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Covid-19 can damage hearts of some college athletes (nih.gov)
157 points by rkolberg 27 days ago | hide | past | favorite | 108 comments



Medlife crisis, a cardiologist youtuber has recently made a video [0] about a similar study, that also looked at MRI images of patients [1]. That same story is referenced in the article as well. According to medlife crisis, MRI images aren't really helpful as a sole tool to diagnose miocarditis, instead one uses them together with other data like symptom reports or ECG. Alone, they would be too flaky. Also, we don't even know how healthy people look like as we don't put them into scanners.

Now this [2] study, the one the blog post is about, didn't just study MRI images but also collected other data, like ECG. But quoting the study:

> There were no diagnostic ST/T wave changes on electrocardiogram, and ventricular volumes and function were within the normal range in all athletes by transthoracic echocardiogram and CMR imaging. No athlete had elevated serum levels of troponin I.

Some individuals reported mild symptoms typical to COVID, but most were asymptomatic. So the study confirmed that there are no abnormal changes beyond the MRI scans, which, as written above, can be flaky.

[0]: https://www.youtube.com/watch?v=iaiQGJqZ6Y8

[1]: https://doi.org/10.1001/jamacardio.2020.3557

[2]: https://doi.org/10.1001/jamacardio.2020.4916


With tens of thousands of publications on COVID, its absolutely amazing how few there are on the follow up of these patients. (ie what comes next after infection). There is so little data we are flying blind (again).

That said, there is evidence that the other coronaviruses that caused epidemics (SARS and MERS) can cause clinically meaningful myocarditis and heart failure as a result. In vitro and autopsy evidence suggests that SARS-CoV-2 directly infects myocardial cells. So it's plausible that there will be some cardiac sequelae of COVID, perhaps in many patients or maybe just in those at high risk. We just don't know. Assuming that myocarditis will be a major problem because 2 uncontrolled studies said so is as silly as assuming hydroxychloroquine works because of similar strength of evidence. But dismissing it out of hand (which I'm not suggesting GP is doing) is not smart either. We should be appropriately skeptical, but need to investigate further.


> That said, there is evidence that the other coronaviruses that caused epidemics (SARS and MERS) can cause clinically meaningful myocarditis and heart failure as a result.

It'd be interesting to know how it compares to the flu. Here's an interesting study from just this year:

> A CDC study looking at more than 80,000 adult patients hospitalized with flu over eight seasons found that sudden, serious heart complications were common, occurring in 12% of patients, or 1 in 8.

https://newsroom.uw.edu/news/study-confirms-link-between-inf...


If you have to be hospitalized for the flu, you are pretty close to death's door. It's not a very common occurance.

Hospitalization for COVID is, unfortunately, quite common.


That really depends on the particular flu strain. All are dangerous to frail and elderly patients. Some stains are also likely to cause cytokine storms in young, healthy patients.


> Some stains are also likely to cause cytokine storms in young, healthy patients.

Wasn't this the case with the 1918 spanish flu? Kids had no issues, due to undeveloped immune systems, elder had little issues, due to old, shitty immune systems, and the 'middle' generations got fscked by the virus.


The problem is that far too many people are blasé about flu.

Flu is a nasty disease, a killer with severe repurcussions for certain people.

And it is very likely to kill and harm younger people.

There’s a reason we have a vaccine for flu - despite it being monumentally difficult to produce one.


Quite the opposite. Covid is dangerous for elderly and people having severe medical condition, much, much less dangerous for young and healthy. Flu is more dangerous to young people than Covid.

Flu also causes hospitalizations in comparable amounts to Covid[1]. Note that we have a vaccine for flu, and it is still causing almost a million hospitalizations in bad seasons.


And here's the missing reference:

[1] https://www.cdc.gov/flu/about/burden/index.html


...because people do not get vaccinated.


Keep in mind that the vaccine has, on average, efficacy of 50%.


Yes, I bore that in mind when I made the statement. Especially the younger people the GP talked about do not bother getting flu shots. If everyone got vaccinated, the yearly influenza waves would result in way fewer deaths.

Since you can get both influenza and Covid-19, even at the same time, German health authorities have strongly recommended getting flu shots and started the vaccination campaign earlier this year. It's good advice. Get your flu shot!


Flu kills a lot of old people every year. Covid isn't that much worse than a bad flu season.

Hospitals were being over whelemed a couple of years ago. https://time.com/5107984/hospitals-handling-burden-flu-patie...


Also the general population of adults (not even adults hospitalized with the flu) is going to be drastically worse in overall health before infection when compared to college athletes. So "this happens with the flu too" isn't too helpful without there being some comparison to how often it happens with COVID versus the flu.


"Hospitalization for COVID is, unfortunately, quite common."

Not in the demographic followed in this study. Amongst healthy 19-year-olds the flu represents about the same threat of both hospitalization and death, and flu is possibly a little bit worse than Covid:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...

https://www.lung.org/getmedia/98f088b5-3fd7-4c43-a490-ba8f47...


I don't see how the provided links support your statements.


It's pretty straightforward: they show fatality numbers for Covid and Flu in the specified age-brackets (19) that are comparable. Covid might be a bit higher. As I said.


They are not IFR numbers.


They are, in fact, estimates of IFR.

Yeah, is unfortunate the world is not made of healthy 19 year olds otherwise this would be a significant discovery.


If we're concerned about the risk of COVID-19 to cause morbidity in youth, like these reports indicate could be a problem, it's reasonable to compare the frequency to other risks out there that we accept-- will it cause more morbidity in this population than a typical flu year? Less? About the same? It's a reasonable yardstick to use.


Are you suggesting this blog post might be misleading by not disclosing the limitations of the referenced work? Why would anybody do such a thing? /s


So does flu. From https://www.cdc.gov/flu/symptoms/symptoms.htm possible serious complications triggered by flu can include inflammation of the heart (myocarditis), brain (encephalitis) or muscle (myositis, rhabdomyolysis) tissues, and multi-organ failure (for example, respiratory and kidney failure). Flu virus infection of the respiratory tract can trigger an extreme inflammatory response in the body and can lead to sepsis, the body’s life-threatening response to infection.


Just my own anecdote...

In 2013, I was in ok shape, late 30's, running maybe about 15 miles/week with some gym activity. I was suddenly hospitalized for 4 days with pneumonia and "something else." About four months later, I got on a treadmill and couldn't run for more than a minute.

Long story short, I was diagnosed with viral cardiomyopathy. A virus basically comes in, fucks up your heart, then leaves. Myocarditis was the method in my case. They never ran a test to see what virus, because at that point, there wasn't any reason to. The damage was done. My ejection fraction was at 15% (50-55% is normal). I was given a defibrillator vest to shock me if I collapsed, and eventually I got a permanent implant.

In various conversations with cardiologists, they mentioned that it's believed to be much more common than they once thought. My primarily cardiologist said the week prior to me, she had a young, perfectly healthy male, in his early 20's that had a very similar hospitalization event. His was so bad they immediately put him on the transplant list.


I suspect that a high percentage of chronic medical conditions that people deal with were triggered at least partly by undiagnosed viral infections. But that's just conjecture, there's no way to prove it.


Did you eventually recover ?


permanent implant doesn't sound like a recovery one would wish for


Not 100%. About a third of people recover fully within 3-4 months, but if it's beyond that, you're likely stuck. I am, however, one of the few that got up to 80-90% of normal a couple of years afterwards. My primary cardiologist said in 20 years of practice, I was one of the only three patients that he treated that did this.

I credit returning to long distance running. I don't recommend it as a treatment. Not scientifically studied and was/is definitely against doctor's orders.


And as I discovered in my family hyponatremia which has left my mother on anti-seizure tablets for the rest of her days.

Don’t underestimate flu


Yes, but with the flu, most people (a) know that they had it and (b) are aware that they should take it easy with the training for a few weeks after they get well again. With Covid, apparently there is danger of myocarditis even for mild or asymptomatic cases...


Mild or asymptomatic cases are also common with influenza.

https://wwwnc.cdc.gov/eid/article/22/6/15-1080_article

Some of those cases do have heart problems.


These studies are very tricky to interpret because there's no context for how bad these results are.

How many healthy people have (presumably benign) cardiac abnormalities when you do a cardiac MRI? How many people who got a cold or flu have cardiac abnormalities when you do a cardiac MRI? Covid is undoubtedly more fatal than the flu, but in some demographics, like the young, it is less fatal.

The first cited study of athletes does not provide any context. The other cited study (Puntmann et al) did attempt to have a control group of people who did not contract Covid but had similar risk factors as the people who did contract Covid. If you look at this control group, a ton of people have cardiac abnormalities (in Table 1, as many as 26% of the non-Covid group could have the criteria for myocarditis that the study states).


It is anecdotal, but one example is professional baseball player Eduardo Rodriguez. He had COVID-19 in early July which resulted in myocarditis. He wasn't even cleared to walk on a treadmill until this week[1]. While he is expected to return to form eventually, team officials had said they don't expect him to be completely back to normal next season even though the season doesn't start until April[2].

This virus isn't something you want to mess with even if you are young and fit.

[1] - https://sports.yahoo.com/red-sox-ace-finally-cleared-to-walk...

[2] - https://www.masslive.com/redsox/2020/09/eduardo-rodriguez-bo...


So there's no permanent harm. I don't think preventing athletes from doing their jobs for a few months by restricting everyone in that way is a sensible trade.


>So there's no permanent harm.

The average MLB player's career is 5.5 seasons and this guy might be losing 1.5 seasons. That is still a huge cost even if he escapes without permanent damage.

>I don't think preventing athletes from doing their jobs for a few months by restricting everyone in that way is a sensible trade.

I never suggested any specific ways to avoid this situation let alone any type of shutdown. I am simply pointing out the dangers.


Even if they completely lost their careers, it wouldn't exactly but be huge damage to society.


As many people in this and other threads have pointed out, we don't have any prior measurements, so we are absolutely unable to conclude that Rodriguez didn't have myocarditis and constipation of the heart prior to contracting COVID.


It would be extremely rare for a professional athlete to have an undiagnosed heart condition serious enough that doctors recommend months of zero physical activity. This isn't a normal person. This is someone watched over by world class doctors and who constantly has his performance, health, and bio data measured. The condition is almost certainly a result of COVID.


The rub is that extremely rare is not impossible. It's happened before with ephedra famously.

Since this is basically an anecdote we cannot conclude anything on the population


I mean I started that first comment with "It is anecdotal". I realize this isn't hard science, but pretending that it is meaningless because it "is not impossible" that he had a prior condition is also pretty worthless from a scientific standpoint. I don't think you realize how closely professional athletes are monitored nowadays. We obviously can't say anything with certainty while observing from afar, but it is incredibly unlikely his condition wasn't caused by COVID. And since this is just an anecdote, I don't understand the inclination to advocate for the devil and that tiny likelihood of it not being COVID related.


But you went from an anectodal note to the conclusion "This virus isn't something you want to mess with even if you are young and fit." as if it was an universal truth, whereas if you're young and fit, the virus is at 99.9% something you can mess with without any consequence.


Enjoy this survey paper titled "Sudden Cardiac Death in Athletes."[1]

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969030/


As I said:

>a professional athlete... is someone watched over by world class doctors and who constantly has his performance, health, and bio data measured.

You can't compare the likelihood of a heart issue going undiagnosed in a professional athlete versus a high school kid or an adult participating in an unorganized sport.


So 4/26 athletes had elongated T2, in an uncontrolled study, with no pre-exposure baseline measures.

This is one-half step above meaningless. The only argument they have is that the other 22 athletes had a mean T2 of 51, vs 59 for the four in question. The highest reported “abnormal” time is 63ms. The others are 55, 59 and 61ms.

Here is the first set of slides I found for topic from a presentation by a doctor at Columbia University. Slide 14 shows the distributions of T2 times for several control and disease groups. You’ll note that the control group runs from 50-61ms:

https://cdn.ymaws.com/scmr.org/resource/resmgr/2019/new_york...


The studies on covid lung damage found that it lasts 1-3 months and then recovers in all cases where ARDS is not diagnosed. I wonder if this is similar (e.g. intense viral infection, regardless of symptoms, leads to myocarditis but then heals over time). That's the biggest open question mark about how bad covid is that hasn't been addressed yet.


Earlier this year my immune system developed COVID FOMO and caused inflammation that destroyed my heart's AV nerves. I got relatively lucky that the inflammation didn't seem to cause any muscle damage. My heart looked perfect on an MRI, despite only beating at 21 BPM at the time. Apparently inflammation doesn't really show up on an MRI unless it's horrendously bad or it's caused fibrous scarring. The scan that really shows inflammation well is PET, and you don't really want to do a PET scan without good reason since it requires getting injected with a radioactive substance.

I've likely had inflammation in my lungs for years based on a previously unexplained chronic cough, and since getting treated for the inflammatory condition, within weeks my cough was gone and my pulmonary function is quantifiably normal.

So, it seems to me like systemic organ inflammation isn't too big a deal unless it happens to cause nerve damage, or gets bad enough to cause fibrous scarring. Unfortunately, if you can see it on an MRI, then you're probably already screwed. You can get a good view of any inflammation via PET, but you're going to glow for a while after.

Perhaps viral inflammation is a lot more destructive than autoimmune inflammation alone? It sounds like contemporary COVID treatment has become more effective with the addition of anti-inflammatory medications, though, which is great news.


My blood pressure dropped from 135/85 to 115/80 after I got COVID.

I haven't checked it recently because I'm left with tinnitus in my right ear (that rings very loud when stressed or when exerting myself) and I was stressed about that, but I'll do an ultrasound checkup on my heart.

You did not mention an ultrasound exam on your heart, I thought it was pretty good?


I believe at this point I've had every type of non-invasive scan available, not including all the various contrasts and radioactive tracers that are possible. An echocardiogram showed my heart beating weird obviously, but revealed no structural problems. The doctors seemed to use ultrasound mainly to look for perfusion through my heart muscle after pacemaker surgery, and once again provided no clues as to the cause of the nerve damage. It was a mystery until I had a PET scan, which was very telling, and then a subsequent biopsy to confirm the diagnosis.

I now have a lot of cool images of my insides on a CD, and I'm Bluetooth enabled.


I'm so tired of all reports talking about things that could happen, may happen, but fail to produce numbers of how common it is.

Hundreds of millions of people have had sars-cov-2 by now, if long-term effects were a widespread phenomenon, we would know by now. And yet, absolute crickets except rare outliers.

An old friend of mine was sick for months with the virus, and she has many months of rehab in front of her before she's back to normal. That sucks, but she's still the outlier. And you can't let the outliers dictate your behaviour, or you would never leave the house for fear of falling pianos or lightning strikes.


Trust me we are all tired.

> Hundreds of millions of people have had sars-cov-2 by now,

No, worldwide numbers are ~34 million confirmed. You don't get to just randomly multiply by some fudge factor that feels right to you and then reason based on that.

When you do this it makes it clear that numbers really don't mean anything to you and it will just be more sophistry to justify giving up and letting the disease everywhere because of something about "others dictating your behaviour" or something or other. This attitude and shades of it are exactly why 1 million people worldwide have died.

Yeah, we're tired.


> No, worldwide numbers are ~34 million confirmed. You don't get to just randomly multiply by some fudge factor that feels right to you and then reason based on that.

Certainly any other number is entirely speculative, but given the minor symptoms it usually causes (and the lack of symptoms in many people) it seems a huge stretch to assume that confirmed cases == number of infections.


Sure. Nobody knows the real number and efforts to estimate it vary wildly in their outcomes.

Please read my comment again, what you quoted and also what I didn't say. I am not asserting that confirmed == actual. Of course that would be silly to believe that. I am explicitly cautioning others from just fudging out numbers and then reasoning based on speculative numbers. I am not substituting a different number or different reasoning. I only quoted actual facts, and I am explicitly encouraging us all to stick closer to actual data, because we just wander into bad conclusions otherwise.


Weren't there randomized antibody tests in multiple countries, dealing with just that (basically, calculating the approximate number of people who got it, and then comparing to number of people getting tested positive)?


Yes but now that we are months into the pandemic those antibody seroprevalence studies also underestimate the true number of infections. Some patients, especially those with minor infections, never produce detectible levels of antibodies or they fade away quickly. In order to get really accurate data we would have to also check memory cells, but that requires specialized and expensive laboratory procedures.


Looking at confirmed case numbers leads to bad conclusions because those numbers are almost completely worthless. It's common knowledge now that the majority of cases are never counted in official statistics.


> Looking at confirmed case numbers leads to bad conclusions because those numbers are almost completely worthless.

They really aren't, and trying to portray official numbers as "worthless" is something that flies in the face of reason. In the very least they serve as a verified conservative estimate, or a reliable lower bound.

Moreover, it's stupid and disingenuois to claim that "majority of cases are never counted in official statistics" because "official statistics" represent only test results taken at specific moments in time, and never were assumed to represent the total number of cases.


So instead look at this number I just pulled out of my fucking ass


> it seems a huge stretch to assume that confirmed cases == number of infections.

I didn't saw anyone claiming that confirmed cases match total cases.

However, that doesn't mean anyone can simply fabricate numbers out of thin air to try to pass them off as the truth.


True, but reinfections (with symptoms) have occurred[0], so numbers of confirmed may not be an important metric, further studies are needed to conclude either way.

[0] https://www.google.com/amp/s/nationalpost.com/news/world/rei...


So that makes two people in the entire world who are known to have re-tested positive.

Immunity is never 100%. Why would we highlight 2 cases out of 30 million and turn that into a talking point like it means something?


The virus the second time it was a different strain, so 2 people can become millions if the virus keeps mutating, let's remember it doesn't even have a year in existence so we know near nothing about how it mutates.


In this fictional hypothetical, we get really good at manufacturing new vaccines, and we also get really really good at targeting suppression policies at only the highest risk individuals.

Because for the majority of the population it’s less of a concern than annual flu.

Back in reality, coronavirus mutates much slower than flu, and vaccines are targeted at particularly stable features even within an overall fairly stable structure.


https://www.irishtimes.com/news/ireland/irish-news/covid-19-...

"An estimated 750 million, or 10 per cent of the world’s population, have been infected by Covid-19, World Health Organisation (WHO) official Dr Mike Ryan has said."


You can't possibly be serious thinking that the confirmed cases is nothing more than a lower bound for the actual number of people that have been infected. Do we know the exact multiplier, of course not. But from various studies it seems like 10x is in the ballpark.


Please stop with this "10x ballpark" stuff. It just leads to absurd conclusions. For example, 10x 34 million is 340 million, leaving 7.4 billion people yet to be infected, or about 20x more than currently. 20x the number of deaths would be 20 million people. That's horrific. I don't want to even think about that. I absolutely hate this calculus. Instead I want to stop this pandemic from getting worse, and we can and should have been working together to limit the spread of this thing.

I'm absolutely tired of having this conversation because it's been 6 months of this throwing around bullshit numbers (only .1% die! no only 1% die! no only 2% die! oh look it's back to 1.5%!) and people arguing from what is basically a completely selfish point of view where nothing changes, nothing impacts their lives. When in reality every time we have this conversation the absolute numbers have another zero on them.

Even back when it was only 50,000 cases worldwide, experts were warning of potentially millions of worldwide deaths. And idiots were arguing not to shut things down and not to wear masks because it was overblown. Goddamn. God damn. Now there are literally one thousand times as many cases. Now 1 million people are dead. And the conversation is still the same. We'll have this argument again and again and forever and the millions of dead will keep ticking by because so many people are completely unserious about dealing with this. It is absolutely disgraceful so many people putting their own money and entertainment above the lives of others and don't even have the decency to wear goddamn masks. Sickening.

Sorry, I don't mean to unload on you personally because your comment wasn't the above, but goddamn I am so tired of this throwing around numbers game. Can we just fucking fight this virus already?


but goddamn I am so tired of this throwing around numbers game. Can we just fucking fight this virus already?

Because the numbers actually matter. We could save lives by quarantining the entire population during every flu season. We don't, because the social and economic costs would far outweigh the benefits. It may well be the case that COVID is so dangerous that it justifies destroying millions of jobs, disrupting children's education, and forbidding physical proximity with friends and family. But if you're going to argue for that you need to use numbers rather than righteous indignation.


At the same time ... I'm not sure we haven't just been complacent as a civilization regarding the seasonal flu.

Yearly lockdowns may be a step too far, but would it be so terrible if everyone wore cloth masks during flu seasons, if remote work was more standard for white collar jobs, if everyone else were able to take time off when sick, and if we had a plan for sick kids besides sending them to school with a pocket full of kleenex?


Flu is uncommonly asymptomatic during the infectious period.

Adopting the Asian custom of wearing bog-standard blue medical masks when we have the sniffles is a fine idea, overdue really.

Everyone wearing cloth masks during every flu season is an absurd overreaction.


> Because the numbers actually matter.

If numbers actually mattered for then then they wouldn't be both neglecting official statistics, specially growth rates, and also fabricating their own data out of thin air.

These people don't care about numbers or facts. These people are too embroiled in their petty world view or conspiracy theories to care about the harm they are doing to everyone around them. These idiots complain about jobs and classes as if having a million people dying on them and many more being debilitated is something that harms no one or their economy.

This shit could have been contained if these idiots acted responsible and stayed put and took basic sanitary precautions. But no.

I lived in Spain during the start of the year, and witnessed the spanish army trucks carting healthcare workers around and carrying loudspeakers asking people to stay indoors in a time where, according to verified tests, nearly a thousand people were dying per day due to covid. The death rate was so high that the spanish government had to commandeer an ice ring to serve as a makeshift morgue. Social distancing and lockdown and basic sanitary care drove those numbers to single digits in about a month.


By the time there were 50000 cases we had already lost any realistic chance of eradicating the virus. That's unfortunate but we can't change the past and have to deal with reality. At this point shutting things down causes more harm than good.

Wearing masks in close contact settings may be fine for a few months but it's obviously not sustainable indefinitely. Most likely this pandemic will play out much like the HCoV-OC43 pandemic did in 1889.


> By the time there were 50000 cases we had already lost any realistic chance of eradicating the virus.

Disagree strongly. I am currently in Australia, which shut down early and has been serious about fighting this from the beginning, despite repeated outbreaks from international travel, most recently in Victoria, which prompted a hard and long shutdown...that worked.

27,000 total cases over the course of the entire pandemic. Less than 1,000 deaths. And all of the worst of that has been lapses in vigilance and mistakes.

Those 50,000 worldwide cases were the seeds of the 34 million that have been confirmed. Every one of those hotspots could have been and should have been isolated and quarantined. We'd be through this if we had responded simultaneously, fast and hard. But no one was really prepared for what that shutdown meant or looked like.

But now we are stuck with a persistent infection that just keeps getting worse.

> At this point shutting things down causes more harm than good.

And people then were saying that a shutdown would do more harm than good. I think a 3-4 week hard simultaneous worldwide lockdown would have stopped this in its tracks, but the logistics and necessity of that were absolutely not clear. Instead we were constantly one step behind, enacting half measures and wishful thinking based on past pandemics. Incredible that people said almost exactly the same thing 6 months ago and look how screwed we are.

Now we are three steps behind and there is no putting this thing back in the bottle. We're boned. Millions more deaths are coming and the only hope of even remotely normal life now is a vaccine.


Not really. The IFR has trended downwards fairly dramatically over time - it's the rapidity and novelty of the spread which is driving deaths in an extremely (and I don't use that word lightly, it is extreme) stratified by age manner.

If the vaccine doesn't work, you'd seriously never consider going back to normal ever, in your entire lifetime? That's absurd.

It's rather concerning that people like you are pinning all your hopes on a vaccine. I don't know about you, but at some point living a life with such restrictions and a complete halt or threat to halt many of the things that make life interesting becomes a trade-off that's not worth making. If a vaccine does not work to protect the elderly particularly well, would you seriously be willing to close international borders for the next 5-10 years, for example? Even worse, since there's zero endpoint to anything if you are unwilling to tolerate life as normal without a vaccine, why not just extend all restrictions indefinitely?


Chances are pretty good that at least one of the vaccines we currently have under development will work decently well. Probably well enough to reduce the risk to be comparable with Influenza. I don't think discussions about a vaccine-free world are particularly productive right now.


While I hope that's true, it's never a good idea to plan exclusively for the best case scenario. There's a lot riding on your 'probably' when it's considered by many to be the only viable way forward.


I don't see any benefit in discussing what to do without a vaccine right now. There is no time pressure. We'll have plenty of time to figure things out if the vaccines turn out not to work.


Are you saying that we should wait to see if we have a vaccine/one that is effective enough and only then if it does not go to plan start planning for the alternative case? I'm not sure I have it right. If that's the case, I couldn't disagree more from a disaster/public health/societal planning perspective. If we do that, we'll always be behind.


"Disagree strongly. I am currently in Australia, which shut down early and has been serious about fighting this from the beginning, despite repeated outbreaks from international travel, most recently in Victoria, which prompted a hard and long shutdown...that worked."

Except that it didn't work. You did it once, and it came back. So now you're doing it again.

And you'll keep doing it again and again, unless you plan on keeping Australia isolated from the world until a vaccine has been administered to some huge percentage of the world population. Even if you do keep Australia isolated, it's clearly not a cure, either: the current outbreak happened in spite of your country's travel ban.

Reasonable people can certainly disagree about the trade-offs involved here, but you have to start from facts.


> Except that it didn't work. You did it once,

Look, I know the comments section of hackernews is not going to contain a long, nuanced conversation about what did and did not work, and I probably overstated it "working", but let's be clear; the lockdown in Victoria absolutely brought the outbreak under control, from over 500 per day to now nearly zero. If you want to see graphs, please browse: https://www.abc.net.au/news/2020-03-17/coronavirus-cases-dat...

It's been a long, hard slog. It sucks. Lockdowns aren't binary, and I hope I didn't represent them as so. Unfortunately they are only effective to the extent that they don't let infections slip through the cracks. To be effective, the actual numbers need to be low enough, and kept low enough, that contact tracing and quarantining work, so that the economy can function at all. That ship has sailed for America. It is sad.

Victoria is an example of what happens when the thing gets out and starts spreading. Here in the ACT where I am, and the seat of government is, things are in much better shape, with only a few hundred cases overall through the pandemic, and a handful of deaths. A phased reopening has meant life here has gone back to nearer to normal, and even mask wearing isn't required. Canberra has been very lucky and I can actually live my life like the virus doesn't exist, because right now, right here, it pretty much doesn't. But I can't stay here forever, I'll be out in the wild with the rest of ya soon enough. Thanks for letting the virus run rampant over my homeland. Cheers!


I never claimed that Australia didn't bring cases down. It did. Then cases shot back up. Like I said: it "worked" once, then it came back, and now you're doing it again. So it didn't actually work...it just postponed things for a while.

We've eliminated one human virus in all of history, and it took two hundred years and a vaccine. The final push took a really effective vaccine, and decades of intensive effort to weed out the last cases. You're not going to eliminate this one by locking people in their homes for a few months.


> So it didn't actually work...it just postponed things for a while.

Lockdowns are not a permanent solution, duh. Yeah, of course they postpone things for a while, if the virus is still spreading and the population is just as susceptible. I thought that part was clear to people from the outset, but apparently not. Lockdowns buy time, slow or hopefully even stop the spread, identify and isolate cases in order to focus efforts, and then quarantine those people so it does not get out of hand. If you don't isolate the virus during the lockdown then it was pointless as it will just escape again. Unfortunately the logistics of doing that are pretty involved and it takes a serious effort and little to no defection from people escaping quarantines. It helps a lot when political leaders understand and explain the basic strategy instead of being more concerned about their political fortunes and the fragility of the economy and calling it a hoax. Mixed messages confuse people. The US government completely fumbled that one.

You want to protect people's jobs? Then do it. Provide unemployment benefits, provide wage subsidies, provide support to businesses so they don't go under. Impose a rent moratorium so people aren't evicted. Banks will not go under because of a rent moratorium. The financial system doesn't crash because of a rent moratorium. The financial system will crash if millions default, though. But instead America's political leaders chose poorly and did none of those things, or did them poorly. They bailed out absolutely the wrong people. Instead everyone's been in a rush to open everything back up, because fuck it, or something.

And the defections, the arguing, the denial. Unfortunately along with "you can't lock us in here forever"--a semi-reasonable argument which I will generously spot you--there are lots of irresponsible people out there who can't even do the bare minimum to slow or stop the spread, or who just plain don't care, who rationalize away hundreds of thousands of people dying, because fuck it, or something. So we are in a situation where these people spread the virus everywhere. And every step of the way there were so many voices of dissent like this that sound subtly different on the surface but all pretty much amount to "fuck it, that sounds hard". And yeah, now it is exponentially harder to fix this problem. And yes it's still a global pandemic killing thousands and millions of people, despite how tired we are all of the whole mess, despite how our news cycle ADD attention span. And it will absolutely keep getting worse.

> You're not going to eliminate this one by locking people in their homes for a few months.

Like I said, that alone wouldn't have been sufficient. But anyway, not now. It's far too late for America. It would have worked in February to get this under control, get effective testing and tracing programs in place, and keep numbers from spiking. But now the massive number of tests being done just finds this blasted thing is everywhere; a total failure of containment.


A bunch of countries in Asia are evidence that 100% contact tracing and then targetted quarantines work.


"A bunch of countries in Asia are evidence that 100% contact tracing and then targetted quarantines work."

Are they? China still has cases. So do ~all of the southeast Asian nations, Korea, Taiwan and Japan. The virus is endemic, and while these countries may have controlled it temporarily, they have not eliminated it. Save for perhaps Korea (and maybe China, but it's not clear), most of these countries aren't testing at high rates, so they don't really know what is happening.

Unless you believe the virus is hiding out in cats, the only other logical conclusion is that it's spreading asymptomatically, and they're simply not detecting it until it pops up in a symptomatic way.


When case count is super low, you can do contact tracing and keep it from flaring up, all while having live return to mostly normal.

Vietnam had had 35 deaths in total.

Singapore, an international transit hub, 27 deaths.

Thailand, 59.

Read about how Vietnam handled coronavirus. Heavy lock downs at the very beginning quarantine for everyone entering the country, and then localized lockdowns in areas that had breakouts combined with extreme levels of contact tracing.

People in other countries are back to school, back to work, back to living normally.


You're shifting the goalposts. None of those countries have returned to "mostly normal". Maybe people aren't trapped in their houses by police, but that's "normal" only if you have a twisted view of normalcy.

All of them have stopped international travel and closed their borders. Vietnam has a mandatory quarantine -- in government-run centers -- for most people who do enter the country. Singapore is similar. Thailand has a two-week quarantine, and their economy is devastated, as essentially all tourism has stopped.

All of those countries have extensive restrictions in place, and have only recently begun to re-open their own businesses. For example, Vietnam just started re-opening businesses in mid-September:

https://www.vietnam-briefing.com/news/vietnam-business-opera...

Singapore, while much better than before, still has widespread community transmission:

https://www.scmp.com/week-asia/economics/article/3103353/sin...

It still has restrictions on group gatherings, people can't to to restaurants in groups larger than 5, and alcohol can't be sold after 10:30. I guess this counts as "mostly normal", right?

So basically, all of those countries are still locked down, or have just barely re-opened, and even then, there's no suppression, just a lower level of community transmission than before. It's far too early to be declaring victory.

You can control the virus for a time when you trap your society inside, deprive them of their livelihood and otherwise accumulate huge social and economic costs. Then you stop, and the virus comes back.


I think you got downvoted on the basis that what you say is speculation... but I do not disagree and think there should be room for that in this context.

Confirmed cases will never be equal to total cases unless the virus affected everyone the same and had 100% mortality with distinctive causes i.e hemorrhaging.

The asymptomatic or mild case rate is so high that treating confirmed cases as anything other than a speculative baseline is hard for me to accept.


> No, worldwide numbers are ~34 million confirmed.

With 34 million cases confirmed, it is probably that hundreds of millions actually had it but stayed at home, as it is the first recommendation. Yeah, we're all tired.


To be fair on the numbers front, there is a lot of evidence suggesting the true death rate for infected individuals is under 1% - so with 1 million dead I don't think it's unreasonable to guess at least 100 million have had it.

That said I am surprised how many dismissive comments there are in any thread about COVID around here. It is tiring how many people are not taking it seriously enough, and ironically this attitude also contributes to businesses not being able to safely reopen.


> if long-term effects were a widespread phenomenon, we would know by now

Wouldn't you have to wait until a long time period has passed before you could make any real claims in regards to "long-term effects"?


To be clear, since it never is, I'm commenting that scientifically it's open and shut except for heart stuff. So it's interesting to see early indications. I agree about implications, I'm not arguing for extreme measures, simply stating fact. If it is airborne HIV like people feared in April (which it is not), I would like to know.


Do you have any links? (Or a search term to use if you don't know them).

I see numerous reports of "long term" or "permanent" damage, despite the virus having been around for less than a year.


Have a link? I missed those studied.


I've searched extensively for any studies that describe the 3 month follow up and found exactly one, recently published. I would love if you could identify more.

Results aren't really as described here. Some patients recover, but about 1/3 had persistent lung findings and many had decreased lung function (as measured by DLCO).

[0] https://www.thelancet.com/journals/eclinm/article/PIIS2589-5...


Thanks! I suspect OP either misinterpreted this study or just inventing things. I’ve followed this fairly closely and know of no study showing absence of longer run effects, or definite presence of them. It’s too early.

Also note for anyone reading the above study: they were hospitalized patients, with critical excluded. That would be “moderate” in the technical terms used to describe the virus.


Here is a study from 2009 that shows it happens to athletes that have flu / influenza / "common cold"

https://jcmr-online.biomedcentral.com/articles/10.1186/1532-...


My 15 year-old cousin had undiagnosed hypertropic cardiomyopathy and collapsed during half-time at a high-school basketball game. Since AEDs were rare then (and still are in rural, less affluent areas), his heart rhythm couldn't be restored and he died.

There are two important points: 1) you don't want to be exercising with many different heart conditions whether temporary or permanent and 2) when you're out and about in your community, keep an eye out for AEDs ... if you don't see them at a reasonable frequency, speak up and help get them in place.

Donations are accepted and funding may be available at https://gregaed.com/


AED is an abbreviation of automated external defibrillator.


Makes you think about the LSU football team being so bad this year after admitting most of the team had covid.

I hope the athletes whose pro careers are now in jeopardy are able to hold the college administration and other officials pushing for the return of football accountable for the damage they've caused.


> I hope the athletes whose pro careers are now in jeopardy are able to hold the college administration and other officials pushing for the return of football accountable for the damage they've caused.

On the flipside, a year out of competition may be enough to kill someone's career, or at least seriously derail it. Most people only get a few years at high levels of sport, so losing one is a big hit.


This is good research (I presume) but poor quality news. (Like most medical news, but covid really made a focus on it). Obviously covid can do a lot of terrible things. What matters for the public is overall balance of factors and meaningful concrete lifestyle and policy choices based on those, not these single small pieces of info.


Only college athletes? Normal people (or professional athletes) aren't at risk?


Maybe the damage only matters if you regularily push your heart to the limit.


https://news.ycombinator.com/item?id=24366614

Relevant other discussion on Covid-19 and athletes. Exaggerated headline proven to be false.


For professional athlete, the risk of not playing is greater than the risk from covid.


For the "not yet professional" athlete, however, the risk of damage is probably higher than sitting out a year.

The careers of these people live and die based upon their ability to process oxygen. Even a couple percent drop move them out of the "elite" category and can mean the difference between a couple of years as a pro vs a dead end at college.


By sitting out a year, they could lose their skill and competitiveness and also getting one year older. For athlete because of short career timespan, time is precious.

Even the risk of playing and having injury during non pandemic time is probably greater than covid.


> For athlete because of short career timespan, time is precious.

Primarily because of injury. A year spent training but not playing has significantly reduced probability of injury.

And, it's not clear that delaying a year is actually a downside even normally.

Baseball pitchers, for example, have significantly improved career lifespan if you limit their exertion while they are young.


Sure, but these are unpaid college athletes.


Don't they get paid in the form of scholarship?

Even if unpaid and no scholarship, without playing they could lose their skill and competitiveness, and they are not getting any younger.




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