Now and Later

When I was a kid I liked a synthetically fruity candy called, Now and Later. Unfortunately, what I am about to share isn't nearly as sweet.


In recent weeks we have heard a lot about "COVID Fatigue" and the fact that the pandemic is over and we are "learning to live with the virus." My response is, well maybe., and how well are we going to live? With something like a coronavirus, which a lot of people - usually non-medical commentators - equate with flu, the potential for longer term pathology is not only different, but in a broader sense, potentially worse.


Some recent and ongoing studies indicate that it is not just individuals who had severe illness that are affected. In fact, according to an evaluation available at the National Library of Medicine Long COVID: An overview (nih.gov) of the individuals affected, about 80% had mild to moderate disease. So, focusing just on the acute risk of death and disability may actually lead to greater issues in the long term. To truly get this, it helps to understand how COVID works on a body.


Exhibit A: Pathology , or how it impacts the body.

An Immuno-Cardiac Model for Macrophage-Mediated Inflammation in COVID-19 Hearts | Circulation Research (ahajournals.org)

This referenced article explains the potential mechanism of autoimmune factors affecting the heart. In short, the virus activates certain chemical triggers that set off the body's own attack mechanisms against the tissue of the heart.

According to the Mayo Clinic, common signs and symptoms that may indicate Long COVID include:

  • Fatigue

  • Shortness of breath or difficulty breathing

  • Cough

  • Joint pain

  • Chest pain

  • Memory, concentration or sleep problems

  • Muscle pain or headache

  • Fast or pounding heartbeat

  • Loss of smell or taste

  • Depression or anxiety

  • Fever

  • Dizziness when you stand

  • Worsened symptoms after physical or mental activities


Exhibit B: It's not a respiratory illness.... not really

Coronaviruses are transmitted via droplets, certainly, but the impact on the body is not really due entirely to its effect on the lung. According to studies at the NIH, "The SARS-CoV-2 virus uses the ACE2 receptor (ACE2) to enter type 2 pneumocytes ( lung cells), macrophages ( white blood cells), perivascular pericytes (tissue), and cardiomyocytes (heart cells). This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction. In addition, ACE2 is expressed in several other organs including cells lining the blood vessels (endothelial cells)..." LOnger-term Effects of COVID-19 INfection on Blood Vessels And Blood pRessure (LOCHINVAR) - Full Text View - ClinicalTrials.gov


This slide taken from an article by Janardhan et al. Illustrates the point nicely

COVID-19 as a Blood Clotting Disorder Masquerading as a Respiratory Illness: A Cerebrovascular Perspective and Therapeutic Implications for Stroke Thrombectomy - PubMed (nih.gov)

J Neuroimaging. 2020 Sep;30(5):555-561. doi: 10.1111/jon.12770.Epub 2020 Aug 18.



What this means is that blood vessels are affected. That makes sense when one looks at the symptoms described by Long COVID patients. The cases of brain fog, confusion, fatigue, paroxysmal tachycardia (sudden onset rapid heart rate) stroke, heart attacks, liver function problems, and endocrine isses such as diabetes onset appear to have a connection to inflammation, and blood vessel issues. In some people, lasting health effects may include long-term breathing and heart problems, chronic kidney impairment, stroke and Guillain-Barre syndrome — a condition that causes temporary paralysis.


It's not just old sick people.

A new study published by the Centers for Disease Control & Prevention (CDC) indicates that children who have had COVID-19 may face an increased risk of developing diabetes. The results of the study coincide with what many researchers in Europe are reporting as well.

Risk for Newly Diagnosed Diabetes 30 Days After SARS-CoV-2 Infection Among Persons Aged 18 Years — United States, March 1, 2020–June 28, 2021 | MMWR (cdc.gov)


So what can you do?

First, even if you or your child did not have severe illness or were asymptomatic and found out you had COVID because of a test, self monitor, and if you have concerns, see a physician with exoertise in Internal Medicine. If you had COVID, tell them. If you are not sure, your provider will know what to do to rule out other causes.


Be your own advocate. If the pandemic has taught us anything, it is that with the stresses on the health care system a patient really has to be an active member of their own care team. Hopefully this infomation will bolster that.


Be well.



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