Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day ninety since
Speaker 1: coronavirus was declared a global pandemic. Our main story. Most
Speaker 1: people who survive COVID nineteen recover within a few weeks,
Speaker 1: but some suffer from debilitating pain and fatigue for months. Now,
Speaker 1: researchers are trying to better understand what causes these long
Speaker 1: term symptoms and what can be done, if anything, to
Speaker 1: avoid them in the future. But first, here's what happened today.
Speaker 1: A top World Health Organization official is backpedaling on her
Speaker 1: comments over the role asymptomatic carriers play in spreading COVID nineteen.
Speaker 1: Maria van Kirkhove said on Monday that asymptomatic transmission of
Speaker 1: coronavirus is very rare. That comment revived a controversy over
Speaker 1: how the virus spreads. Today, she says she was referring
Speaker 1: specifically to two or three studies. New York City reached
Speaker 1: a milestone today. It reported just one percent of its
Speaker 1: residents tested positive for the coronavirus for the first time
Speaker 1: since the beginning of the outbreak. The city had reached
Speaker 1: a high of seventy one testing positive in April. The
Speaker 1: city is now conducting more than thirty thousand tests a day,
Speaker 1: and much of the world continues to open up. The
Speaker 1: Eiffel Tower in Paris will reopen following its longest shutdown
Speaker 1: since World War Two. France also unveiled a massive rescue
Speaker 1: plan for its struggling aerospace industry, and the European Union
Speaker 1: is considering a leader summit to discuss measures for speeding
Speaker 1: up a recovery. The United Nations says that the pandemic,
Speaker 1: combined with a global recession, is contributing to a worldwide
Speaker 1: food emergency. The organization released a policy brief that says
Speaker 1: these factors could set the stage for a health and
Speaker 1: nutrition crisis on a scale not seen for decades and
Speaker 1: now our main story. Many survivors of coronavirus report feeling
Speaker 1: unwell weeks after they've supposedly beat the infection. That's raised
Speaker 1: questions about the long term consequences of COVID nineteen. Never
Speaker 1: in the modern scientific era have so many people been
Speaker 1: infected with this same virus in such a short period
Speaker 1: of time. As Bloomberg Senior editor Jason Gale reports, that
Speaker 1: could actually sent a unique opportunity to discover strategies for
Speaker 1: preventing post COVID illness in the future. Anyone who's had
Speaker 1: shingles knows about the lasting effects of chicken pox. Many
Speaker 1: infections can cause secondary diseases. We only need to look
Speaker 1: at the rare multi system inflammatory syndrome reported around the
Speaker 1: world in children to see that the coronavirus can trigger
Speaker 1: some subsequent complications, some of them lethal. With millions of
Speaker 1: people afflicted by COVID nineteen, survivors and their doctors are
Speaker 1: wondering what other persistent effects this illness might have. It's
Speaker 1: an important question, not just because of the sheer volume
Speaker 1: of people afflicted, but also because of the likelihood that
Speaker 1: many sufferers could be left with permanent damage to their
Speaker 1: lungs and other vital organs, requiring costly long term medical
Speaker 1: care and support. So, you know, we've taught for a
Speaker 1: long time that once you have and then you're done
Speaker 1: with it, that would be yet you know. This is
Speaker 1: Dr RV. Nath. He's a physician scientist with the National
Speaker 1: Institutes of Health in Bethesda, Maryland, vous clinical director of
Speaker 1: the Institute of Neurological Disorders and Stroke and heads the
Speaker 1: section that looks at infections of the nervous system, tells
Speaker 1: of the patients now complaining of the fact that they
Speaker 1: have persistent symptoms that fewer goes away, and you know
Speaker 1: all the other symptoms, the carf and other things that
Speaker 1: now they're developing other those kinds of symptoms. The lingering
Speaker 1: symptoms that COVID patients experience are fairly broad. V is
Speaker 1: interested in brain fog, malays tiredness symptoms reminiscent of myalgic
Speaker 1: encephalomyelitis or chronic fatigue syndrome, which he says is linked
Speaker 1: with a lot of viral infections. COVID, though has also
Speaker 1: been associated with some other neurological complications, including strokes as
Speaker 1: well as brain bleeds and inflammation. These things are happening
Speaker 1: later in the course of the infection, suggesting that there's
Speaker 1: an immune component to it, so you know, the virus
Speaker 1: goes down and the immune system gets hyperactive, and it
Speaker 1: can cause a variety of different types of neurological symptoms.
Speaker 1: As unfortunate as these rare problems are obvious, says, they
Speaker 1: represent an opportunity to learn how and why these post
Speaker 1: viral syndromes occur their biological pathways, so that we might
Speaker 1: be able to prevent them. For example, biological samples taken
Speaker 1: from patients at the start of their illness may reveal
Speaker 1: evidence of key aspects of the disease process, and oftentimes
Speaker 1: they by the time you see the patient, you don't
Speaker 1: really know what infection they had, and the virus has
Speaker 1: never figured out, and and it's too late to figure
Speaker 1: out what virus they have. Now that's not an excuse
Speaker 1: any longer. You know exactly what virus caused that, and
Speaker 1: you know exactly what the syndrome is, and you know
Speaker 1: exactly what happened in between. So I think it's an
Speaker 1: unfortunate situation, but you can use it to get an
Speaker 1: advantage to try and understand these diseases that we haven't
Speaker 1: been able to for a long, long long time. Obviously,
Speaker 1: he and other scientists are preparing studies to understand what's
Speaker 1: different about the minority of people who don't recover normally
Speaker 1: from their coronavirus infection. I haven't had the infection for
Speaker 1: long enough for us to know how long these things
Speaker 1: are going to persist, and sometimes it takes people a
Speaker 1: month or two to recover from it. Everybody's a little
Speaker 1: bit different. However, we are concerned that some of them
Speaker 1: may have plowing symptoms. The NAH has several research teams
Speaker 1: trying to unlock the secrets of these post viral illnesses.
Speaker 1: Another doctor I spoke with is investigating what's termed the
Speaker 1: natural history of infection in dozens of COVID patients. My
Speaker 1: name is Anthony Superdidy. I'm a critical care physician. I
Speaker 1: work in the Critical Care Medicine department at the Clinical Center,
Speaker 1: which is the research hospital associated with the National Institutes
Speaker 1: of Health. Anthony began enrolling patients last week in a
Speaker 1: study that aims to follow patients for a year to
Speaker 1: track the impact it's had on their heart, lungs, and kidneys.
Speaker 1: Uh the The study is composed of two cohorts patients
Speaker 1: who are acutely ill who would be followed from the
Speaker 1: time of the onset of their symptoms into out to
Speaker 1: one year, and then we will be getting patients from
Speaker 1: who have been treated at the outside hospitals who would
Speaker 1: be enrolled after their acute illness and to see again
Speaker 1: the consequences in terms of their cardiac their pulmonary function
Speaker 1: as well as their their their kidney function renal functions.
Speaker 1: The participants are going to be given a thorough work up.
Speaker 1: Tests will include m RIS, ultrasounds and different types of
Speaker 1: CT scans on multiple organs. The images and blood and
Speaker 1: urine tests will be taken at various time points to
Speaker 1: track the progression of changes. Our hope is to get
Speaker 1: the m r S at least at three different time points.
Speaker 1: One would be at the time of study entry, and
Speaker 1: that's across the board with people that are our patients
Speaker 1: who would be you know, relatively low symptom o asymptomatic
Speaker 1: or low symptom mode to those that are going to
Speaker 1: be hospitalized, and then we would get them at the
Speaker 1: recovery phase after they've cleared their virus and have improved,
Speaker 1: and then we would get them at convalescence in terms
Speaker 1: of eight weeks to twelve months. Anthony will be comparing
Speaker 1: the results across a spectrum of COVID patients and we're
Speaker 1: really trying to enroll not just the critically ill patients.
Speaker 1: Were very interested and also the the young person who
Speaker 1: might have an infection. They lose their sense of smell
Speaker 1: and taste, they have a fever, they feel kind of
Speaker 1: like they've had a bad flu, and they get better.
Speaker 1: So those people are very interesting to look at simply
Speaker 1: because what are the consequences, how do they get better? Uh,
Speaker 1: and how does that differ from from someone in a
Speaker 1: similar age group who doesn't get better and who deteriorates
Speaker 1: and requires an IC you admission. Doctors also need to
Speaker 1: disentangle the causes because they might be the direct result
Speaker 1: of the virus, the body's a immune response to it,
Speaker 1: and it could be the result of the treatment patients received.
Speaker 1: One of the things that becomes complicated. However, there's many
Speaker 1: things we do in critical care that affect neurocognitive function,
Speaker 1: muscular recovery, even as things as simple as getting back
Speaker 1: to your work. A study in Canada that followed patients
Speaker 1: with a life threatening lung injury known as acute respiratory
Speaker 1: distress syndrome now many patients were suffering neurocognitive problems and
Speaker 1: trouble sleeping a year later. Anthony says that might be
Speaker 1: a result of the type of sedatives sometimes you use
Speaker 1: so that patients will tolerate the intubation required for mechanical ventilation.
Speaker 1: We use benzo diazepines and they're very good on one hand.
Speaker 1: On the other hand, the recent data that has come
Speaker 1: out would suggest that that's associated with post traumatic stress disorder,
Speaker 1: among other things and so on. In the context of that,
Speaker 1: many people try to avoid those drugs. However, if you
Speaker 1: if you looked at around the world right now, when
Speaker 1: people are really, really sick and they're really trying to
Speaker 1: make sure their loans don't get injured further with not
Speaker 1: just the information from the from the COVID, but from
Speaker 1: the from the support measures we used in terms of
Speaker 1: how we ventilate them on the mechanical ventilator UM, they're
Speaker 1: often pushed to the UH, to the situation where they
Speaker 1: have to use almost everything to keep the person sedated
Speaker 1: to be able to tolerate the UH less injurious UH
Speaker 1: modalities of mechanical ventilation. So we're kind of stuck in
Speaker 1: a situation where we we may not have even defined
Speaker 1: the best ways of supporting people right now. Fortunately, there
Speaker 1: is a vast amount of research being published each week,
Speaker 1: much of it is informing ways to improve patient care.
Speaker 1: The other good news is that awareness of the secondary
Speaker 1: effects of the coronavirus is growing. As a Vanette says,
Speaker 1: people should know that if they have persistent symptoms, they're
Speaker 1: not crazy. There may well be thing biologically wrong and
Speaker 1: that they should see a doctor about them. Identifying such
Speaker 1: medical concerns in real time could help solve the mystery
Speaker 1: of these post viral illnesses, prevent them in the future,
Speaker 1: and find better treatments for those who suffer from them,
Speaker 1: including post COVID nineteen patients. That was Jason Gale, and
Speaker 1: that's our show today. For coverage of the outbreak from
Speaker 1: one bureaus around the world, visit Bloomberg dot com slash
Speaker 1: coronavirus and if you like the show, please leave us
Speaker 1: a review and a rating on Apple Podcasts or Spotify.
Speaker 1: It's the best way to help more listeners find our
Speaker 1: global reporting. The Prognosis Daily edition is produced by over
Speaker 1: foreheads Jordan Gaspore, Magnus Hendrickson and me Laura Carlson. Today's
Speaker 1: main story was reported by Jason Gale. Original music by
Speaker 1: Leo Sidrin. Our editors are Francesca Levi and Rick Shine.
Speaker 1: Francesco Levi is Bloomberg's head of podcasts. Thanks for listening.