Issues & Insights

COVID-19’s Long-Term Effects Change The Calculus – And The Talking Points

In spite of the surging number of new cases of COVID-19 in many U.S. hot spots, worrisome increases in the percentage of positive tests, and scores of intensive-care units at or near capacity, some (mostly conservative) pundits and politicians seem not to “get it.” They parrot talking points that seem intended to divert attention from serious issues by burying their audience with arcane and irrelevant statistics.

For a while, as the body count climbed, some conservative commentators insisted there is “a big difference between dying from the virus and dying with the virus.” Then they shifted to quibbling over the discrepancies between when a death occurred and when it was reported.

Thereby, the punditocracy seems to have persuaded many Republicans to be less concerned than Democrats about COVID-19 infection, according to a Pew Research Center poll:

Republican Sen. Ron Johnson of Wisconsin trotted out some newer themes in a recent Wall Street Journal op-ed, the punchline of which was that we don’t now need another huge economic stimulus bill from Congress.

I don’t have a problem with his conclusion, but the reasoning he used was sophistic, and omitted essential parts of the story. For example, he cited a recent study in JAMA Internal Medicine that measured antibodies in blood to SARS-CoV-2 (the virus that causes COVID-19) which showed that the number of COVID-19 infections in the population – the penetrance – was six to 24 times the number of symptomatic “reported cases.” That was hardly a surprise; we’ve known for months that the majority of COVID-19 infections are asymptomatic and are never diagnosed.

But, critically, Johnson failed to mention the downside of those findings: As the authors of the study noted, “The findings may reflect the number of persons who had mild or no illness or who did not seek medical care or undergo testing but who still may have contributed to ongoing virus transmission in the population” (emphasis added).

That observation has important implications for the conundrum of when schools can be reopened safely: In locales that have large numbers of new cases of COVID-19 infections and high rates of testing positivity, it would be dangerous to have children congregating in classrooms, cafeterias, and gyms. (Children older than 10 spread COVID-19 infections as well as adults, while those under 10 spread it about half as effectively.)

To be clear, if there is widespread COVID-19 in the community, it is likely that children in school will infect their classmates, teachers, school support staff, and relatives, who will then go on to further spread the virus. As Dr. Anthony Fauci has pointed out repeatedly, people harboring asymptomatic COVID-19 are a critical link in the transmission of infections in the community.

Johnson then shifted to discussing COVID-19 fatality rates, comparing them to those from the seasonal flu.  Because they don’t differ appreciably, he concluded that, therefore, “there is no need to continue broad economic shutdowns with fatality rates in these ranges.”

Not so fast, Senator; there’s much more to pandemic statistics than fatality rates. For one thing, the absolute number of fatalities this year (around 147,000, as of July 27) is already more than four times the yearly average from seasonal flu.

Case counts are also important. The protean manifestations of COVID-19 and its sequelae in many patients who have “recovered” make it more ominous than a usually transient, flu-like respiratory infection. Although it often presents with pulmonary symptoms and can cause severe pneumonia and “post-COVID pulmonary fibrosis,” there have been numerous reports of non-respiratory signs and symptoms, including loss of sense of smell or taste, confusion and cognitive impairments, fainting, sudden muscle weakness or paralysis, abnormal blood-coagulation tests, blood clots, seizures, ischemic strokes, kidney damage, and, rarely, a severe pediatric, multi-organ inflammatory syndrome

Recovery is often incomplete, with various symptoms persisting after the acute infection has subsided. A recent article in the journal JAMA found in a small study that 87.4% of patients who had recovered from COVID-19 reported persistence of at least one symptom, most often fatigue or dyspnea (i.e., shortness of breath) two months after recovery. The frequency of post-acute COVID-19 symptoms is shown here:

Credit: A Carfi et al,

Extrapolating those findings to the U.S. and making certain conservative assumptions, Dr. Bob Morris estimates the frequency of symptoms in the U.S. would translate to these shocking statistics for COVID-19 patients discharged from hospitals as of July 19:

SymptomUS Cases
Difficulty Breathing 252,000
Joint Pain158,000
3 or More319,000

Those two figures, along with the finding that almost nine in 10 of people who had recovered from COVID-19 reported persistence of at least one symptom two months later, illustrate the fallacy in focusing on fatality rates. 

Possibly overlapping with Morris’ “three or more category,” above, are reports of patients experiencing long-term adverse effects that resemble a condition variously known as myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS).  Its signs and symptoms may include fatigue, loss of memory or concentration, sore throat, swelling of neck or armpit lymph nodes, unexplained muscle or joint pain, headaches, non-restorative sleep, and extreme exhaustion that lasts more than 24 hours after physical exercise or mental stimulation (“post-exertional malaise”).

People with ME/CFS are often incapable of performing ordinary activities, and sometimes become completely debilitated, unable even to get out of bed. A good word picture was provided in an interview of three COVID-19 patients on NPR’s July 11 “Weekend Edition,” who described in poignant terms their ongoing symptoms, and CNN anchor Chris Cuomo recently described on-air experiencing some of these symptoms following his bout with COVID-19.

The manifestations of the syndrome can persist for years, although, of course, we can’t yet know what the typical, long-term post-COVID-19 course will be. What we do know is that in recent decades, outbreaks of other infectious diseases, including Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) (both of which are also caused by coronaviruses), as well as West Nile virus, H1N1 influenza, and Ebola — have been followed by a range of long-term complaints that resemble those of ME/CFS. Therefore, it’s no surprise to see this phenomenon repeated in COVID-19 patients.

The appearance of serious, persistent COVID-19 sequelae has important implications. 

First, fatalities aside, the increase in cases and the high numbers of hospitalizations in epicenters of infection cannot be dismissed as simply a self-limited, “flu-like illness” whose effects are done and gone in a week or so. We need, therefore, to aggressively suppress and mitigate COVID-19.  The fewer new cases, the fewer lingering illnesses there will be, with all their attendant misery and expense.  (A corollary is that “COVID parties” are dangerous, antisocial, and colossally stupid.)

Second, the persistence of debilitating symptoms argues strongly against vaccine “challenge trials,” in which infectious SARS-CoV-2 virus is intentionally administered to test subjects, some of whom have received a trial vaccine while others have gotten a placebo. In the absence of highly effective drugs to treat COVID-19, such studies would arguably be unethical.

Finally, we need research on the long-term effects of COVID-19, so that we can better understand the pathophysiology of both the acute viral infection and the persistent post-infection sequelae. A research group at the NIH’s National Institute for Neurological Diseases and Stroke is preparing to enroll patients in a study that will investigate possible aberrations in the immune systems of “long-haulers,” people who have persistent symptoms after recovering from COVID-19, but we need much more.

The sad truth is that in terms of both the spread of infections and an understanding of COVID-19’s pathophysiology, we are still in the early days of this pandemic. Cherry-picking data to make political points and support flawed policies will only prolong it.

Henry I. Miller, a physician and molecular biologist, was a research fellow at the National Institutes of Health and the founding director of the Office of Biotechnology at the FDA.

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  • So, very similar to potential side-effects for pneumonia when caused by other Influenza-like illnesses?

  • When you mention/rely on CNN or NPR in an article chastising conservatives for not believing the lies spewed by the MSM, we re going to have a problem.

  • The point of this piece seems to be that we don’t know how bad the virus is, and it might be really bad. I think most people realize that. Just like they knew — even before the dramatic, italicized reveal — that asymptomatic people spread the virus.

    They also know that the thing is not the black death, but its been reacted to as if it were.

    My dentist would prefer that I brush twelve times a day and never eat sweets. I’ll keep that in mind. And it will inform, but not control, my decision about how many peanut butter cups to eat.

  • The death counts are falsely attributed to with COVID when they died of other causes. You’re in a hospice given a few weeks to live, test positive; COVID. Dying of clearly an alternate cause but had COVID at the same time; Jeopardy Answer? COVID. Post Mortem test that comes up positive? COVID. Though he died in a car crash. Post Mortem negative tests as in NY but based on symptoms similar to seasonal flu, or pneumonia? COVID cash register. 3700 like cases from NY had to be backed, while you’re at it Doc, back out all the nursing home deaths resulting from seeding the facility with COVID patients in all blue states that did that, Update death certificates as? Manslaughter. People presumed to have died of COVID but never tested positive, how are they added to your count Doc? Other more honest doctors felt pressured to list deaths as COVID when they believe it to be the case! Pressures, they never felt for seasonal flu! Extortion $$ from Medicare, bankrupt agency. This is essentially a nursing home , LTC and ITC disease. It is not in the main a plague as the despicable media has ginned up. CDC data appears to be showing that COVID may not have killed many , if any , who were not weeks to a couple of months from death. The median IFR for people under 70 is ? Jeopardy Answer?0.04 percent. And for your numbers of people recovering and have some serious side effects, if they were denied standard of care early that included HCQ with zinc or doxycycline or Ivermectin, maybe that’s why consequences are present. And many current and recent hospitalizations are people really there for treatments they had to forego because of Bat Soup Plague but test positive. They’re not there for COVID! Asian Flu mortality rate .67 percent, COVID falsely beaten upwards, .26 percent! 58-59, no masks, no anti social distancing, no quarantining of the healthy, no picking and choosing what businesses were essential and not, and no deprivation of human rights from martial law, under grubby, sinister power hungry governors.

  • This article makes valid points and the doctor’s advice that politics be left aside when dealing with the CCP virus is solid. That said, the medical profession in the US bears responsibility for much of the dismissive attitude of conservatives when confronted with the pandemic. Too many prominent doctors like Fauci have contradicted themselves repeatedly, changing dramatically advice from one month to the next. And conservatives wonder about the silence of medical people as the communist rioters took to the streets of America. Why the alarm over people at the beach but passivity when Antifa and BLM gathered huge crowds to torch our cities? And then there is the medical community’s generally negative and even mendacious attitude towards Hydroxichloriquine. Even a layman could see that much of what was being said about that drug was a bald face lie. Why? Why this refusal to even try a palliative that test after test shows to be effective if used early in the disease’s onset?

    It’s very hard to avoid the suspicion that medical people for some reason have been playing politics just as hard as the GOP state senator mentioned in this article.

  • Dr. Miller is correct to point out the other complicating factors. However, he failed to note, while the flu kills fewer people annually, there is a vaccine for the flu. And it is routinely taken by, I assume, a fairly substantial fraction of the people that Covid is killing, not to mention others in the less susceptible range.

    Further, all of the scientific studies of masks I have read acknowledge that masks have never been demonstrated to be effective against a virus. Those tests were done with the flu virus, but the viral size is of the same order of magnitude. And of course, broad general use if masks by healthy persons has never been a remedy for anything.

    As far as the death rates, we have, in qualitative terms, no data at all. We know that some fraction of deaths were merely *with* Covid, not *from* Covid, and that is exacerbated by the fact that the “bounty” paid for Covid deaths created a certain, one-way inflationary error. We just do not know how much. Thus the numerator for the calculation is essentially useless.

    And the denominator is no better because we know that an unknown fraction of those who were infected never sought help or testing because they were asymptomatic. So, for the denominator we have SWAGs, Scientific Wild Assed Guesses, by experts. And it was the experts who predicted multiple millions of deaths in the US alone. So, no thinking person should trust that.

    So, the best that can be said, at this point in the history of a very knew disease, is that some smart people have made guesses, for which they are not accountable, about how deadly the disease. But we know for certain that the initial suggested remedy for the disease – the lockdown – has done more damage to human lives than the disease has.

    • Nicely reasoned. Beyond what you say (and what I posted above), there is the fact — not conjecture, but fact — that the famous Dr. Fauci, the de facto leader of those recommending draconian measures to end the CCP engineered flu, has been wrong, spectacularly so, both in the past and at several junctures during the current health crisis. I remember that Fauci once predicted AIDS would break out of homosexual circles and enter massively into hetero circles, but that never happened. We laymen know that, had we made that kind of error in our field of endeavor, we would have lost our position tout de suite. Fauci, however, continues to bask in the light of public adulation and official approval, as if he never blundered at all. And now his CCP flu “no masks”, “masks perhaps”, “masks will save us” routine hasn’t raised an eyebrow among our clearly mendacious mass media.

      I’ve said for weeks now that the principal casualty of this virus attack is the medical profession in the US. As they make war with one another over everything from the efficacy of masks to the reliability of Hydroxichloriquine, we laymen get the strong notion that these kings have no clothes after all, that their claim to impartiality and wisdom is specious. That leaves Dr. Miller’s point of view just one among many others that contradict what he says. So, again, while he chooses to throw rocks at the GOP state senator he mentions, he fails to notice the vitreous composition of his own home.

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