1 00:00:02,240 --> 00:00:08,039 Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day one nine 2 00:00:08,400 --> 00:00:13,520 Speaker 1: since coronavirus was declared a global pandemic. Today's main story. 3 00:00:14,720 --> 00:00:19,279 Speaker 1: Patients who suffer mild cases of COVID nineteen or have 4 00:00:19,400 --> 00:00:23,440 Speaker 1: the virus without showing symptoms may think they got off easy, 5 00:00:24,640 --> 00:00:29,080 Speaker 1: but we're learning now that even those people can suffer serious, 6 00:00:29,560 --> 00:00:35,600 Speaker 1: long lasting consequences from the virus. But first, here's what 7 00:00:35,720 --> 00:00:45,240 Speaker 1: happened in virus news today. The US is watching New 8 00:00:45,320 --> 00:00:49,239 Speaker 1: York closely, as it's the last large school district in 9 00:00:49,240 --> 00:00:53,000 Speaker 1: the country to say it will send students back to 10 00:00:53,080 --> 00:00:59,360 Speaker 1: school this fall. Today, Governor Andrew Cuomo confirmed that, based 11 00:00:59,360 --> 00:01:03,000 Speaker 1: on infection rates around the state, every school district can 12 00:01:03,040 --> 00:01:08,399 Speaker 1: reopen in September. Governor Cuomo said every region in the 13 00:01:08,480 --> 00:01:12,840 Speaker 1: state falls below the three percent infection rate threshold that 14 00:01:12,959 --> 00:01:17,959 Speaker 1: had been established. He also said school openings would be 15 00:01:18,080 --> 00:01:24,800 Speaker 1: revisited if infection rates spiked. Thailand will allow schools to 16 00:01:24,880 --> 00:01:29,959 Speaker 1: fully reopen starting next Thursday. The Southeast Asian nation has 17 00:01:30,040 --> 00:01:34,240 Speaker 1: not had a locally transmitted case for more than two months. 18 00:01:35,680 --> 00:01:39,839 Speaker 1: All schools will be allowed to function without any capacity 19 00:01:39,880 --> 00:01:46,560 Speaker 1: limits or social distancing rules. According to the Education Minister. Finally, 20 00:01:46,760 --> 00:01:51,120 Speaker 1: in India, the country's all female army of contact tracers 21 00:01:51,440 --> 00:01:56,880 Speaker 1: is going on strike. Months of harassment, low pay, and 22 00:01:57,200 --> 00:02:01,080 Speaker 1: lack of protection from infection has wish them to the 23 00:02:01,160 --> 00:02:06,240 Speaker 1: breaking point. About six hundred thousand of the country's one 24 00:02:06,360 --> 00:02:11,600 Speaker 1: million accredited social health activists will strike today and tomorrow. 25 00:02:12,680 --> 00:02:15,840 Speaker 1: They want better and on time pay, as well as 26 00:02:15,840 --> 00:02:21,440 Speaker 1: a legal status that ensures minimum wages. Losing the asha's 27 00:02:21,560 --> 00:02:26,080 Speaker 1: would not only threaten India's virus containment effort, but also 28 00:02:26,120 --> 00:02:30,760 Speaker 1: impact the other essential health services they provide, from child 29 00:02:30,880 --> 00:02:38,040 Speaker 1: vaccinations to tuberculosis control. The country's catastrophic coronavirus outbreak is 30 00:02:38,080 --> 00:02:46,720 Speaker 1: now the third largest in the world. And now for 31 00:02:46,760 --> 00:02:51,920 Speaker 1: today's main story. The coronavirus has been spreading worldwide for 32 00:02:52,160 --> 00:02:56,560 Speaker 1: over seven months now, and more than eighteen million people 33 00:02:56,919 --> 00:03:01,040 Speaker 1: are known to have been infected by it over that time. 34 00:03:01,280 --> 00:03:05,320 Speaker 1: We've come to understand that in most people, the virus 35 00:03:05,360 --> 00:03:09,639 Speaker 1: causes mild symptoms or none at all, at least at 36 00:03:09,680 --> 00:03:14,519 Speaker 1: the time they have the virus, but even asymptomatic patients 37 00:03:14,800 --> 00:03:20,320 Speaker 1: may suffer lingering effects. It's yet another of the pandemics mysteries. 38 00:03:21,639 --> 00:03:26,200 Speaker 1: Bloomberg Senior editor Jason Gale explains it may contribute to 39 00:03:26,240 --> 00:03:35,720 Speaker 1: the pandemics significant long term social and economic costs. First 40 00:03:35,880 --> 00:03:39,520 Speaker 1: was like typical flu, like syndrome, but no shortage or 41 00:03:39,600 --> 00:03:44,760 Speaker 1: breath particularly it's with fever and extreme fatigue basically. Dr 42 00:03:44,760 --> 00:03:49,120 Speaker 1: Peter Piot is one of our generation's most celebrated microbiologists. 43 00:03:49,560 --> 00:03:51,480 Speaker 1: In the mid ninet seventies, he was part of the 44 00:03:51,480 --> 00:03:54,520 Speaker 1: team that isolated the bolivirus and to help control the 45 00:03:54,560 --> 00:03:57,760 Speaker 1: first outbreak in what was then Zaire. Later he helped 46 00:03:57,800 --> 00:04:00,760 Speaker 1: lead to fight against AIDS as President of International Aid 47 00:04:00,800 --> 00:04:04,440 Speaker 1: Society and executive director of u n AS. For almost 48 00:04:04,520 --> 00:04:06,880 Speaker 1: a decade it has been director of the London School 49 00:04:06,920 --> 00:04:10,280 Speaker 1: of Hygiene and Tropical Medicine. So it was big news 50 00:04:10,440 --> 00:04:13,440 Speaker 1: when he needed to be hospitalized for COVID nineteen almost 51 00:04:13,480 --> 00:04:17,080 Speaker 1: five months ago. And that was ironically, after having spent 52 00:04:17,200 --> 00:04:20,560 Speaker 1: most of my professional life fighting viruses. It was the 53 00:04:20,600 --> 00:04:25,120 Speaker 1: first time ever I not seriously ill because my situation deteriorated. 54 00:04:25,200 --> 00:04:28,520 Speaker 1: I was admitted to the hospital with my oxygen saturation 55 00:04:28,760 --> 00:04:34,080 Speaker 1: was like eighty three on admission and thanks to oxygen 56 00:04:34,200 --> 00:04:37,279 Speaker 1: I made it through seven days there. Peter is speaking 57 00:04:37,360 --> 00:04:40,000 Speaker 1: in an interview with the New England Journal of Medicine. 58 00:04:40,440 --> 00:04:43,120 Speaker 1: He told the journal last week that he developed pneumonia 59 00:04:43,279 --> 00:04:47,080 Speaker 1: complicated by an aberrant hyper inflammatory response to this sas 60 00:04:47,200 --> 00:04:52,400 Speaker 1: cove To virus, and it illustrated that COVID nineteen is 61 00:04:52,600 --> 00:04:54,440 Speaker 1: far more than either you have a bit of the 62 00:04:54,480 --> 00:04:58,280 Speaker 1: flu or you end up in intensive care and die. 63 00:04:58,320 --> 00:05:00,520 Speaker 1: And then they often say, oh, that's people who are 64 00:05:00,560 --> 00:05:04,440 Speaker 1: over seventy and or pre existing conditions, as if we 65 00:05:04,480 --> 00:05:06,479 Speaker 1: don't count, you know, there are lots of people in 66 00:05:06,520 --> 00:05:11,560 Speaker 1: between with this chronic condition and this long tail of 67 00:05:11,760 --> 00:05:16,800 Speaker 1: in my case, pneumonia, of mutual fibrillation, extreme tachycardia all 68 00:05:16,800 --> 00:05:19,920 Speaker 1: the time. Peter had an irregular and often rapid heart 69 00:05:20,000 --> 00:05:23,320 Speaker 1: right that persisted for months after his acute illness. He's 70 00:05:23,520 --> 00:05:26,039 Speaker 1: seventy one and he managed a five kilometer job the 71 00:05:26,040 --> 00:05:29,640 Speaker 1: morning he was interviewed. Even still he gets fatigued. He 72 00:05:29,680 --> 00:05:34,880 Speaker 1: says the ordeal changed his perspective. One viruses particularly sounds two. Well, 73 00:05:34,920 --> 00:05:37,880 Speaker 1: first of all, it's something to avoid at all costs. 74 00:05:37,960 --> 00:05:39,839 Speaker 1: I mean it's a bit of a lottery in a 75 00:05:39,920 --> 00:05:45,640 Speaker 1: sense whether you'll develop an asymptomatic infection or serious illness 76 00:05:45,640 --> 00:05:48,039 Speaker 1: like what I had. Of course there are risk factors 77 00:05:48,080 --> 00:05:51,440 Speaker 1: being old, having diabetes hypertension, but I didn't have any 78 00:05:51,480 --> 00:05:54,960 Speaker 1: of these underlying factors, and even young people today can 79 00:05:55,000 --> 00:05:57,359 Speaker 1: die from it. There are many more and more examples, 80 00:05:57,400 --> 00:06:00,640 Speaker 1: and that's particularly important to realize now that a lot 81 00:06:00,680 --> 00:06:03,400 Speaker 1: of the infections are happening in young people, and the 82 00:06:03,440 --> 00:06:07,159 Speaker 1: scientific evidence suggests a proportion of these patients may endure 83 00:06:07,360 --> 00:06:11,200 Speaker 1: decades of chronic diseases. Doctors refer to these conditions as 84 00:06:11,360 --> 00:06:15,120 Speaker 1: sequel I. When they persist in younger patients, the impact 85 00:06:15,160 --> 00:06:18,000 Speaker 1: on society is much larger because people have to live 86 00:06:18,040 --> 00:06:21,560 Speaker 1: longer with their disabling effects. The physician who treated UK 87 00:06:21,640 --> 00:06:25,800 Speaker 1: Prime Minister Boris Johnson could COVID nineteen this generation's polio. 88 00:06:25,839 --> 00:06:29,360 Speaker 1: Because of the physical, cognitive, and psychological disability, the illness 89 00:06:29,360 --> 00:06:33,280 Speaker 1: will lead requiring long term healthcare. I think we will 90 00:06:33,560 --> 00:06:38,520 Speaker 1: be faced as a medical community also were probably soon 91 00:06:38,680 --> 00:06:41,920 Speaker 1: hundreds of thousands, if not millions, of people ultimately with 92 00:06:43,040 --> 00:06:46,680 Speaker 1: chronic conditions with long term sequality, and I think it's 93 00:06:46,720 --> 00:06:50,880 Speaker 1: important that we are prepared for the fallout of chronic 94 00:06:50,920 --> 00:06:54,760 Speaker 1: illness mental health issues, and of course, in my particular case, 95 00:06:54,839 --> 00:07:03,960 Speaker 1: I'm double motivated to defeat this epidemic. The coronavirus target 96 00:07:04,000 --> 00:07:07,040 Speaker 1: cells line in the airway, sometimes triggering an overzealous immune 97 00:07:07,080 --> 00:07:10,600 Speaker 1: response like what Peter Pond experienced that can weaken the 98 00:07:10,680 --> 00:07:13,360 Speaker 1: muscles used for breathing and called scarring in the lungs 99 00:07:13,400 --> 00:07:16,920 Speaker 1: of patients who experience even a mile about of COVID nineteen. 100 00:07:17,360 --> 00:07:20,080 Speaker 1: The question is how will that affect lung capacity of 101 00:07:20,160 --> 00:07:23,280 Speaker 1: the long term and what other lasting disabilities will COVID 102 00:07:23,360 --> 00:07:27,360 Speaker 1: nineteen survivor's face. Dr Thomas Filets, President of the Infectious 103 00:07:27,400 --> 00:07:30,200 Speaker 1: Diseases Society of America. He says, we can look for 104 00:07:30,240 --> 00:07:33,040 Speaker 1: clues among people who were sickened by severe acute respiratory 105 00:07:33,040 --> 00:07:36,400 Speaker 1: syndrome or SARS almost twenty years ago. We do know 106 00:07:36,680 --> 00:07:41,280 Speaker 1: from studies about that infection that people who have had 107 00:07:42,040 --> 00:07:46,680 Speaker 1: particularly long scarring from a STARS, that they can have 108 00:07:47,080 --> 00:07:51,000 Speaker 1: persistent symptoms for years. And we're of even one study 109 00:07:51,120 --> 00:07:53,760 Speaker 1: that looked at fifteen years later and some of these 110 00:07:53,760 --> 00:07:58,360 Speaker 1: patients still had abnormalities of their lungs. And so this 111 00:07:58,440 --> 00:08:00,720 Speaker 1: is something that we're going to have to whine closely, 112 00:08:01,120 --> 00:08:05,000 Speaker 1: but I think we're already seeing it. We're seeing effects 113 00:08:05,560 --> 00:08:07,880 Speaker 1: on the lungs We're seeing effects on the heart, on 114 00:08:08,240 --> 00:08:13,520 Speaker 1: the neuro neurologic system, the emotional system, psychological system. So 115 00:08:13,600 --> 00:08:16,800 Speaker 1: this is gonna have I think a significant burden on 116 00:08:16,840 --> 00:08:21,239 Speaker 1: our health care system for years to come. In Wuhan, 117 00:08:21,360 --> 00:08:24,240 Speaker 1: the Chinese city where saskovit too emerged late last year, 118 00:08:24,640 --> 00:08:27,200 Speaker 1: more than a third of severe COVID nineteen patients had 119 00:08:27,200 --> 00:08:31,360 Speaker 1: complications such as stroke, acute kidney injury, and post traumatic 120 00:08:31,400 --> 00:08:35,040 Speaker 1: stress disorder. As the pandemic spread across the world, doctors 121 00:08:35,040 --> 00:08:38,559 Speaker 1: have reported similar problems. For example, one center in Italy 122 00:08:38,559 --> 00:08:41,079 Speaker 1: found that almost nine out of ten patients reported the 123 00:08:41,080 --> 00:08:44,560 Speaker 1: persistence of at least one symptom some sixty days later. 124 00:08:44,880 --> 00:08:48,280 Speaker 1: Where they looked at patients who had all been hospitalized, 125 00:08:48,320 --> 00:08:51,319 Speaker 1: so these are all fairly sick patients, uh, And they 126 00:08:51,400 --> 00:08:54,880 Speaker 1: found that literally eighties seven percent of these patients still 127 00:08:54,960 --> 00:08:59,640 Speaker 1: had significant symptoms, multiple symptoms quite honestly, two months later 128 00:08:59,720 --> 00:09:02,960 Speaker 1: after they're onset of symptoms, even after they were discharged 129 00:09:03,200 --> 00:09:07,520 Speaker 1: from the hospital. Thomas's post traumatic stress disorder could be 130 00:09:07,559 --> 00:09:10,920 Speaker 1: another disturbing product of the pandemic. They're already beginning to 131 00:09:10,920 --> 00:09:14,800 Speaker 1: see some patients who have been released from the hospital 132 00:09:14,840 --> 00:09:17,920 Speaker 1: and some patients quite honestly, who never were sick enough 133 00:09:17,920 --> 00:09:20,440 Speaker 1: to come in the hospital, but yet they're It really 134 00:09:20,480 --> 00:09:25,840 Speaker 1: concerns them about what's happening with, you know, their long 135 00:09:25,920 --> 00:09:29,160 Speaker 1: term health status. We do know that it can affect 136 00:09:29,600 --> 00:09:34,000 Speaker 1: the brain, for example, and it can have neurocognitive considerations, 137 00:09:34,240 --> 00:09:37,280 Speaker 1: and so I think post traumatic stress disorder is going 138 00:09:37,320 --> 00:09:40,360 Speaker 1: to be an issue that the psychologist psychologists are going 139 00:09:40,400 --> 00:09:43,560 Speaker 1: to have to deal with. Thomas's heart problems may also manifest. 140 00:09:44,080 --> 00:09:47,120 Speaker 1: There was a recent study showing that there's this UH 141 00:09:47,480 --> 00:09:53,160 Speaker 1: stress associated heart issue where patients coming in with looks 142 00:09:53,200 --> 00:09:56,560 Speaker 1: like heart attacks, but when they do coronary artery um 143 00:09:56,880 --> 00:10:01,280 Speaker 1: and geograms they really don't see particular coronary odor is, 144 00:10:01,320 --> 00:10:04,120 Speaker 1: but yet they do have heart damage. And so there 145 00:10:04,280 --> 00:10:08,680 Speaker 1: is this issue about the psychological issue and the stress 146 00:10:09,120 --> 00:10:13,120 Speaker 1: mental stress that can be associated with the UH sort 147 00:10:13,120 --> 00:10:18,400 Speaker 1: of physical finding. The CDC two weeks ago published a 148 00:10:18,440 --> 00:10:21,800 Speaker 1: survey of two hundred and seventy non hospitalized adults who 149 00:10:21,840 --> 00:10:24,600 Speaker 1: tested positive for COVID. About a third of them said 150 00:10:24,640 --> 00:10:27,120 Speaker 1: they hadn't returned to their normal health two to three 151 00:10:27,120 --> 00:10:30,120 Speaker 1: weeks later. Among eighteen to thirty four year olds with 152 00:10:30,160 --> 00:10:33,439 Speaker 1: no chronic medical conditions, one in five went back to normal. 153 00:10:34,120 --> 00:10:36,480 Speaker 1: The authors of the report so that, in contrast, over 154 00:10:37,360 --> 00:10:40,800 Speaker 1: our patients with influenza recovered within about two weeks of 155 00:10:40,840 --> 00:10:44,120 Speaker 1: testing positive for fluid. A COVID symptom study, which has 156 00:10:44,160 --> 00:10:46,480 Speaker 1: gathered data from millions of people in the US, UK 157 00:10:46,600 --> 00:10:51,000 Speaker 1: and Sweden, suggests ten percent of fift of people, including 158 00:10:51,040 --> 00:10:55,160 Speaker 1: some mild cases, don't recover quickly. We're beginning to become 159 00:10:55,200 --> 00:10:59,840 Speaker 1: aware of increasing percentage of patients who have had symptoms 160 00:10:59,840 --> 00:11:03,320 Speaker 1: and even who are asymptomatic quite honestly, who may have 161 00:11:03,760 --> 00:11:07,360 Speaker 1: long term health issues. And certainly this seems to be 162 00:11:07,559 --> 00:11:10,440 Speaker 1: much different than other respiratory viruses. The fact that people 163 00:11:10,480 --> 00:11:13,880 Speaker 1: who have no apparent COVID nineteen symptoms can still have 164 00:11:13,960 --> 00:11:18,600 Speaker 1: health problems highlights their insidious nature of sounds. Two. There's 165 00:11:18,640 --> 00:11:21,600 Speaker 1: two studies now that have come out to show that 166 00:11:21,640 --> 00:11:26,240 Speaker 1: patients who have had even asymptomatic infection, and these are 167 00:11:26,280 --> 00:11:29,679 Speaker 1: patients who are identified either through contact tracings. And then 168 00:11:29,679 --> 00:11:33,800 Speaker 1: the other group are patients who had come from cruise 169 00:11:33,840 --> 00:11:37,080 Speaker 1: lines or cruise ships and we're quarantined for a while 170 00:11:37,520 --> 00:11:41,240 Speaker 1: and we're tested but never developed symptoms. And a group 171 00:11:41,280 --> 00:11:45,240 Speaker 1: of them um did studies imaging studies of their lung 172 00:11:45,760 --> 00:11:49,520 Speaker 1: and found scarring on their lungs. This could mean that 173 00:11:49,640 --> 00:11:52,839 Speaker 1: they're going to have some decreased lung function, which may 174 00:11:52,880 --> 00:11:55,880 Speaker 1: not be sort of physically evident now because they have 175 00:11:56,000 --> 00:11:59,400 Speaker 1: good lung capacity, but as they get older, or if 176 00:11:59,400 --> 00:12:02,920 Speaker 1: they have other conditions asthma or whatever, it could be 177 00:12:03,240 --> 00:12:07,920 Speaker 1: a significant consequences down the line. So this is going 178 00:12:07,960 --> 00:12:11,240 Speaker 1: to be an issue. It's almost five months since the 179 00:12:11,240 --> 00:12:14,680 Speaker 1: World Health Organization declared COVID nineteen the pandemic. We have 180 00:12:14,760 --> 00:12:18,800 Speaker 1: no effective treatment, no vaccine, and we're still yet to 181 00:12:18,880 --> 00:12:23,959 Speaker 1: fully understand the prognosis. The global contagions immediate threat is obvious, 182 00:12:24,559 --> 00:12:27,520 Speaker 1: but the one we can't yet fathom might tenant to 183 00:12:27,559 --> 00:12:42,160 Speaker 1: be just as catastrophe. That was Jason Gale and that's 184 00:12:42,200 --> 00:12:44,880 Speaker 1: it for our show today. For coverage of the outbreak 185 00:12:44,920 --> 00:12:48,520 Speaker 1: from one and twenty bureaus around the world, visit Bloomberg 186 00:12:48,600 --> 00:12:52,920 Speaker 1: dot com slash coronavirus and if you like the show, 187 00:12:53,440 --> 00:12:56,000 Speaker 1: please leave us a review and a rating on Apple 188 00:12:56,120 --> 00:12:59,600 Speaker 1: Podcasts or Spotify. It's the best way to help more 189 00:12:59,679 --> 00:13:04,600 Speaker 1: or less nurs find our global reporting. The Prognosis Daily 190 00:13:04,720 --> 00:13:09,840 Speaker 1: edition is produced by Topher foreheads Jordan Gospourey, Magnus Hendrickson 191 00:13:09,960 --> 00:13:14,680 Speaker 1: and me Laura Carlson. Today's main story was reported by 192 00:13:14,760 --> 00:13:19,679 Speaker 1: Jason Gale. Special thanks to the New England Journal of Medicine. 193 00:13:20,360 --> 00:13:24,480 Speaker 1: Original music by Leo sidran Our. Editors are Rick Shine 194 00:13:24,520 --> 00:13:29,240 Speaker 1: and Francesca Levi. Francesca Levi is Bloomberg's head of podcasts. 195 00:13:29,840 --> 00:13:30,679 Speaker 1: Thanks for listening.