COVID-19 in Trinidad & Tobago (Local Updates & Discussions Only)

[shake d livin wake d dead]

Didnt get anything regarding numbers after the 2650 figure

[Dohplaydat]

Didnt get anything regarding numbers after the 2650 figure

Thanks Shakes, that implies we are definitely averaging over 100 cases a day.

Any word on if the dining in at bars/resturants, gyms and cinemas will be revoked after 28 days? Spacing out persons and wearing masks when needed can be ok. Most of the UK is doing so for almost 2 months (July 4th) and there's been no serious 2nd wave.

https://www.bbc.com/news/business-52977388



Honestly, without any more government grants these businesses suffering immensely. Seeing quite a few closing up (temporarily in some cases) but a few owners are saying things are unbearable hard for them right now.

[redmanjp]

^ doh know how u can wear masks and drink rum or eat at d same time padna. we need to go back down to sporadic cases where ALL cases can be traced and none of unknown origin- no community spread.

we have about 5000 bars. does a small country like ours really need so much? maybe it's a good thing that some closing. there isn't going to be a 'back to normal' until a vaccine reach, or we have a very good treatment available- opening up these places may work for a few weeks until one person goes into a bar takes off their mask to drink and starts the next wave. these places are recognized as the highest risk globally- ppl in the UK may be more disciplined to socially distance but no not trinis.

[pugboy]

16 more 1 dead

[K74T]

[adnj]

Didnt get anything regarding numbers after the 2650 figure

Thanks Shakes, that implies we are definitely averaging over 100 cases a day.

Any word on if the dining in at bars/resturants, gyms and cinemas will be revoked after 28 days? Spacing out persons and wearing masks when needed can be ok. Most of the UK is doing so for almost 2 months (July 4th) and there's been no serious 2nd wave.

https://www.bbc.com/news/business-52977388



Honestly, without any more government grants these businesses suffering immensely. Seeing quite a few closing up (temporarily in some cases) but a few owners are saying things are unbearable hard for them right now.

The UK has a case prevalence 3x that of TTO. Their death prevalence is 25x. The virus has already affected a larger percentage of the UK population by comparison.

[redmanjp]

you know what's fun? reading covid19 trip reports like the one below (not mine)

Two weeks of fever never coming down below 38°C; not much compared to a stay in the ICU under ventilator, or god forbid, induced coma, but still the sickest I've ever been, a good deal worse than a classic flu, with a much longer rehabilitation period.

Always shivering, as in tumble drying a pair of clogs when I wasn't sweating profusely. I had 4 t-shirts on rotation, air drying between wearing them, to hell with the funk, I'd be looking at washing a dozen t-shirts a day otherwise.
The hardest part was not knowing when it would end, that took a toll. Ten days in is when you start thinking this could be permanent, or you read about all those cases where after a week they felt better until suddenly they were much worse and died within 24 hours. Fun stuff.

I filled out an online questionnaire and when answering as truthfully I could I got the answer I wanted, that is to stay home and wait it out. But modifying a single answer and the recommendation would invariably be to get myself checked at a hospital. Which. I. Did. Not. Want. To.
How do you gauge your breathing anyway when you have a fever and hardly had a thing to eat in a week?

Worst part was I think day 12, I thought I felt better and hadn't taken any paracetamol for several hours so I took a hopeful reading .. of 39.2°. God damnit, I'd gotten so used to running a fever I could even feel it anymore (my baseline is 36° which is low but not unusual).
And then 2 days later the fever dropped under 38 and stayed there.

One weird but well attested thing is how you stop caring about stuff after a while, it's as if someone had entered the control room and flicked off every switch.
When the fever dropped and stayed down there was none of the relief you can feel after a classic flu when you feel your strength and appetite suddenly come back?
No I had to manually and deliberately flick the switches back on, starting with food. I had to tell myself I wanted this. I concentrated on the voluntary act of eating for a couple of days before my body remembered it was hungry.
I hoped that would send the ball rolling, but no, I more or less had to do this voluntary act with every aspect of daily life.
I was looking at my latest toy I hadn't even tested yet trying to feel excited about it.
Thankfully I was on vacation so I didn't have to think about going back to work, and eventually I got all the gears turning.
A small blessing was I could kick a few bad habits, I was drinking too much beer and I'm ashamed to admit I had a very real addiction to Lakerol pastilles (they replaced my prior nicotine addiction, go me) simply by not flicking that switch.

Another thing I'm thankful for is that when we visited my mother in law, 83, we insisted on staying outside and I kept my distance physically and did not hug her goodbye, which was pretty awkward and contrived at the time. This was less than a week before I came down the the rona..

Tested positive for antibodies in case you wonder, my coworker who was sick at the same time as me but with much milder symptoms tested positive for the virus so I absolutely expected it, but mostly I wanted it to be official.

The only thing that bothers me is I suspect I might have degraded lung functionality after all, I'll have to get it checked eventually but it's really hard to gauge what is Covid damage and what is simple middle age.

if say for everyone that dies there are 10 with some type of permanent damage or health issues, how much ppl we looking at so far? 300?

[paid_influencer]

Most of the UK is doing so for almost 2 months (July 4th) and there's been no serious 2nd wave.

https://www.bbc.com/news/business-52977388

that article is dated August 4. We are now at September 6 and the UK and most of Europe is in a full-blown second wave.

[Dohplaydat]

Didnt get anything regarding numbers after the 2650 figure

Thanks Shakes, that implies we are definitely averaging over 100 cases a day.

Any word on if the dining in at bars/resturants, gyms and cinemas will be revoked after 28 days? Spacing out persons and wearing masks when needed can be ok. Most of the UK is doing so for almost 2 months (July 4th) and there's been no serious 2nd wave.

https://www.bbc.com/news/business-52977388



Honestly, without any more government grants these businesses suffering immensely. Seeing quite a few closing up (temporarily in some cases) but a few owners are saying things are unbearable hard for them right now.

The UK has a case prevalence 3x that of TTO. Their death prevalence is 25x. The virus has already affected a larger percentage of the UK population by comparison.

I agree, but you're trusting our local stats too much here. And secondly, herd immunity is still far from achieved in the UK. Yet the entire country is moreless back to normal.

[pugboy]

Not to mention out curve is a vertical line and icu facilities are packed.

[adnj]

Didnt get anything regarding numbers after the 2650 figure

Thanks Shakes, that implies we are definitely averaging over 100 cases a day.

Any word on if the dining in at bars/resturants, gyms and cinemas will be revoked after 28 days? Spacing out persons and wearing masks when needed can be ok. Most of the UK is doing so for almost 2 months (July 4th) and there's been no serious 2nd wave.

https://www.bbc.com/news/business-52977388



Honestly, without any more government grants these businesses suffering immensely. Seeing quite a few closing up (temporarily in some cases) but a few owners are saying things are unbearable hard for them right now.

The UK has a case prevalence 3x that of TTO. Their death prevalence is 25x. The virus has already affected a larger percentage of the UK population by comparison.

I agree, but you're trusting our local stats too much here. And secondly, herd immunity is still far from achieved in the UK. Yet the entire country is moreless back to normal.

Actually, the opposite. The UK tests about 2500/M ppl each day. With a daily infection rate of less than 20. Their confirmed rate of infection is less than 1%.

Trinidad doesn't provide their raw testing data and there is no random testing. The confirmed rate of infection is about 10%. To keep up with the UK, TTO would be have to run their labs at about 50x the rate that seems apparent. I don't believe that will occur. Nor do I believe that vaccination logistics will be adequately in place until 4 to 6 months after the approval of a vaccine with moderate storage temperature requirements.

Insufficient testing, high rate of positives, community spread, and a low number of related deaths equates to a population that is at risk for runaway infection.

The only mitigating action is to limit mobility, contact and exposure.

[Dohplaydat]

Didnt get anything regarding numbers after the 2650 figure

Thanks Shakes, that implies we are definitely averaging over 100 cases a day.

Any word on if the dining in at bars/resturants, gyms and cinemas will be revoked after 28 days? Spacing out persons and wearing masks when needed can be ok. Most of the UK is doing so for almost 2 months (July 4th) and there's been no serious 2nd wave.

https://www.bbc.com/news/business-52977388



Honestly, without any more government grants these businesses suffering immensely. Seeing quite a few closing up (temporarily in some cases) but a few owners are saying things are unbearable hard for them right now.

The UK has a case prevalence 3x that of TTO. Their death prevalence is 25x. The virus has already affected a larger percentage of the UK population by comparison.

I agree, but you're trusting our local stats too much here. And secondly, herd immunity is still far from achieved in the UK. Yet the entire country is moreless back to normal.

Actually, the opposite. The UK tests about 2500/M ppl each day. With a daily infection rate of less than 20. Their confirmed rate of infection is less than 1%.

Trinidad doesn't provide their raw testing data and there is no random testing. The confirmed rate of infection is about 10%. To keep up with the UK, TTO would be have to run their labs at about 50x the rate that seems apparent. I don't believe that will occur. Nor do I believe that vaccination logistics will be adequately in place until 4 to 6 months after the approval of a vaccine with moderate storage temperature requirements.

Insufficient testing, high rate of positives, community spread, and a low number of related deaths equates to a population that is at risk for runaway infection.

The only mitigating action is to limit mobility, contact and exposure.

I agree that our testing rate absolutely sucks.

However, do not look at the UK as a whole. The UK has many cities similar sized populations to TT, with everything open for more than 2 months now, yet there isn't an explosion of cases like here? Cities that haven't been hit hard by Covid in the first wave as well.

It seems to me be that we might be going through our peak right now which typically lasts a month.

I'm not questioning the lockdowns, i do believe we need them. But I'm asking how is it that cities that are more congestied, far colder, more time spent indoors in crowds, with similar population sizes, with more testing.......but are having far less cases than us.

[MaxPower]

I'm not questioning the lockdowns, i do believe we need them. But I'm asking how is it that cities that are more congestied, far colder, more time spent indoors in crowds, with similar population sizes, with more testing.......but are having far less cases than us.

Hello DPD,

Culture is the answer to your question.

[De Dragon]

During this time of great uncertainty, it has been very disappointing to see some of the reactions here to the sobering statistics recently. There seems to be a general sense of "glee" or "I told you so" which is tied to one's political beliefs. As far as I can tell, the coronavirus has not targeted PNM or UNC or Hispanic people exclusively. Even though this is just an ole talk forum and I really should not expect much in the way of intelligence, this forum represents a snapshot of people's thinking and it leaves a lot to be desired. I totally agree that the government has made mistakes, as have many citizens as well who have contributed to our predicament. I do not profess to be a person with a medical background, epidemiologist, statistician or government official, so my only recourse is to use common sense in interacting in the new world order in which we find ourselves.

I don't give a fack about your disappointment! Mistakes? LYING and deliberately covering up, manipulating data, and massaging positive case numbers is not a facking mistake, it is pure EVIL! This is why successive GORTT's have come to view themselves as untouchable, and operate with an air of arrogance. They know that because we don't hold them accountable, or only do so every 5 years, that they can act with impunity. PNM did that level of evil, but JUHN Scarfy says' iz time to unite gaainst Covid" and like docile, brainless sheep we should shut up and take it? You can do that if you want, but many people aren't taking this sheit lightly.

[De Dragon]

^ doh know how u can wear masks and drink rum or eat at d same time padna. we need to go back down to sporadic cases where ALL cases can be traced and none of unknown origin- no community spread.

we have about 5000 bars. does a small country like ours really need so much? maybe it's a good thing that some closing. there isn't going to be a 'back to normal' until a vaccine reach, or we have a very good treatment available- opening up these places may work for a few weeks until one person goes into a bar takes off their mask to drink and starts the next wave. these places are recognized as the highest risk globally- ppl in the UK may be more disciplined to socially distance but no not trinis.

I love how your persistent in your view that only bars are causing Covid-19 spread I also love how casually you dismiss someone losing their livelihood as a "good thing" It's almost as if you really believe that these bar owners are a single entity, with absolutely no one counting on them for their own livelihood as well, such as spouses, children, employees etc.

[matr1x]

^ doh know how u can wear masks and drink rum or eat at d same time padna. we need to go back down to sporadic cases where ALL cases can be traced and none of unknown origin- no community spread.

we have about 5000 bars. does a small country like ours really need so much? maybe it's a good thing that some closing. there isn't going to be a 'back to normal' until a vaccine reach, or we have a very good treatment available- opening up these places may work for a few weeks until one person goes into a bar takes off their mask to drink and starts the next wave. these places are recognized as the highest risk globally- ppl in the UK may be more disciplined to socially distance but no not trinis.

I love how your persistent in your view that only bars are causing Covid-19 spread I also love how casually you dismiss someone losing their livelihood as a "good thing" It's almost as if you really believe that these bar owners are a single entity, with absolutely no one counting on them for their own livelihood as well, such as spouses, children, employees etc.

Because redman sounds retarded. Dumb people can't think further than the next letter in their name

[FrankChag]

[matr1x]

Almost all who died had some sort of pre existing condition. Most who get covid 19 will be fine.

[shake d livin wake d dead]

Why are you all comparing European testing to us???

[bluefete]

if say for everyone that dies there are 10 with some type of permanent damage or health issues, how much ppl we looking at so far? 300?

Almost all who died had some sort of pre existing condition. Most who get covid 19 will be fine.

That is the main worry right now.

It has been shown that Covid leaves many survivors with some sort of permanent damage to their lungs. Of course, this is never mentioned by the relevant authorities because not enough "studies" have been done.

This was posted since April 2020. Do not get tied up by the information they are giving us.

https://www.hopkinsmedicine.org/health/ ... -the-lungs

What Coronavirus Does to the Lungs

Panagis Galiatsatos, M.D., M.H.S.

Like other respiratory illnesses, COVID-19, the disease caused by the new coronavirus, can cause lasting lung damage. As we continue to learn about COVID-19, we’re understanding more regarding how it affects the lungs while people are sick and after recovery.

Panagis Galiatsatos, M.D., M.H.S., is an expert on lung disease at Johns Hopkins Bayview Medical Center and sees patients with COVID-19. He explains some of the short- and long-term lung problems brought on by the new coronavirus.

What type of damage can coronavirus cause in the lungs?
COVID-19, the disease caused by the new coronavirus, can cause lung complications such as pneumonia and, in the most severe cases, acute respiratory distress syndrome, or ARDS. Sepsis, another possible complication of COVID-19, can also cause lasting harm to the lungs and other organs.

COVID-19 Pneumonia
In pneumonia, the lungs become filled with fluid and inflamed, leading to breathing difficulties. For some people, breathing problems can become severe enough to require treatment at the hospital with oxygen or even a ventilator.

The pneumonia that COVID-19 causes tends to take hold in both lungs. Air sacs in the lungs fill with fluid, limiting their ability to take in oxygen and causing shortness of breath, cough and other symptoms.

While most people recover from pneumonia without any lasting lung damage, the pneumonia associated with COVID-19 may be severe. Even after the disease has passed, lung injury may result in breathing difficulties that might take months to improve.

Acute Respiratory Distress Syndrome (ARDS)
As COVID-19 pneumonia progresses, more of the air sacs become filled with fluid leaking from the tiny blood vessels in the lungs. Eventually, shortness of breath sets in, and can lead to acute respiratory distress syndrome (ARDS), a form of lung failure. Patients with ARDS are often unable to breath on their own and may require ventilator support to help circulate oxygen in the body.

Whether it occurs at home or at the hospital, ARDS can be fatal. People who survive ARDS and recover from COVID-19 may have lasting pulmonary scarring.

Sepsis
Another possible complication of a severe case of COVID-19 is sepsis. Sepsis occurs when an infection reaches, and spreads through, the bloodstream, causing tissue damage everywhere it goes.

“Lungs, heart and other body systems work together like instruments in an orchestra,” Galiatsatos says. “In sepsis, the cooperation between the organs falls apart. Entire organ systems can start to shut down, one after another, including the lungs and heart.”

Sepsis, even when survived, can leave a patient with lasting damage to the lungs and other organs.

Superinfection
Galiatsatos notes that when a person has COVID-19, the immune system is working hard to fight the invader. This can leave the body more vulnerable to infection with another bacterium or virus on top of the COVID-19 — a superinfection. More infection can result in additional lung damage.

Three Factors in Coronavirus Lung Damage
Galiatsatos notes three factors that affect the lung damage risk in COVID-19 infections and how likely the person is to recover and regain lung function:

Disease severity. “The first is the severity of the coronavirus infection itself — whether the person has a mild case, or a severe one,” Galiatsatos says. Milder cases are less likely to cause lasting scars in the lung tissue.

Health conditions. Galiatsatos says, “The second is whether there are existing health problems, such as chronic obstructive pulmonary disease (COPD) or heart disease that can raise the risk for severe disease.” Older people are also more vulnerable for a severe case of COVID-19. Their lung tissues may be less elastic, and they may have weakened immunity because of advanced age.

Treatment. “Treatment is the third factor,” he says. “A patient’s recovery and long-term lung health is going to depend on what kind of care they get, and how quickly.” Timely support in the hospital for severely ill patients can minimize lung damage.

Can coronavirus patients lessen the chance of lung damage?
There are things patients can do to increase their chances for less severe lung damage, Galiatsatos says.

“If you have a health issue that puts you at higher risk, make sure you’re doing everything you can to minimize that. For example, people living with diabetes, COPD or heart disease should be especially careful to manage those conditions with monitoring and taking their medications as directed.”

Galiatsatos adds that proper nutrition and hydration can also help patients avoid complications of COVID-19. “Staying well fed is important for overall health. Proper hydration maintains proper blood volume and healthy mucous membranes in the respiratory system, which can help them better resist infection and tissue damage.”

Is COVID-19 lung damage reversible?
After a serious case of COVID-19, a patient’s lungs can recover, but not overnight. “Recovery from lung damage takes time,” Galiatsatos says. “There’s the initial injury to the lungs, followed by scarring. Over time, the tissue heals, but it can take three months to a year or more for a person’s lung function to return to pre-COVID-19 levels.”

He notes that doctors and patients alike should be prepared for continuing treatment and therapy.

“Once the pandemic is over, there will be a group of patients with new health needs: the survivors. Doctors, respiratory therapists and other health care providers will need to help these patients recover their lung function as much as possible.”

Posted April 13, 2020

[pugboy]

allyuh remember the trotman woman who say this is gonna be a mild mild flu ?

[adnj]

Didnt get anything regarding numbers after the 2650 figure

Thanks Shakes, that implies we are definitely averaging over 100 cases a day.

Any word on if the dining in at bars/resturants, gyms and cinemas will be revoked after 28 days? Spacing out persons and wearing masks when needed can be ok. Most of the UK is doing so for almost 2 months (July 4th) and there's been no serious 2nd wave.

https://www.bbc.com/news/business-52977388



Honestly, without any more government grants these businesses suffering immensely. Seeing quite a few closing up (temporarily in some cases) but a few owners are saying things are unbearable hard for them right now.

The UK has a case prevalence 3x that of TTO. Their death prevalence is 25x. The virus has already affected a larger percentage of the UK population by comparison.

I agree, but you're trusting our local stats too much here. And secondly, herd immunity is still far from achieved in the UK. Yet the entire country is moreless back to normal.

Actually, the opposite. The UK tests about 2500/M ppl each day. With a daily infection rate of less than 20. Their confirmed rate of infection is less than 1%.

Trinidad doesn't provide their raw testing data and there is no random testing. The confirmed rate of infection is about 10%. To keep up with the UK, TTO would be have to run their labs at about 50x the rate that seems apparent. I don't believe that will occur. Nor do I believe that vaccination logistics will be adequately in place until 4 to 6 months after the approval of a vaccine with moderate storage temperature requirements.

Insufficient testing, high rate of positives, community spread, and a low number of related deaths equates to a population that is at risk for runaway infection.

The only mitigating action is to limit mobility, contact and exposure.

I agree that our testing rate absolutely sucks.

However, do not look at the UK as a whole. The UK has many cities similar sized populations to TT, with everything open for more than 2 months now, yet there isn't an explosion of cases like here? Cities that haven't been hit hard by Covid in the first wave as well.

It seems to me be that we might be going through our peak right now which typically lasts a month.

I'm not questioning the lockdowns, i do believe we need them. But I'm asking how is it that cities that are more congestied, far colder, more time spent indoors in crowds, with similar population sizes, with more testing.......but are having far less cases than us.

TTO is going through a peak in cases according to projections.

The flaw in the logic of your comparison is that you did not deduce that a nationwide rate of infection that is three times higher for the nation as a whole is likely even higher in areas of increased population density. In fact, while the UK and TTO have a very similar population density, a similarly sized city such as Birmingham (about 1M ppl) has a population density that is about ten times higher.

Infection opportunities go up with population density and down with the total time since introduction, all other things being equal.

[shake d livin wake d dead]

allyuh remember the trotman woman who say this is gonna be a mild mild flu ?

Noticed how she just walked away into the sunset and was never seen again

[zoom rader]

During this time of great uncertainty, it has been very disappointing to see some of the reactions here to the sobering statistics recently. There seems to be a general sense of "glee" or "I told you so" which is tied to one's political beliefs. As far as I can tell, the coronavirus has not targeted PNM or UNC or Hispanic people exclusively. Even though this is just an ole talk forum and I really should not expect much in the way of intelligence, this forum represents a snapshot of people's thinking and it leaves a lot to be desired. I totally agree that the government has made mistakes, as have many citizens as well who have contributed to our predicament. I do not profess to be a person with a medical background, epidemiologist, statistician or government official, so my only recourse is to use common sense in interacting in the new world order in which we find ourselves.

I don't give a fack about your disappointment! Mistakes? LYING and deliberately covering up, manipulating data, and massaging positive case numbers is not a facking mistake, it is pure EVIL! This is why successive GORTT's have come to view themselves as untouchable, and operate with an air of arrogance. They know that because we don't hold them accountable, or only do so every 5 years, that they can act with impunity. PNM did that level of evil, but JUHN Scarfy says' iz time to unite gaainst Covid" and like docile, brainless sheep we should shut up and take it? You can do that if you want, but many people aren't taking this sheit lightly.

A nation that was conned good and proper. PNM fools said they handle the covid very well.

Yet still these clowns try all hope to rebutt PNM on the mess they made.

Another clowns comes on here to say UNC responsible for Covid.

A selfish government that has put peoples health in danger and folks has died all in favour of high voter turnout.

Stupid country filled with stupid PNM people

[j.o.e]

allyuh remember the trotman woman who say this is gonna be a mild mild flu ?

Well it still is for most people which was her point hence all those asymptomatic and mild people quarantining at home. Her statement was about the symptoms not about the spread

[bluefete]

https://www.sciencemag.org/news/2020/07 ... scientists


Neuroscientist Athena Akrami has had debilitating symptoms since her coronavirus infection more than 4 months ago. RYAN LOW

From ‘brain fog’ to heart damage, COVID-19’s lingering problems alarm scientists
By Jennifer Couzin-FrankelJul. 31, 2020 , 1:30 PM

Science’s COVID-19 reporting is supported by the Pulitzer Center and the Heising-Simons Foundation.

Athena Akrami’s neuroscience lab reopened last month without her. Life for the 38-year-old is a pale shadow of what it was before 17 March, the day she first experienced symptoms of the novel coronavirus.

At University College London (UCL), Akrami’s students probe how the brain organizes memories to support learning, but at home, she struggles to think clearly and battles joint and muscle pain. “I used to go to the gym three times a week,” Akrami says. Now, “My physical activity is bed to couch, maybe couch to kitchen.”

Her early symptoms were textbook for COVID-19: a fever and cough, followed by shortness of breath, chest pain, and extreme fatigue. For weeks, she struggled to heal at home. But rather than ebb with time, Akrami’s symptoms waxed and waned without ever going away. She’s had just 3 weeks since March when her body temperature was normal.

“Everybody talks about a binary situation, you either get it mild and recover quickly, or you get really sick and wind up in the ICU,” says Akrami, who falls into neither category. Thousands echo her story in online COVID-19 support groups. Outpatient clinics for survivors are springing up, and some are already overburdened. Akrami has been waiting more than 4 weeks to be seen at one of them, despite a referral from her general practitioner.

The list of lingering maladies from COVID-19 is longer and more varied than most doctors could have imagined. Ongoing problems include fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys, and brain.

The likelihood of a patient developing persistent symptoms is hard to pin down because different studies track different outcomes and follow survivors for different lengths of time. One group in Italy found that 87% of a patient cohort hospitalized for acute COVID-19 was still struggling 2 months later. Data from the COVID Symptom Study, which uses an app into which millions of people in the United States, United Kingdom, and Sweden have tapped their symptoms, suggest 10% to 15% of people—including some “mild” cases—don’t quickly recover. But with the crisis just months old, no one knows how far into the future symptoms will endure, and whether COVID-19 will prompt the onset of chronic diseases.


Doctors and nurses inspect a patient’s scans in Istanbul. Concern is growing that the lungs and other organs can struggle to heal after infection. CHRIS MCGRATH/GETTY IMAGES


Researchers are now facing a familiar COVID-19 narrative: trying to make sense of a mystifying illness. Distinct features of the virus, including its propensity to cause widespread inflammation and blood clotting, could play a role in the assortment of concerns now surfacing. “We’re seeing a really complex group of ongoing symptoms,” says Rachael Evans, a pulmonologist at the University of Leicester.

Survivor studies are starting to probe them. This month, researchers across the United Kingdom including Evans launched a study that will follow 10,000 survivors for 1 year to start, and up to 25 years. Ultimately, researchers hope not just to understand the disease’s long shadow, but also to predict who’s at highest risk of lingering symptoms and learn whether treatments in the acute phase of illness can head them off.

For Götz Martin Richter, a radiologist at the Klinikum Stuttgart in Germany, what’s especially striking is that just as the illness’ acute symptoms vary unpredictably, so, too, do those that linger. Richter thinks of two patients he has treated: a middle-aged man who experienced mild pneumonia from COVID-19, and an elderly woman already suffering from chronic leukemia and arterial disease, who almost died from the virus and had to be resuscitated. Three months later, the man with the mild case “falls asleep all day long and cannot work,” Richter says. The woman has minimal lung damage and feels fine.

EARLY IN the pandemic, doctors learned that SARS-CoV-2, the virus that causes COVID-19, can disrupt a breathtaking array of tissues in the body. Like a key fitting neatly into a lock, SARS-CoV-2 uses a spike protein on its surface to latch onto cells’ ACE2 receptors. The lungs, heart, gut, kidneys, blood vessels, and nervous system, among other tissues, carry ACE2 on their cells’ surfaces—and thus, are vulnerable to COVID-19. The virus can also induce a dramatic inflammatory reaction, including in the brain. Often, “The danger comes when the body responds out of proportion to the infection,” says Adrija Hajra, a physician at Albert Einstein College of Medicine in New York City. She continues to care for those who were infected in the spring and are still recovering.

Despite the novelty of SARS-CoV-2, its long-term effects have precedents: Infections with other pathogens are associated with lasting impacts ranging from heart problems to chronic fatigue. “Medicine has been used to dealing with this problem” of acute viral illness followed by ongoing symptoms, says Michael Zandi, a neurologist at UCL. Even common illnesses such as pneumonia can mean a monthslong recovery. “I see a lot of people who had [the brain inflammation] encephalitis 3, 4 years ago, and still can’t think, or are tired,” Zandi says. Infections with certain bacteria and Zika virus, among others, are linked to Guillain-Barre syndrome, in which the immune system attacks nerve tissue, causing tingling, weakness, and paralysis. (Some cases of Guillain-Barre after COVID-19 have been reported, but “it’s not definite [there’s] a spike,” says Rachel Brown, a UCL neurologist who works with Zandi.)

Based on experience with other viruses, doctors can “extrapolate and anticipate” potential long-term effects of COVID-19, says Jeffrey Goldberger, chief of cardiology at the University of Miami. Like SARS-CoV-2, some other viruses, such as Epstein-Barr, can damage heart tissue, for example. In those infections, the organ sometimes heals completely. Sometimes, scarring is mild. “Or,” Goldberger says, “it could be severe and lead to heart failure.”

Michael Marks, an infectious disease specialist at the London School of Hygiene & Tropical Medicine who’s helping lead the U.K. survivor study, says he’s not too surprised at emerging aftereffects. “What we’re experiencing is an epidemic of severe illness,” he says. “So therefore, there is an epidemic” of chronic illness that follows it.

But outcomes following SARS-CoV-2 also appear distinct in ways both hopeful and dispiriting. Early this year, many doctors feared the virus would induce extensive, permanent lung damage in many survivors because two other coronaviruses, the viruses that cause the first severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome, can devastate the lungs. One study of health care workers with SARS in 2003 found that those with lung lesions 1 year after infection still had them after 15 years.

“We expected to see a lot of long-term damage from COVID-19: scarring, decreased lung function, decreased exercise capacity,” says Ali Gholamrezanezhad, a radiologist at the Keck School of Medicine at the University of Southern California who in mid-January began to review lung scans from COVID-19 patients in Asia. Hundreds of scans later, he has concluded that COVID-19 ravages the lungs less consistently and aggressively than SARS did, when about 20% of patients sustained lasting lung damage. “COVID-19 is in general a milder disease,” he says.

At the same time, the sheer breadth of complications linked to COVID-19 is mind-boggling. In late April, Akrami collaborated with Body Politic, a group of COVID-19 survivors, to survey more than 600 who still had symptoms after 2 weeks. She logged 62 different symptoms and is now readying the findings for publication and developing a second survey to capture longer term ailments. “Even though it’s one virus, it can cause all different kinds of diseases in people,” says Akiko Iwasaki, an immunologist at Yale University who is studying lingering effects on the immune system.

BY NOW IT’S CLEAR that many people with COVID-19 severe enough to put them in a hospital face a long recovery. The virus ravages the heart, for example, in multiple ways. Direct invasion of heart cells can damage or destroy them. Massive inflammation can affect cardiac function. The virus can blunt the function of ACE2 receptors, which normally help protect heart cells and degrade angiotensin II, a hormone that increases blood pressure. Stress on the body from fighting the virus can prompt release of adrenaline and epinephrine, which can also “have a deleterious effect on the heart,” says Raul Mitrani, a cardiac electrophysiologist at the University of Miami who collaborates with Goldberger.

Mitrani and Goldberger, who co-authored a June paper in Heart Rhythm urging follow-up of patients who might have heart damage, worry in particular about the enzyme troponin, which is elevated in 20% to 30% of hospitalized COVID-19 patients and signifies cardiac damage. (Troponin is sky-high during a heart attack, for example.) How the heart heals following COVID-19 might determine whether an irregular heartbeat develops or persists, Goldberger believes. “We have one guy in the hospital right now who had COVID 2 months ago and had all sorts of arrhythmia problems” then, Goldberger says. “He’s recovered from his COVID, but still has the arrhythmia.” For some patients with coronavirus-induced heart problems, treatments as simple as cholesterol-lowering drugs, aspirin, or beta blockers could help, Goldberger says.

Many people the pair has seen with heart complications post–COVID-19 had preexisting conditions, most commonly diabetes and hypertension. COVID-19, Goldberger suspects, tips them into more hazardous terrain or accelerates the onset of heart problems that, absent the coronavirus, might have developed later.

But other patients are affected without apparent risk factors: A paper this week in JAMA Cardiology found that 78 of 100 people diagnosed with COVID-19 had cardiac abnormalities when their heart was imaged on average 10 weeks later, most often inflammation in heart muscle. Many of the participants in that study were previously healthy, and some even caught the virus while on ski trips, according to the authors.

Severe lung scarring appears less common than feared—Gholamrezanezhad knows of only one recovered patient who still needs oxygen at rest. Scarring seems most likely to accompany underlying lung disease, hypertension, obesity, and other conditions. Lung damage is also seen in people who spend weeks on a ventilator. Gholamrezanezhad suspects that, as with harm to the heart, previously healthy people are not exempt from the virus’ long-term effects on the lungs, though their risk is likely lower.

Then there’s the nervous system, a worrying target. Severe complications seem relatively rare but aren’t limited to those whom the virus renders critically ill. Brown, Zandi, and colleagues described 43 people with neurologic complications this month in Brain; many had been hospitalized during their acute infection, but not always for long—and for some, neurologic problems were their most debilitating symptom and the reason for hospital admission. Several were struggling to recover from encephalitis. Others had inflammation in their brain’s white matter, which helps transmit electrical signals.

Separately, doctors are starting to see a class of patients who, like Akrami, struggle to think clearly—another outcome physicians have come upon in the past. After some severe viral infections, there are “those people who still don’t feel quite right afterward, but have normal brain scans,” Brown says. Some neurologists and patients describe the phenomenon as “brain fog.” It’s largely a mystery, though one theory suggests it’s similar to a “postviral fatigue related to inflammation in the body,” Brown says.

Could that be happening here? “Who knows, really?” Brown asks. “These patients need to be followed.”

PEOPLE LIKE THESE pose a growing concern (though they are also often dismissed by physicians). Collectively, these “long-haulers” describe dozens of symptoms, including many that could have multiple causes, such as fatigue, joint pain, and fever. “It’s time to give some voice to this huge population of patients,” Akrami says.

The most bedeviling and common lingering symptom seems to be fatigue, but researchers caution against calling it chronic fatigue syndrome. That’s “a specific diagnosis,” Marks says. “You might have fibrosis in the lungs, and that will make you feel fatigued; you might have impaired heart function, and that will make you feel fatigued.” Trying to trace symptoms to their source is critical to understanding and ultimately managing them, he says.

Iwasaki agrees. Doctors would treat symptoms differently depending on whether they result from a lingering infection or are rooted in autoimmune abnormalities. She has begun to recruit people who weren’t hospitalized when they had COVID-19 and will sift through her volunteers’ immune cells, examine whether they’re primed to attack, and measure whether the balance among different cell types is as it should be. She’ll also hunt for virus in saliva. “We’re pretty much searching for anything,” she says.

Iwasaki is especially struck by the number of young, healthy, active people—people like Akrami—who fall into the long-hauler category. As she and others struggle to find ways to help them, she wonders what might head off their symptoms. One possibility, she says, is monoclonal antibodies, which are now being tested as a treatment for acute infection and might also forestall lasting immune problems.

Hers is one of several survivor studies now underway. While Goldberger’s hometown of Miami faces a surge of acutely ill patients, he is looking ahead, applying for funding to image the heart and map its electrical activity in COVID-19 patients after they leave the hospital. Gholamrezanezhad is recruiting 100 patients after hospital discharge to follow for up to 2 years for lung assessments. Like many physicians, he fears the societal impact of even uncommon complications, including in the millions of people never hospitalized. “When you consider how many people are getting the disease, it’s a big problem,” he says.

Across the Atlantic Ocean, Richter has recruited 300 volunteers in Germany for long-term follow-up, including lung scans. In the United Kingdom, patients will soon be able to sign up for that country’s survivor study, with many giving blood samples and being examined by specialists. The researchers will probe patients’ DNA and examine other characteristics such as age and health history to learn what might protect them from, or make them susceptible to, a range of COVID-19 induced health problems. Knowing who’s at risk of, say, kidney failure or cardiac arrhythmia could mean more targeted follow-up. The U.K. researchers are also keen to see whether patients who received certain treatments in the acute phase of illness, such as steroids or blood thinners, are less prone to later complications.

For her part, Akrami is one of 2 million people infected weeks or months ago participating in the COVID Symptom Study. The study welcomes anyone infected, and with 10% to 15% of people who use the app reporting ongoing symptoms, it has already yielded a welter of data, says Andrew Chan, an epidemiologist and physician at Harvard Medical School.

As he and his colleagues parse the data, they are identifying distinct “types” of acute illness, based on clusters of symptoms. Chan wonders whether certain early symptoms correlate with specific ones that linger. He acknowledges the risk that the app’s data could be skewed, because people who aren’t feeling well may be more likely to participate than those who have smooth recoveries. “We’re trying to develop data analysis tools” to account for that tilt, he says, “similar to methods used in polling. You have to weigh the biases.”

One of the few systematic, long-term studies of COVID-19 patients with mild acute symptoms is underway in San Francisco, where researchers are recruiting 300 adults from local doctors and hospitals, for 2 years of follow-up. “We don’t have a broad idea of what’s happening” after the initial illness, says Steven Deeks, an HIV researcher at the University of California, San Francisco, who is leading the study, modeled on HIV cohorts he has followed for decades. What does “ongoing symptoms” even mean, Deeks asks. “Is that weeks, months? We don’t know that it’s years.”

More than 100 people ranging in age from 18 to 80 have signed up so far. Cardiologists, neurologists, pulmonologists, and others are assessing the volunteers, and blood, saliva, and other biological specimens are being banked and analyzed.

Although scientists hope they’ll learn how to avert chronic symptoms and help patients currently suffering, this latest chapter in the COVID-19 chronicle has been sobering. The message many researchers want to impart: Don’t underestimate the force of this virus. “Even if the story comes out a little scary, we need a bit of that right now,” Iwasaki says, because the world needs to know how high the stakes are. “Once the disease is established, it’s really hard to go backward.”

Posted in: HealthCoronavirus
doi:10.1126/science.abe1147

[K74T]

4 new cases and another elderly male death

[zoom rader]

By the end of this goverment 5 years they would have been forgotten on the con job they did with covid and the number of deaths due to their selfishness to retain office at all cost.

Agian stupid will continue supporting them

[redmanjp]

how come is mostly men dying?

[adnj]

how come is mostly men dying?

Data from worldwide locations show that about 3 out of 5 deaths from Covid-19 are male.

The current hypothesis is a greater number of genetic mutations of the immune system in male chromosomes is the cause.

Genetic mutations predispose individuals to severe COVID-19

"We mainly looked at genes that play a role in the immune system. We know that several of these genes are located on the X-chromosome, and with two brother pairs affected X-chromosomal genes were most suspicious. Women carry two X-chromosomes, while men possess a Y-chromosome apart from the X. Therefore, men have only one copy of the X-chromosomal genes. In case men have a defect in such a gene, there is no second gene that can take over that role, as in women."

https://medicalxpress.com/news/2020-07- ... evere.html