1 00:00:03,920 --> 00:00:09,560 Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day ninety since 2 00:00:09,600 --> 00:00:15,640 Speaker 1: coronavirus was declared a global pandemic. Our main story. Most 3 00:00:15,680 --> 00:00:19,680 Speaker 1: people who survive COVID nineteen recover within a few weeks, 4 00:00:20,720 --> 00:00:26,280 Speaker 1: but some suffer from debilitating pain and fatigue for months. Now, 5 00:00:26,680 --> 00:00:30,720 Speaker 1: researchers are trying to better understand what causes these long 6 00:00:30,800 --> 00:00:34,760 Speaker 1: term symptoms and what can be done, if anything, to 7 00:00:34,880 --> 00:00:41,080 Speaker 1: avoid them in the future. But first, here's what happened today. 8 00:00:48,479 --> 00:00:52,400 Speaker 1: A top World Health Organization official is backpedaling on her 9 00:00:52,440 --> 00:00:57,320 Speaker 1: comments over the role asymptomatic carriers play in spreading COVID nineteen. 10 00:00:58,400 --> 00:01:02,600 Speaker 1: Maria van Kirkhove said on Monday that asymptomatic transmission of 11 00:01:02,600 --> 00:01:08,839 Speaker 1: coronavirus is very rare. That comment revived a controversy over 12 00:01:08,880 --> 00:01:13,280 Speaker 1: how the virus spreads. Today, she says she was referring 13 00:01:13,319 --> 00:01:19,959 Speaker 1: specifically to two or three studies. New York City reached 14 00:01:19,959 --> 00:01:23,959 Speaker 1: a milestone today. It reported just one percent of its 15 00:01:24,000 --> 00:01:28,240 Speaker 1: residents tested positive for the coronavirus for the first time 16 00:01:28,360 --> 00:01:31,959 Speaker 1: since the beginning of the outbreak. The city had reached 17 00:01:31,959 --> 00:01:36,880 Speaker 1: a high of seventy one testing positive in April. The 18 00:01:36,920 --> 00:01:41,440 Speaker 1: city is now conducting more than thirty thousand tests a day, 19 00:01:43,959 --> 00:01:47,200 Speaker 1: and much of the world continues to open up. The 20 00:01:47,280 --> 00:01:51,600 Speaker 1: Eiffel Tower in Paris will reopen following its longest shutdown 21 00:01:51,840 --> 00:01:57,440 Speaker 1: since World War Two. France also unveiled a massive rescue 22 00:01:57,440 --> 00:02:01,160 Speaker 1: plan for its struggling aerospace industry, and the European Union 23 00:02:01,280 --> 00:02:05,120 Speaker 1: is considering a leader summit to discuss measures for speeding 24 00:02:05,200 --> 00:02:10,560 Speaker 1: up a recovery. The United Nations says that the pandemic, 25 00:02:10,760 --> 00:02:14,760 Speaker 1: combined with a global recession, is contributing to a worldwide 26 00:02:14,800 --> 00:02:19,240 Speaker 1: food emergency. The organization released a policy brief that says 27 00:02:19,280 --> 00:02:22,360 Speaker 1: these factors could set the stage for a health and 28 00:02:22,440 --> 00:02:31,440 Speaker 1: nutrition crisis on a scale not seen for decades and 29 00:02:31,520 --> 00:02:37,200 Speaker 1: now our main story. Many survivors of coronavirus report feeling 30 00:02:37,320 --> 00:02:43,000 Speaker 1: unwell weeks after they've supposedly beat the infection. That's raised 31 00:02:43,040 --> 00:02:47,960 Speaker 1: questions about the long term consequences of COVID nineteen. Never 32 00:02:48,040 --> 00:02:50,799 Speaker 1: in the modern scientific era have so many people been 33 00:02:50,840 --> 00:02:54,360 Speaker 1: infected with this same virus in such a short period 34 00:02:54,360 --> 00:02:59,160 Speaker 1: of time. As Bloomberg Senior editor Jason Gale reports, that 35 00:02:59,200 --> 00:03:04,080 Speaker 1: could actually sent a unique opportunity to discover strategies for 36 00:03:04,160 --> 00:03:10,640 Speaker 1: preventing post COVID illness in the future. Anyone who's had 37 00:03:10,720 --> 00:03:14,120 Speaker 1: shingles knows about the lasting effects of chicken pox. Many 38 00:03:14,160 --> 00:03:17,720 Speaker 1: infections can cause secondary diseases. We only need to look 39 00:03:17,760 --> 00:03:21,120 Speaker 1: at the rare multi system inflammatory syndrome reported around the 40 00:03:21,160 --> 00:03:24,120 Speaker 1: world in children to see that the coronavirus can trigger 41 00:03:24,200 --> 00:03:28,600 Speaker 1: some subsequent complications, some of them lethal. With millions of 42 00:03:28,600 --> 00:03:32,480 Speaker 1: people afflicted by COVID nineteen, survivors and their doctors are 43 00:03:32,520 --> 00:03:39,680 Speaker 1: wondering what other persistent effects this illness might have. It's 44 00:03:39,680 --> 00:03:43,400 Speaker 1: an important question, not just because of the sheer volume 45 00:03:43,440 --> 00:03:46,720 Speaker 1: of people afflicted, but also because of the likelihood that 46 00:03:46,800 --> 00:03:49,360 Speaker 1: many sufferers could be left with permanent damage to their 47 00:03:49,440 --> 00:03:53,960 Speaker 1: lungs and other vital organs, requiring costly long term medical 48 00:03:54,040 --> 00:03:58,400 Speaker 1: care and support. So, you know, we've taught for a 49 00:03:58,400 --> 00:04:00,720 Speaker 1: long time that once you have and then you're done 50 00:04:00,720 --> 00:04:02,920 Speaker 1: with it, that would be yet you know. This is 51 00:04:03,000 --> 00:04:06,560 Speaker 1: Dr RV. Nath. He's a physician scientist with the National 52 00:04:06,600 --> 00:04:10,720 Speaker 1: Institutes of Health in Bethesda, Maryland, vous clinical director of 53 00:04:10,760 --> 00:04:14,040 Speaker 1: the Institute of Neurological Disorders and Stroke and heads the 54 00:04:14,080 --> 00:04:17,400 Speaker 1: section that looks at infections of the nervous system, tells 55 00:04:17,400 --> 00:04:21,640 Speaker 1: of the patients now complaining of the fact that they 56 00:04:21,680 --> 00:04:25,520 Speaker 1: have persistent symptoms that fewer goes away, and you know 57 00:04:25,560 --> 00:04:27,640 Speaker 1: all the other symptoms, the carf and other things that 58 00:04:27,680 --> 00:04:30,080 Speaker 1: now they're developing other those kinds of symptoms. The lingering 59 00:04:30,120 --> 00:04:34,520 Speaker 1: symptoms that COVID patients experience are fairly broad. V is 60 00:04:34,600 --> 00:04:40,120 Speaker 1: interested in brain fog, malays tiredness symptoms reminiscent of myalgic 61 00:04:40,279 --> 00:04:44,480 Speaker 1: encephalomyelitis or chronic fatigue syndrome, which he says is linked 62 00:04:44,520 --> 00:04:47,920 Speaker 1: with a lot of viral infections. COVID, though has also 63 00:04:48,040 --> 00:04:52,400 Speaker 1: been associated with some other neurological complications, including strokes as 64 00:04:52,440 --> 00:04:56,000 Speaker 1: well as brain bleeds and inflammation. These things are happening 65 00:04:56,080 --> 00:04:59,560 Speaker 1: later in the course of the infection, suggesting that there's 66 00:04:59,560 --> 00:05:02,760 Speaker 1: an immune component to it, so you know, the virus 67 00:05:02,800 --> 00:05:07,200 Speaker 1: goes down and the immune system gets hyperactive, and it 68 00:05:07,240 --> 00:05:10,120 Speaker 1: can cause a variety of different types of neurological symptoms. 69 00:05:10,560 --> 00:05:14,240 Speaker 1: As unfortunate as these rare problems are obvious, says, they 70 00:05:14,279 --> 00:05:17,440 Speaker 1: represent an opportunity to learn how and why these post 71 00:05:17,520 --> 00:05:21,640 Speaker 1: viral syndromes occur their biological pathways, so that we might 72 00:05:21,680 --> 00:05:25,479 Speaker 1: be able to prevent them. For example, biological samples taken 73 00:05:25,520 --> 00:05:28,800 Speaker 1: from patients at the start of their illness may reveal 74 00:05:28,880 --> 00:05:33,440 Speaker 1: evidence of key aspects of the disease process, and oftentimes 75 00:05:33,440 --> 00:05:35,840 Speaker 1: they by the time you see the patient, you don't 76 00:05:35,839 --> 00:05:38,240 Speaker 1: really know what infection they had, and the virus has 77 00:05:38,279 --> 00:05:41,320 Speaker 1: never figured out, and and it's too late to figure 78 00:05:41,320 --> 00:05:43,680 Speaker 1: out what virus they have. Now that's not an excuse 79 00:05:43,720 --> 00:05:46,440 Speaker 1: any longer. You know exactly what virus caused that, and 80 00:05:46,480 --> 00:05:48,760 Speaker 1: you know exactly what the syndrome is, and you know 81 00:05:48,839 --> 00:05:52,800 Speaker 1: exactly what happened in between. So I think it's an 82 00:05:52,960 --> 00:05:55,880 Speaker 1: unfortunate situation, but you can use it to get an 83 00:05:55,880 --> 00:05:59,119 Speaker 1: advantage to try and understand these diseases that we haven't 84 00:05:59,120 --> 00:06:01,240 Speaker 1: been able to for a long, long long time. Obviously, 85 00:06:01,520 --> 00:06:04,960 Speaker 1: he and other scientists are preparing studies to understand what's 86 00:06:05,000 --> 00:06:08,440 Speaker 1: different about the minority of people who don't recover normally 87 00:06:08,520 --> 00:06:12,240 Speaker 1: from their coronavirus infection. I haven't had the infection for 88 00:06:12,360 --> 00:06:14,880 Speaker 1: long enough for us to know how long these things 89 00:06:14,920 --> 00:06:17,680 Speaker 1: are going to persist, and sometimes it takes people a 90 00:06:17,760 --> 00:06:21,240 Speaker 1: month or two to recover from it. Everybody's a little 91 00:06:21,240 --> 00:06:25,000 Speaker 1: bit different. However, we are concerned that some of them 92 00:06:25,160 --> 00:06:31,560 Speaker 1: may have plowing symptoms. The NAH has several research teams 93 00:06:31,600 --> 00:06:35,160 Speaker 1: trying to unlock the secrets of these post viral illnesses. 94 00:06:35,760 --> 00:06:39,080 Speaker 1: Another doctor I spoke with is investigating what's termed the 95 00:06:39,200 --> 00:06:45,120 Speaker 1: natural history of infection in dozens of COVID patients. My 96 00:06:45,200 --> 00:06:48,440 Speaker 1: name is Anthony Superdidy. I'm a critical care physician. I 97 00:06:48,520 --> 00:06:51,400 Speaker 1: work in the Critical Care Medicine department at the Clinical Center, 98 00:06:51,839 --> 00:06:54,840 Speaker 1: which is the research hospital associated with the National Institutes 99 00:06:54,880 --> 00:06:58,159 Speaker 1: of Health. Anthony began enrolling patients last week in a 100 00:06:58,240 --> 00:07:00,960 Speaker 1: study that aims to follow patients for a year to 101 00:07:01,040 --> 00:07:04,080 Speaker 1: track the impact it's had on their heart, lungs, and kidneys. 102 00:07:04,440 --> 00:07:08,719 Speaker 1: Uh the The study is composed of two cohorts patients 103 00:07:08,720 --> 00:07:11,480 Speaker 1: who are acutely ill who would be followed from the 104 00:07:11,520 --> 00:07:14,080 Speaker 1: time of the onset of their symptoms into out to 105 00:07:14,160 --> 00:07:17,480 Speaker 1: one year, and then we will be getting patients from 106 00:07:17,600 --> 00:07:20,840 Speaker 1: who have been treated at the outside hospitals who would 107 00:07:20,880 --> 00:07:24,640 Speaker 1: be enrolled after their acute illness and to see again 108 00:07:24,680 --> 00:07:28,600 Speaker 1: the consequences in terms of their cardiac their pulmonary function 109 00:07:28,680 --> 00:07:31,679 Speaker 1: as well as their their their kidney function renal functions. 110 00:07:31,880 --> 00:07:34,320 Speaker 1: The participants are going to be given a thorough work up. 111 00:07:34,760 --> 00:07:38,120 Speaker 1: Tests will include m RIS, ultrasounds and different types of 112 00:07:38,240 --> 00:07:42,080 Speaker 1: CT scans on multiple organs. The images and blood and 113 00:07:42,240 --> 00:07:45,080 Speaker 1: urine tests will be taken at various time points to 114 00:07:45,160 --> 00:07:48,080 Speaker 1: track the progression of changes. Our hope is to get 115 00:07:48,120 --> 00:07:50,600 Speaker 1: the m r S at least at three different time points. 116 00:07:50,640 --> 00:07:53,280 Speaker 1: One would be at the time of study entry, and 117 00:07:53,320 --> 00:07:56,800 Speaker 1: that's across the board with people that are our patients 118 00:07:56,800 --> 00:08:01,160 Speaker 1: who would be you know, relatively low symptom o asymptomatic 119 00:08:01,240 --> 00:08:03,120 Speaker 1: or low symptom mode to those that are going to 120 00:08:03,120 --> 00:08:05,600 Speaker 1: be hospitalized, and then we would get them at the 121 00:08:05,680 --> 00:08:09,760 Speaker 1: recovery phase after they've cleared their virus and have improved, 122 00:08:10,160 --> 00:08:13,679 Speaker 1: and then we would get them at convalescence in terms 123 00:08:13,680 --> 00:08:17,560 Speaker 1: of eight weeks to twelve months. Anthony will be comparing 124 00:08:17,560 --> 00:08:20,880 Speaker 1: the results across a spectrum of COVID patients and we're 125 00:08:20,920 --> 00:08:23,880 Speaker 1: really trying to enroll not just the critically ill patients. 126 00:08:23,960 --> 00:08:27,040 Speaker 1: Were very interested and also the the young person who 127 00:08:27,120 --> 00:08:30,160 Speaker 1: might have an infection. They lose their sense of smell 128 00:08:30,200 --> 00:08:32,760 Speaker 1: and taste, they have a fever, they feel kind of 129 00:08:32,800 --> 00:08:34,680 Speaker 1: like they've had a bad flu, and they get better. 130 00:08:35,080 --> 00:08:37,800 Speaker 1: So those people are very interesting to look at simply 131 00:08:37,840 --> 00:08:41,480 Speaker 1: because what are the consequences, how do they get better? Uh, 132 00:08:41,520 --> 00:08:44,440 Speaker 1: and how does that differ from from someone in a 133 00:08:44,480 --> 00:08:48,240 Speaker 1: similar age group who doesn't get better and who deteriorates 134 00:08:48,320 --> 00:08:51,240 Speaker 1: and requires an IC you admission. Doctors also need to 135 00:08:51,320 --> 00:08:54,960 Speaker 1: disentangle the causes because they might be the direct result 136 00:08:55,000 --> 00:08:58,040 Speaker 1: of the virus, the body's a immune response to it, 137 00:08:58,440 --> 00:09:01,400 Speaker 1: and it could be the result of the treatment patients received. 138 00:09:01,920 --> 00:09:04,600 Speaker 1: One of the things that becomes complicated. However, there's many 139 00:09:04,679 --> 00:09:09,080 Speaker 1: things we do in critical care that affect neurocognitive function, 140 00:09:09,800 --> 00:09:14,400 Speaker 1: muscular recovery, even as things as simple as getting back 141 00:09:14,400 --> 00:09:18,040 Speaker 1: to your work. A study in Canada that followed patients 142 00:09:18,080 --> 00:09:21,839 Speaker 1: with a life threatening lung injury known as acute respiratory 143 00:09:21,920 --> 00:09:26,840 Speaker 1: distress syndrome now many patients were suffering neurocognitive problems and 144 00:09:26,920 --> 00:09:31,520 Speaker 1: trouble sleeping a year later. Anthony says that might be 145 00:09:31,600 --> 00:09:34,160 Speaker 1: a result of the type of sedatives sometimes you use 146 00:09:34,200 --> 00:09:38,719 Speaker 1: so that patients will tolerate the intubation required for mechanical ventilation. 147 00:09:38,920 --> 00:09:42,640 Speaker 1: We use benzo diazepines and they're very good on one hand. 148 00:09:42,640 --> 00:09:44,959 Speaker 1: On the other hand, the recent data that has come 149 00:09:45,000 --> 00:09:48,880 Speaker 1: out would suggest that that's associated with post traumatic stress disorder, 150 00:09:48,960 --> 00:09:52,959 Speaker 1: among other things and so on. In the context of that, 151 00:09:53,040 --> 00:09:56,360 Speaker 1: many people try to avoid those drugs. However, if you 152 00:09:56,880 --> 00:09:59,200 Speaker 1: if you looked at around the world right now, when 153 00:09:59,240 --> 00:10:01,840 Speaker 1: people are really, really sick and they're really trying to 154 00:10:01,880 --> 00:10:05,080 Speaker 1: make sure their loans don't get injured further with not 155 00:10:05,240 --> 00:10:07,960 Speaker 1: just the information from the from the COVID, but from 156 00:10:07,960 --> 00:10:10,560 Speaker 1: the from the support measures we used in terms of 157 00:10:10,559 --> 00:10:14,400 Speaker 1: how we ventilate them on the mechanical ventilator UM, they're 158 00:10:14,440 --> 00:10:17,440 Speaker 1: often pushed to the UH, to the situation where they 159 00:10:17,480 --> 00:10:20,920 Speaker 1: have to use almost everything to keep the person sedated 160 00:10:21,480 --> 00:10:27,200 Speaker 1: to be able to tolerate the UH less injurious UH 161 00:10:27,440 --> 00:10:32,000 Speaker 1: modalities of mechanical ventilation. So we're kind of stuck in 162 00:10:32,120 --> 00:10:35,640 Speaker 1: a situation where we we may not have even defined 163 00:10:35,679 --> 00:10:40,200 Speaker 1: the best ways of supporting people right now. Fortunately, there 164 00:10:40,280 --> 00:10:43,120 Speaker 1: is a vast amount of research being published each week, 165 00:10:43,679 --> 00:10:46,760 Speaker 1: much of it is informing ways to improve patient care. 166 00:10:47,520 --> 00:10:50,520 Speaker 1: The other good news is that awareness of the secondary 167 00:10:50,559 --> 00:10:54,400 Speaker 1: effects of the coronavirus is growing. As a Vanette says, 168 00:10:54,720 --> 00:10:58,000 Speaker 1: people should know that if they have persistent symptoms, they're 169 00:10:58,000 --> 00:11:02,160 Speaker 1: not crazy. There may well be thing biologically wrong and 170 00:11:02,200 --> 00:11:05,320 Speaker 1: that they should see a doctor about them. Identifying such 171 00:11:05,360 --> 00:11:09,360 Speaker 1: medical concerns in real time could help solve the mystery 172 00:11:09,600 --> 00:11:13,120 Speaker 1: of these post viral illnesses, prevent them in the future, 173 00:11:13,760 --> 00:11:17,680 Speaker 1: and find better treatments for those who suffer from them, 174 00:11:17,720 --> 00:11:33,480 Speaker 1: including post COVID nineteen patients. That was Jason Gale, and 175 00:11:33,520 --> 00:11:36,120 Speaker 1: that's our show today. For coverage of the outbreak from 176 00:11:36,160 --> 00:11:40,679 Speaker 1: one bureaus around the world, visit Bloomberg dot com slash 177 00:11:40,720 --> 00:11:45,080 Speaker 1: coronavirus and if you like the show, please leave us 178 00:11:45,080 --> 00:11:48,400 Speaker 1: a review and a rating on Apple Podcasts or Spotify. 179 00:11:49,080 --> 00:11:51,640 Speaker 1: It's the best way to help more listeners find our 180 00:11:51,720 --> 00:11:56,520 Speaker 1: global reporting. The Prognosis Daily edition is produced by over 181 00:11:56,679 --> 00:12:03,199 Speaker 1: foreheads Jordan Gaspore, Magnus Hendrickson and me Laura Carlson. Today's 182 00:12:03,200 --> 00:12:07,559 Speaker 1: main story was reported by Jason Gale. Original music by 183 00:12:07,640 --> 00:12:12,199 Speaker 1: Leo Sidrin. Our editors are Francesca Levi and Rick Shine. 184 00:12:12,920 --> 00:12:17,559 Speaker 1: Francesco Levi is Bloomberg's head of podcasts. Thanks for listening.