WEBVTT - Why COVID-19 Lingers 0:00:03.920 --> 0:00:09.560 Welcome to Prognosis. I'm Laura Carlson. It's day ninety since 0:00:09.600 --> 0:00:15.640 coronavirus was declared a global pandemic. Our main story. Most 0:00:15.680 --> 0:00:19.680 people who survive COVID nineteen recover within a few weeks, 0:00:20.720 --> 0:00:26.280 but some suffer from debilitating pain and fatigue for months. Now, 0:00:26.680 --> 0:00:30.720 researchers are trying to better understand what causes these long 0:00:30.800 --> 0:00:34.760 term symptoms and what can be done, if anything, to 0:00:34.880 --> 0:00:41.080 avoid them in the future. But first, here's what happened today. 0:00:48.479 --> 0:00:52.400 A top World Health Organization official is backpedaling on her 0:00:52.440 --> 0:00:57.320 comments over the role asymptomatic carriers play in spreading COVID nineteen. 0:00:58.400 --> 0:01:02.600 Maria van Kirkhove said on Monday that asymptomatic transmission of 0:01:02.600 --> 0:01:08.839 coronavirus is very rare. That comment revived a controversy over 0:01:08.880 --> 0:01:13.280 how the virus spreads. Today, she says she was referring 0:01:13.319 --> 0:01:19.959 specifically to two or three studies. New York City reached 0:01:19.959 --> 0:01:23.959 a milestone today. It reported just one percent of its 0:01:24.000 --> 0:01:28.240 residents tested positive for the coronavirus for the first time 0:01:28.360 --> 0:01:31.959 since the beginning of the outbreak. The city had reached 0:01:31.959 --> 0:01:36.880 a high of seventy one testing positive in April. The 0:01:36.920 --> 0:01:41.440 city is now conducting more than thirty thousand tests a day, 0:01:43.959 --> 0:01:47.200 and much of the world continues to open up. The 0:01:47.280 --> 0:01:51.600 Eiffel Tower in Paris will reopen following its longest shutdown 0:01:51.840 --> 0:01:57.440 since World War Two. France also unveiled a massive rescue 0:01:57.440 --> 0:02:01.160 plan for its struggling aerospace industry, and the European Union 0:02:01.280 --> 0:02:05.120 is considering a leader summit to discuss measures for speeding 0:02:05.200 --> 0:02:10.560 up a recovery. The United Nations says that the pandemic, 0:02:10.760 --> 0:02:14.760 combined with a global recession, is contributing to a worldwide 0:02:14.800 --> 0:02:19.240 food emergency. The organization released a policy brief that says 0:02:19.280 --> 0:02:22.360 these factors could set the stage for a health and 0:02:22.440 --> 0:02:31.440 nutrition crisis on a scale not seen for decades and 0:02:31.520 --> 0:02:37.200 now our main story. Many survivors of coronavirus report feeling 0:02:37.320 --> 0:02:43.000 unwell weeks after they've supposedly beat the infection. That's raised 0:02:43.040 --> 0:02:47.960 questions about the long term consequences of COVID nineteen. Never 0:02:48.040 --> 0:02:50.799 in the modern scientific era have so many people been 0:02:50.840 --> 0:02:54.360 infected with this same virus in such a short period 0:02:54.360 --> 0:02:59.160 of time. As Bloomberg Senior editor Jason Gale reports, that 0:02:59.200 --> 0:03:04.080 could actually sent a unique opportunity to discover strategies for 0:03:04.160 --> 0:03:10.640 preventing post COVID illness in the future. Anyone who's had 0:03:10.720 --> 0:03:14.120 shingles knows about the lasting effects of chicken pox. Many 0:03:14.160 --> 0:03:17.720 infections can cause secondary diseases. We only need to look 0:03:17.760 --> 0:03:21.120 at the rare multi system inflammatory syndrome reported around the 0:03:21.160 --> 0:03:24.120 world in children to see that the coronavirus can trigger 0:03:24.200 --> 0:03:28.600 some subsequent complications, some of them lethal. With millions of 0:03:28.600 --> 0:03:32.480 people afflicted by COVID nineteen, survivors and their doctors are 0:03:32.520 --> 0:03:39.680 wondering what other persistent effects this illness might have. It's 0:03:39.680 --> 0:03:43.400 an important question, not just because of the sheer volume 0:03:43.440 --> 0:03:46.720 of people afflicted, but also because of the likelihood that 0:03:46.800 --> 0:03:49.360 many sufferers could be left with permanent damage to their 0:03:49.440 --> 0:03:53.960 lungs and other vital organs, requiring costly long term medical 0:03:54.040 --> 0:03:58.400 care and support. So, you know, we've taught for a 0:03:58.400 --> 0:04:00.720 long time that once you have and then you're done 0:04:00.720 --> 0:04:02.920 with it, that would be yet you know. This is 0:04:03.000 --> 0:04:06.560 Dr RV. Nath. He's a physician scientist with the National 0:04:06.600 --> 0:04:10.720 Institutes of Health in Bethesda, Maryland, vous clinical director of 0:04:10.760 --> 0:04:14.040 the Institute of Neurological Disorders and Stroke and heads the 0:04:14.080 --> 0:04:17.400 section that looks at infections of the nervous system, tells 0:04:17.400 --> 0:04:21.640 of the patients now complaining of the fact that they 0:04:21.680 --> 0:04:25.520 have persistent symptoms that fewer goes away, and you know 0:04:25.560 --> 0:04:27.640 all the other symptoms, the carf and other things that 0:04:27.680 --> 0:04:30.080 now they're developing other those kinds of symptoms. The lingering 0:04:30.120 --> 0:04:34.520 symptoms that COVID patients experience are fairly broad. V is 0:04:34.600 --> 0:04:40.120 interested in brain fog, malays tiredness symptoms reminiscent of myalgic 0:04:40.279 --> 0:04:44.480 encephalomyelitis or chronic fatigue syndrome, which he says is linked 0:04:44.520 --> 0:04:47.920 with a lot of viral infections. COVID, though has also 0:04:48.040 --> 0:04:52.400 been associated with some other neurological complications, including strokes as 0:04:52.440 --> 0:04:56.000 well as brain bleeds and inflammation. These things are happening 0:04:56.080 --> 0:04:59.560 later in the course of the infection, suggesting that there's 0:04:59.560 --> 0:05:02.760 an immune component to it, so you know, the virus 0:05:02.800 --> 0:05:07.200 goes down and the immune system gets hyperactive, and it 0:05:07.240 --> 0:05:10.120 can cause a variety of different types of neurological symptoms. 0:05:10.560 --> 0:05:14.240 As unfortunate as these rare problems are obvious, says, they 0:05:14.279 --> 0:05:17.440 represent an opportunity to learn how and why these post 0:05:17.520 --> 0:05:21.640 viral syndromes occur their biological pathways, so that we might 0:05:21.680 --> 0:05:25.479 be able to prevent them. For example, biological samples taken 0:05:25.520 --> 0:05:28.800 from patients at the start of their illness may reveal 0:05:28.880 --> 0:05:33.440 evidence of key aspects of the disease process, and oftentimes 0:05:33.440 --> 0:05:35.840 they by the time you see the patient, you don't 0:05:35.839 --> 0:05:38.240 really know what infection they had, and the virus has 0:05:38.279 --> 0:05:41.320 never figured out, and and it's too late to figure 0:05:41.320 --> 0:05:43.680 out what virus they have. Now that's not an excuse 0:05:43.720 --> 0:05:46.440 any longer. You know exactly what virus caused that, and 0:05:46.480 --> 0:05:48.760 you know exactly what the syndrome is, and you know 0:05:48.839 --> 0:05:52.800 exactly what happened in between. So I think it's an 0:05:52.960 --> 0:05:55.880 unfortunate situation, but you can use it to get an 0:05:55.880 --> 0:05:59.119 advantage to try and understand these diseases that we haven't 0:05:59.120 --> 0:06:01.240 been able to for a long, long long time. Obviously, 0:06:01.520 --> 0:06:04.960 he and other scientists are preparing studies to understand what's 0:06:05.000 --> 0:06:08.440 different about the minority of people who don't recover normally 0:06:08.520 --> 0:06:12.240 from their coronavirus infection. I haven't had the infection for 0:06:12.360 --> 0:06:14.880 long enough for us to know how long these things 0:06:14.920 --> 0:06:17.680 are going to persist, and sometimes it takes people a 0:06:17.760 --> 0:06:21.240 month or two to recover from it. Everybody's a little 0:06:21.240 --> 0:06:25.000 bit different. However, we are concerned that some of them 0:06:25.160 --> 0:06:31.560 may have plowing symptoms. The NAH has several research teams 0:06:31.600 --> 0:06:35.160 trying to unlock the secrets of these post viral illnesses. 0:06:35.760 --> 0:06:39.080 Another doctor I spoke with is investigating what's termed the 0:06:39.200 --> 0:06:45.120 natural history of infection in dozens of COVID patients. My 0:06:45.200 --> 0:06:48.440 name is Anthony Superdidy. I'm a critical care physician. I 0:06:48.520 --> 0:06:51.400 work in the Critical Care Medicine department at the Clinical Center, 0:06:51.839 --> 0:06:54.840 which is the research hospital associated with the National Institutes 0:06:54.880 --> 0:06:58.159 of Health. Anthony began enrolling patients last week in a 0:06:58.240 --> 0:07:00.960 study that aims to follow patients for a year to 0:07:01.040 --> 0:07:04.080 track the impact it's had on their heart, lungs, and kidneys. 0:07:04.440 --> 0:07:08.719 Uh the The study is composed of two cohorts patients 0:07:08.720 --> 0:07:11.480 who are acutely ill who would be followed from the 0:07:11.520 --> 0:07:14.080 time of the onset of their symptoms into out to 0:07:14.160 --> 0:07:17.480 one year, and then we will be getting patients from 0:07:17.600 --> 0:07:20.840 who have been treated at the outside hospitals who would 0:07:20.880 --> 0:07:24.640 be enrolled after their acute illness and to see again 0:07:24.680 --> 0:07:28.600 the consequences in terms of their cardiac their pulmonary function 0:07:28.680 --> 0:07:31.679 as well as their their their kidney function renal functions. 0:07:31.880 --> 0:07:34.320 The participants are going to be given a thorough work up. 0:07:34.760 --> 0:07:38.120 Tests will include m RIS, ultrasounds and different types of 0:07:38.240 --> 0:07:42.080 CT scans on multiple organs. The images and blood and 0:07:42.240 --> 0:07:45.080 urine tests will be taken at various time points to 0:07:45.160 --> 0:07:48.080 track the progression of changes. Our hope is to get 0:07:48.120 --> 0:07:50.600 the m r S at least at three different time points. 0:07:50.640 --> 0:07:53.280 One would be at the time of study entry, and 0:07:53.320 --> 0:07:56.800 that's across the board with people that are our patients 0:07:56.800 --> 0:08:01.160 who would be you know, relatively low symptom o asymptomatic 0:08:01.240 --> 0:08:03.120 or low symptom mode to those that are going to 0:08:03.120 --> 0:08:05.600 be hospitalized, and then we would get them at the 0:08:05.680 --> 0:08:09.760 recovery phase after they've cleared their virus and have improved, 0:08:10.160 --> 0:08:13.679 and then we would get them at convalescence in terms 0:08:13.680 --> 0:08:17.560 of eight weeks to twelve months. Anthony will be comparing 0:08:17.560 --> 0:08:20.880 the results across a spectrum of COVID patients and we're 0:08:20.920 --> 0:08:23.880 really trying to enroll not just the critically ill patients. 0:08:23.960 --> 0:08:27.040 Were very interested and also the the young person who 0:08:27.120 --> 0:08:30.160 might have an infection. They lose their sense of smell 0:08:30.200 --> 0:08:32.760 and taste, they have a fever, they feel kind of 0:08:32.800 --> 0:08:34.680 like they've had a bad flu, and they get better. 0:08:35.080 --> 0:08:37.800 So those people are very interesting to look at simply 0:08:37.840 --> 0:08:41.480 because what are the consequences, how do they get better? Uh, 0:08:41.520 --> 0:08:44.440 and how does that differ from from someone in a 0:08:44.480 --> 0:08:48.240 similar age group who doesn't get better and who deteriorates 0:08:48.320 --> 0:08:51.240 and requires an IC you admission. Doctors also need to 0:08:51.320 --> 0:08:54.960 disentangle the causes because they might be the direct result 0:08:55.000 --> 0:08:58.040 of the virus, the body's a immune response to it, 0:08:58.440 --> 0:09:01.400 and it could be the result of the treatment patients received. 0:09:01.920 --> 0:09:04.600 One of the things that becomes complicated. However, there's many 0:09:04.679 --> 0:09:09.080 things we do in critical care that affect neurocognitive function, 0:09:09.800 --> 0:09:14.400 muscular recovery, even as things as simple as getting back 0:09:14.400 --> 0:09:18.040 to your work. A study in Canada that followed patients 0:09:18.080 --> 0:09:21.839 with a life threatening lung injury known as acute respiratory 0:09:21.920 --> 0:09:26.840 distress syndrome now many patients were suffering neurocognitive problems and 0:09:26.920 --> 0:09:31.520 trouble sleeping a year later. Anthony says that might be 0:09:31.600 --> 0:09:34.160 a result of the type of sedatives sometimes you use 0:09:34.200 --> 0:09:38.719 so that patients will tolerate the intubation required for mechanical ventilation. 0:09:38.920 --> 0:09:42.640 We use benzo diazepines and they're very good on one hand. 0:09:42.640 --> 0:09:44.959 On the other hand, the recent data that has come 0:09:45.000 --> 0:09:48.880 out would suggest that that's associated with post traumatic stress disorder, 0:09:48.960 --> 0:09:52.959 among other things and so on. In the context of that, 0:09:53.040 --> 0:09:56.360 many people try to avoid those drugs. However, if you 0:09:56.880 --> 0:09:59.200 if you looked at around the world right now, when 0:09:59.240 --> 0:10:01.840 people are really, really sick and they're really trying to 0:10:01.880 --> 0:10:05.080 make sure their loans don't get injured further with not 0:10:05.240 --> 0:10:07.960 just the information from the from the COVID, but from 0:10:07.960 --> 0:10:10.560 the from the support measures we used in terms of 0:10:10.559 --> 0:10:14.400 how we ventilate them on the mechanical ventilator UM, they're 0:10:14.440 --> 0:10:17.440 often pushed to the UH, to the situation where they 0:10:17.480 --> 0:10:20.920 have to use almost everything to keep the person sedated 0:10:21.480 --> 0:10:27.200 to be able to tolerate the UH less injurious UH 0:10:27.440 --> 0:10:32.000 modalities of mechanical ventilation. So we're kind of stuck in 0:10:32.120 --> 0:10:35.640 a situation where we we may not have even defined 0:10:35.679 --> 0:10:40.200 the best ways of supporting people right now. Fortunately, there 0:10:40.280 --> 0:10:43.120 is a vast amount of research being published each week, 0:10:43.679 --> 0:10:46.760 much of it is informing ways to improve patient care. 0:10:47.520 --> 0:10:50.520 The other good news is that awareness of the secondary 0:10:50.559 --> 0:10:54.400 effects of the coronavirus is growing. As a Vanette says, 0:10:54.720 --> 0:10:58.000 people should know that if they have persistent symptoms, they're 0:10:58.000 --> 0:11:02.160 not crazy. There may well be thing biologically wrong and 0:11:02.200 --> 0:11:05.320 that they should see a doctor about them. Identifying such 0:11:05.360 --> 0:11:09.360 medical concerns in real time could help solve the mystery 0:11:09.600 --> 0:11:13.120 of these post viral illnesses, prevent them in the future, 0:11:13.760 --> 0:11:17.680 and find better treatments for those who suffer from them, 0:11:17.720 --> 0:11:33.480 including post COVID nineteen patients. That was Jason Gale, and 0:11:33.520 --> 0:11:36.120 that's our show today. For coverage of the outbreak from 0:11:36.160 --> 0:11:40.679 one bureaus around the world, visit Bloomberg dot com slash 0:11:40.720 --> 0:11:45.080 coronavirus and if you like the show, please leave us 0:11:45.080 --> 0:11:48.400 a review and a rating on Apple Podcasts or Spotify. 0:11:49.080 --> 0:11:51.640 It's the best way to help more listeners find our 0:11:51.720 --> 0:11:56.520 global reporting. The Prognosis Daily edition is produced by over 0:11:56.679 --> 0:12:03.199 foreheads Jordan Gaspore, Magnus Hendrickson and me Laura Carlson. Today's 0:12:03.200 --> 0:12:07.559 main story was reported by Jason Gale. Original music by 0:12:07.640 --> 0:12:12.199 Leo Sidrin. Our editors are Francesca Levi and Rick Shine. 0:12:12.920 --> 0:12:17.559 Francesco Levi is Bloomberg's head of podcasts. Thanks for listening.