, it's hard to be headstrong and nonchalant when it's obvious that nobody really knows what's going on with this thing.

No one said it’s supposed to be easy.

It's not easy and nobody seems to give a hoot. Give up your prime money making years for $600 a week.

Give up your prime money making years

Lockdowns only started four months ago.

It is difficult to get a man to understand something, when his salary depends upon his not understanding it! – Upton Sinclair

Populism / neo-liberalism in general don't arrive easily at "unknown unknowns".

> I’ve never understood why the long term effects of Covid-19 have seemingly been ignored by the people who say this isn’t a big deal, deaths aren’t significant, and it mostly effects old people.

It's because most people who claim this know that they're being disingenuous. Minimization is a common manipulation technique.

Am I being overly charitable if I'd say it's typical for a homo sapiens examples to deny/minimize/buy into conspiracy theories to save themselves from getting mentally overloaded

> Am I being overly charitable

No, you're being reasonable in your assessment. It's an entirely common reason for why it happens. People rationalize away things that make them feel uncomfortable, scared, or things they simply don't want to deal with (if they confront it, it forces a change in their life, or a difficult choice and similar).

There's a finite load that people can handle at one time, whether that's trying to quit smoking or dealing with problems with their children or work, etc.

Ignorance plays an important role, no question, however it's related to the unwillingness to confront an issue first and foremost. An unwillingness to confront a thing (eg ignorance about SARS-CoV-2) is a consequence rather than cause; that unwillingness is often caused by the existing mental tax, life stress, the person is under (and all people have varying capacities for absorbing that, some people can't absorb much). This is another reason why childhood education is so critical, it can be very difficult to find the time to properly educate yourself later in life, as life's burdens attempt to swallow you; and your brain is more often going to spongehappy (knowledge nom nom nom), versus a more resistent adult brain that recognizes the effort and untangling required in dealing with/reconciling internal knowledge conflicts once incorrect information is in place. Teaching children how to think is hugely important, versus the person attempting to remake their brain processes later in life (such as during a global pandemic, as they're losing their job), when it's guaranteed to be a huge struggle with existing cruft/debt.

Probably overly charitable. People who believe that the Holocaust is a hoax, or that Jewish people control the world, probably don't earnestly believe their claims as much as they just like to shit on people that they don't like and the historical tragedies that impacted those people.

Or it's because you and the GP presented no conclusive data, and people don't buy into your personal opinion.

Not everybody wants to join a hand-wringing pity party for no valid reason.

this is a little too strong of a statement, but it's not entirely wrong, long term effect studies are starting to come out just now

however, it is quite documented by now that any kind of heavy, long term inflammatory response trigger cascading effects on health, including atherosclerosis

what it's missing from the discussion is whether these findings from covid patients are within the standard expected outcome of a heavy inflammatory response or something new and specific to covid response

Lurking on medical twitter I've also seen that pulmonary fibrosis might be another surprisingly common post covid19 ailment:



From the wiki link "The scarring is permanent once it has developed", that is scary

The long-term neurological effects are scary too. https://theconversation.com/coronavirus-and-the-brain-diagno...

Even more frightening is the statement, “life expectancy is generally less than five years.”

Not to downplay lung scarring from covid, but the "life expectancy less than five years" in this article refers to idiopathic pulmonary fibrosis which is a completely different disease. We don't yet have the data to say what long term outcomes are after severe cases of covid.

> our findings reveal that significant cardiac involvement occurs independently of the severity of original presentation and persists beyond the period of acute presentation, with no significant trend toward reduction of imaging or serological findings during the recovery period. Our findings may provide an indication of potentially considerable burden of inflammatory disease in large and growing parts of the population and urgently require confirmation in a larger cohort.

This is unexpected. A chronic inflammatory disease seems to persist well beyond recovery from SARS-CoV-2 infection.

I have a really hard time reading through something like this and pulling out pertinent information. This seems to be the quick and dirty summary in something close to layman's terms:

A total of 78 patients who recovered from COVID-19 infection (78%) had cardiovascular involvement ... The most prevalent abnormality was myocardial inflammation ... detected in 60 patients recently recovered from COVID-19 (60%), followed by regional scar and pericardial enhancement.

If anyone can else can give us a better breakdown that is succinct and doesn't require a medical degree to follow the jargon, please do. (I have had a class in medical terminology and I read medical records for five years as part of my job. But I was processing accident claims, not sickness claims, so I almost never read medical records saying anything about the heart.)

I've just passed this to friends and family. Thanks for sharing.

Thanks. I did read it. I'm just having a tough week.

>CMR revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), independent of preexisting conditions, severity and overall course of the acute illness, and time from the original diagnosis.

If damage to people’s hearts proves long term or if even mild COVID cases predispose people to heart problems later on, the knock on effects for countries that chose to let the pandemic run rampant are going to be horrendous.

Err, before everyone gets too excited, it would be nice to know what the equivalent study done on comparable influenza patients would look like. If it looks similar, then we probably don't have much to worry about, if the covid picture is more severe or more frequent, then we might have cause to worry

This virus has nothing in common with the flu, except being a respiratory virus. I don't mean this in terms of survival rates, although it's transparently obvious that diminishing the danger is the purpose of this talking point.

But even ignoring that, there is just no reason why COVID should be compared with the flu and not, say, Hepatitis A (B or C), Ebola, HPV. Route of infection (here: respiratory) correlates welll with the effectiveness of various countermeasures. Symptoms are still somewhat similar but less so, with COVID causing rare symptoms like anosmia but relatively little fever and almost no rhinitis. It's completely useless for pharmaceutical treatments as well as for predicting severity, which for respiratory (and every other class) ranges from benign to certain death.

Cardiologists are already concerned beyond what they see with influenza patients (which can also cause heart damage), especially because large amounts of viral replication has been found in the hearts of deceased patients:



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