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A 'Mild Attack' of Corona could be Dangerously Misleading

Otherwise healthy people who thought they recovered from coronavirus are reporting persistent and strange symptoms - including strokes writes Adrienne Matei in The Guardian 

 

‘It’s important to keep in mind how little we truly know about this vastly complicated disease.’ Photograph: Yara Nardi/Reuters


Conventional wisdom suggests that when a sickness is mild, it’s not too much to worry about. But if you’re taking comfort in World Health Organization reports that over 80% of global Covid-19 cases are mild or asymptomatic, think again. As virologists race to understand the biomechanics of Sars-CoV-2, one thing is becoming increasingly clear: even “mild” cases can be more complicated, dangerous and harder to shake than many first thought.

Throughout the pandemic, a notion has persevered that people who have “mild” cases of Covid-19 and do not require an ICU stay or the use of a ventilator are spared from serious health repercussions. Just last week, Mike Pence, the US vice-president, claimed it’s “a good thing” that nearly half of the new Covid-19 cases surging in 16 states are young Americans, who are at less risk of becoming severely ill than their older counterparts. This kind of rhetoric would lead you to believe that the ordeal of “mildly infected” patients ends within two weeks of becoming ill, at which point they recover and everything goes back to normal.

While that may be the case for some people who get Covid-19, emerging medical research as well as anecdotal evidence from recovery support groups suggest that many survivors of “mild” Covid-19 are not so lucky. They experience lasting side-effects, and doctors are still trying to understand the ramifications.

Some of these side effects can be fatal. According to Dr Christopher Kellner, a professor of neurosurgery at Mount Sinai hospital in New York, “mild” cases of Covid-19 in which the patient was not hospitalized for the virus have been linked to blood clotting and severe strokes in people as young as 30. In May, Keller told Healthline that Mount Sinai had implemented a plan to give anticoagulant drugs to people with Covid-19 to prevent the strokes they were seeing in “younger patients with no or mild symptoms”.

Doctors now know that Covid-19 not only affects the lungs and blood, but kidneys, liver and brain – the latter potentially resulting in chronic fatigue and depression, among other symptoms. Although the virus is not yet old enough for long-term effects on those organs to be well understood, they may manifest regardless of whether a patient ever required hospitalization, hindering their recovery process.

Another troubling phenomenon now coming into focus is that of “long-haul” Covid-19 sufferers – people whose experience of the illness has lasted months. For a Dutch report published earlier this month (an excerpt is translated here) researchers surveyed 1,622 Covid-19 patients with an average age of 53, who reported a number of enduring symptoms, including intense fatigue (88%) persistent shortness of breath (75%) and chest pressure (45%). Ninety-one per cent of the patients weren’t hospitalized, suggesting they suffered these side-effects despite their cases of Covid-19 qualifying as “mild”. While 85% of the surveyed patients considered themselves generally healthy before having Covid-19, only 6% still did so one month or more after getting the virus.

After being diagnosed with Covid-19, 26-year-old Fiona Lowenstein experienced a long, difficult and nonlinear recovery first-hand. Lowenstein became sick on 17 March, and was briefly hospitalized for fever, cough and shortness of breath. Doctors advised she return to the hospital if those symptoms worsened – but something else happened instead. “I experienced this whole slew of new symptoms: sinus pain, sore throat, really severe gastrointestinal issues,” she told me. “I was having diarrhea every time I ate. I lost a lot of weight, which made me weak, a lot of fatigue, headaches, loss of sense of smell …”

By the time she felt mostly better, it was mid-May, although some of her symptoms still routinely re-emerge, she says.

“It’s almost like a blow to your ego to be in your 20s and healthy and active, and get hit with this thing and think you’re going to get better and you’re going to be OK. And then have it really not pan out that way,” says Lowenstein.

Unable to find information about what she was experiencing, and wondering if more people were going through a similarly prolonged recovery, Lowenstein created The Body Politic Slack-channel support group, a forum that now counts more than 5,600 members – most of whom were not hospitalized for their illness, yet have been feeling sick for months after their initial flu-like respiratory symptoms subsided. According to an internal survey within the group, members – the vast majority of whom are under 50 – have experienced symptoms including facial paralysis, seizures, hearing and vision loss, headaches, memory loss, diarrhea, serious weight loss and more.

“To me, and I think most people, the definition of ‘mild’, passed down from the WHO and other authorities, meant any case that didn’t require hospitalization at all, that anyone who wasn’t hospitalized was just going to have a small cold and could take care of it at home,” Hannah Davis, the author of a patient-led survey of Body Politic members, told me. “From my point of view, this has been a really harmful narrative and absolutely has misinformed the public. It both prohibits people from taking relevant information into account when deciding their personal risk levels, and it prevents the long-haulers from getting the help they need.”

At this stage, when medical professionals and the public alike are learning about Covid-19 as the pandemic unfolds, it’s important to keep in mind how little we truly know about this vastly complicated disease – and to listen to the experiences of survivors, especially those whose recoveries have been neither quick nor straightforward.

It may be reassuring to describe the majority of Covid-19 cases as “mild” – but perhaps that term isn’t as accurate as we hoped.

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The secret of Hugo Chavez

Grace Livingstone in The Independent

When I was a history student, I always wished I could hear one of the great orators of our time, a man or a woman who could sway a crowd and change the course of events with the power of their rhetoric. So I felt lucky to see Hugo Chavez, the revolutionary president of Venezuela, speak many times in Caracas.

What immediately struck you was his wit. His speeches were full of jokes and laughter, often misunderstood and misinterpreted by the foreign, particularly the American, media. He picked people out from the crowd, asking about their families or home towns, recalling a titbit of history about the place. He could switch from homespun banter to soaring rhetoric in an instant. He was learned and well read. US journalists were baffled when Chavez began to refer to George W Bush as "Mr Danger", but his Venezuelan audience picked up the literary allusion to the country's most famous novel, Dona Barbara – Mr Danger being an archetypal imperialist. But, most of all, Chavez was a teacher. I remember him exhorting his illiterate followers to learn to read. "Reading will liberate you," he told them and urged them to take part in his government's literacy drive in the shanty towns. Thousands did learn to read, many going on to become tutors themselves.

Chavez used the language of the street. The elite found him vulgar and shuddered that a lower-middle-class mixed-race soldier held the highest office in the land. But he spoke for tens of thousands of poor Venezuelans who had been overlooked for decades. Some said Chavez's language was inflammatory, but he put the country's poor on to the centre stage and told them: "You are the real Venezuela."

The coalition that supported Chavez included militant trade unionists and left-wing activists, but overwhelmingly it comprised thousands of poor Venezuelans who had never taken part in politics before. Precisely because Chavez was such a charismatic figure, the most startling fact about his Venezuela is usually overlooked – the upsurge of revolutionary grass-roots activism all over the country: hundreds of radio stations set up, popular councils, peasants' co-operatives, literacy circles, committees to bring water to shanty towns, a buzz of activity in place of despondency.

Chavez, of course, had faults. Despite being in office for years, he continued to rage like an opposition revolutionary against the powers that be. The privately owned TV stations in Venezuela were extraordinarily biased, exhorting people to protest against the elected president, misreporting a coup against Chavez and broadcasting cartoons when the coup began to unravel. So Chavez's broadsides against media magnates touched a nerve with many of his supporters, but when he began to berate individual journalists, it looked like bullying.

It was also understandable that Chavez was wary of the US. As a devourer of history books, he knew that the US had undermined and destabilised many left-wing Latin American governments; and, sure enough, the Bush administration embraced the coup against Chavez. But Chavez's desire to build a Third World coalition against the US "empire" led him to embrace many unsavoury leaders, from Gaddafi to Bashar al-Assad – an association that tarnished Venezuela which, in fact, held fair elections and respected human rights.

Perhaps the greatest error was that of his closest supporters who failed to criticise Chavez openly. Their behaviour did not reflect the vigorous debate taking place. Chavez's early death may help the Venezuelan revolution avoid the fate of Cuba – stultifying ossification – because an open debate about the future of the movement will be possible.

In his last few weeks, as Chavez lost his battle against cancer, he could be content that thousands of Venezuelans had learnt to stand up for their rights and that Latin America is now far more united than at any time in its history. He did not face the lonely and disillusioned end of his hero Simon Bolivar, the 19th-century Venezuelan independence leader, who died lamenting: "America is ungovernable. He who has served the revolution has ploughed the sea."

For all his flaws, Chavez will be remembered as one of the towering figures of Latin America history, alongside Salvador Allende, Che Guevara, Fidel Castro and, of course, his revered Simon Bolivar.

Everybody Hurts - aka Weltschmertz

By Pritish Nandy in the Times of India

We all live with weltschmerz in these difficult times. There's no exact translation of this charming word coined by Jean Paul Richter in 1810. What it suggests is a kind of world weariness that has entered our lives. What you can call a universal pain. Everyone lives with it and yet everyone is in denial of it. That's why we have this great love affair with the entertainment business. Movies. Broadway. Vegas. The IPL. Formula One. We are living in the greatest era of escapism simply because we live in the greatest era of pain.

This pain is not always personal. It's not just about you and me and those who we love. You see it in the eyes of the urchin who comes begging to you at a street corner. She has lost her childhood, her innocence. You see it in the eyes of those who work for you at home, cooking, cleaning, washing your clothes, or taking your well groomed dogs out for a walk. Each one of them, however well you may take care of them, dreams that one day they will walk away to be their own master. You see it in the eyes of your colleagues at work, however enthusiastic they may be about what they do. The long travel to work, the pitiable condition of public transportation, the missing footpaths, the growing pollution, the problems with putting kids through school and college, the frequent confrontations over rent, power, water, tax: everything contributes to this weltschmerz. It's everywhere.

I see it in parties and film premieres too. There's something very tragic in watching middle aged men and women dressed in absurd designer togs, their hair dyed and faces botoxed, prancing around like teenagers and pretending to have a great time. There are more sad-eyed drunks and dope heads there than in the dance bars of suburban Mumbai or the glitzy discotheques of five star hotels. While the real youngsters of this generation, equally sad-eyed, shot and lonely, are racing down empty Mumbai roads late at night on rented souped up bikes trying to prove their machismo. They challenge danger because they find it tougher to challenge life. They hide their pain by escaping it. So do their parents who helplessly watch them suffer, knowing that sermons don't help.

The day we all realise this, that the rich is in as much pain as the poor, that the employer is having as tough a time as the employee, that the cop who asks you for a bribe lives as sad a life as you, the pickpocket you catch has risked being lynched because he has no other alternative means of livelihood, that the movie star you idolise is as lonely as you are, that the one who brutalises you is perhaps as brutalised by life as you are, the less we will seek to blame others for our fate. You will feel less anger against that guy in the tax office who asks you for a bribe when you realise he is still paying back, after ten years on his job, his father's debt for getting him the job. We are lucky. The Americans are consuming today what their next 13 generations will have to pay for. The Greeks will be lucky if their next generation can survive their current crisis.

We have, all of us, mortgaged our futures to pay for being around. No, I am not saying this. Ask anyone who understands economics or the environment and they will tell you this. Yet man bravely strides ahead. As we flirt with more pain, more danger, we discover more and more ways to seek gratification, more technology to flaunt, more entertainment to excite us and, most important, more dreams to chase. So we pursue new ways to earn more money, grow more food, hunt down more pleasures, seek to extend our life spans. British scientists recently declared that by 2050 we will find a way to overcome mortality.
This is the miracle of our times. Even as most things go wrong, man's ingenuity to seek hope and happiness keeps improving. But where we fail most is in sustaining relationships. The best companies collapse, as do the best marriages, the best rock groups, the most intense relationships because our weltschmerz makes us lonely islands of pain. That's why last week, when R.E.M broke up after 31 years, I remembered their most popular song, which became the anthem of our times. Everybody hurts. Yes, everybody hurts. And that is why we hurt each other so much.

How many inquiries do we need?

By Andrew Gilligan in The Telegraph

8:50PM BST 21 Jul 2011

After the past three extraordinary weeks, do you know how many inquiries have now been spawned by the hacking scandal? The answer – unless I have missed some – is 13. As well as the Leveson inquiry, in two separate parts, there are: two criminal inquiries, Elveden and Weeting; two parliamentary inquiries, one now concluded, by the home affairs and media select committees; inquiries by the Independent Police Complaints Commission and the Inspectorate of Constabulary; a probe by the former parliamentary watchdog Elizabeth Filkin into relationships between the police and the media; an inquiry by the Met’s directorate of professional standards; a News International internal inquiry; a Press Complaints Commission review; and, finally, my own personal favourite: an inquiry into how the Commons security authorities can best interdict future supplies of shaving foam. All British scandals tumble eventually into farce. What a tribute to the information age that this one is toying with it already.

On top of all this, there is talk of further action by the Metropolitan Police Authority, the London Assembly, the Serious Fraud Office and HM Revenue and Customs. And that is without the inquiries likely to begin in America. Soon, I predict, there will be more people investigating the News of the World than actually worked for it, and the only official bodies not scrutinising the despicable crimes of the rogue Murdoch regime will be the Drinking Water Inspectorate and the Care Council for Wales.

Yet as the scandal begins to cede the top slot on the news, I sense that more and more people are asking: has
this gone too far? Four days ago, as John Yates, the Met’s assistant commissioner, was forced to resign, even the crime correspondent of the Guardian, the paper whose admirable journalism and persistence opened the Augean stable doors, called the affair a “mad witch-hunt of a story” which had claimed “another decent copper”.

The danger of this extraordinary brood of inquiries is twofold. First, they crash against each other like dodgems in a rink. Witnesses are already refusing to answer questions because it might prejudice their case before other inquiries. Second, they will leave nobody in power or in the police with time to do their actual jobs – jobs that concern more important matters than phone hacking. John Yates ran Britain’s counter-terrorism effort, which has now been decapitated. Let us cross our fingers that no terror attack occurs while his successor is still learning the ropes.

Mr Yates, by his own admission, didn’t look carefully enough at the Guardian’s new allegations of hacking. But he did have the country to protect from al-Qaeda at the time. And as I watched him being attacked by that well-known pillar of virtue, Keith Vaz MP, as an “unconvincing” witness to Mr Vaz’s home affairs committee, I thought: I would rather have 50 John Yateses than one Keith Vaz.

Older readers may remember that while John Yates has been found guilty of nothing, Mr Vaz is the man who received one of the longest Commons suspensions on record – for actively obstructing, not just neglecting, an official investigation. On the day that Sir Paul Stephenson, Yates’s boss, resigned as Met commissioner after taking free stays at the Champneys health spa from a friend, Stephen Purdew, Mr Vaz appeared on television to praise Sir Paul for “accepting responsibility”. Mr Vaz neglected to mention that he, too, is a personal friend of Mr Purdew’s, attended his wedding, endorsed one of his other spas and has himself stayed at Champneys.

Throughout the crisis, too, a certain Alastair Campbell has been touring the television studios in his exciting new role as an apostle of truth and enemy of Rupert Murdoch. Mr Campbell has provided much amusement for politicians and journalists – but has the poor man not even an atom of self-awareness?

Last week, almost entirely unnoticed amid the Dresden-like firestorm, there emerged perhaps the most significant evidence yet about an earlier phase of Mr Campbell’s career. The Chilcot inquiry into the Iraq war published the testimony of a senior MI6 officer that “there were from the outset concerns” in the intelligence service about “the extent to which the intelligence could support some of the judgments that were being made” in Tony Blair’s famous WMD dossier. Note those words: from the outset.

What that shows us is not just that our worst fears over the dossier were correct. It also shows just how misplaced may be our hopes in the current slew of hacking inquiries. Over Iraq, there were a mere five inquiries – none, interestingly, operating under oath, though the hacking inquiry will. Clearly, the lies and misjudgments that caused the deaths of 150,000 people are not quite as serious a matter as journalists intercepting voicemails.

But the striking fact is that despite all those inquiries, last week’s potentially conclusive piece of evidence has only just come out – nine years after the dossier was published. We hoped that earlier inquiries would yield the truth about Iraq and punish those responsible. Broadly, they did not. They did reveal a great deal of valuable information but in their own findings, the inquiries glossed over that evidence, and held back from the conclusions it warranted.

Nor is that in any way unusual. Of course, some much-anticipated judicial inquiries do achieve what is widely accepted as justice. But many others have been, by consensus unsatisfactory – Lord Devlin’s 1950s inquiry into British massacres of the Mau Mau; Lord Denning on Profumo; Widgery into Bloody Sunday; Scott on arms-to-Iraq; and Hutton.

Still others, while less controversial at the time, have proved damaging: the last big inquiry into the police, Lord Macpherson’s into the death of Stephen Lawrence, wielded too broad a brush, painting the entire Met as institutionally racist. The destabilising effect of Macpherson’s judgment on force morale, and therefore on crime, was considerable. And inquiries can cost enormous amounts of money. The second inquiry into Bloody Sunday, by Lord Saville, lasted 12½ years and cost almost £200 million.

Inquiries do, of course, go down paths that can be deeply uncomfortable for everyone, government included. But broadly, each of these inquiries found more or less what the governments who set them up wanted them to find – that no one was wrongly killed on Bloody Sunday, that the Iraq intelligence had not been misrepresented, that the Met was insufficiently progressive and needed a kicking.

The various Iraq inquiries were additionally used by the Blair government, and its supporters, as ways of attacking its enemies. As a witness in them myself, and watching the grilling of my source, David Kelly, I developed a particularly low opinion of the partisan hectoring of the foreign affairs committee, under its Labour loyalist chairman Donald Anderson (a worthy predecessor of Keith Vaz).

It is quite clear what the Government wants this inquiry to find. Though press, police and politicians are almost equally at fault, Lord Leveson’s remit is simply to “inquire into the culture, practices, and ethics of the press”. Leveson has also been asked to investigate the “relationships between national newspapers and politicians”. But several anti-hacking campaigners and the lawyer for Milly Dowler’s family protest that there is no mention of officials and special advisers such as Andy Coulson and Alastair Campbell.

Leveson’s first task is to “make recommendations for a new, more effective policy and regulatory regime” on the press: in other words, how they should be forced to behave. As far as the police and politicians are concerned, however, he will only make recommendations for their “future conduct” – how they should merely be asked to behave.

Yet hacking was not a failure of press regulation. There already is a rather strong regulation against hacking people’s telephones – the law. And no future press regulator, however strong, could possibly have the power to kick down doors at newspapers, seize emails and question journalists under caution. Those are police powers – powers which the police had, but refused to exercise.

Over virtually every issue that judges have inquired into, it was the media that got more of the facts, more quickly, than any Lord Justice. Now, however, with regulation coming and the likes of Keith Vaz in the driving seat, getting the facts will be harder. Not for nothing is the phrase “judge-led inquiry” one of the scariest in the language.