WEBVTT - A Generation of Health Damage 0:00:02.240 --> 0:00:08.039 Welcome to Prognosis. I'm Laura Carlson. It's day one nine 0:00:08.400 --> 0:00:13.520 since coronavirus was declared a global pandemic. Today's main story. 0:00:14.720 --> 0:00:19.279 Patients who suffer mild cases of COVID nineteen or have 0:00:19.400 --> 0:00:23.440 the virus without showing symptoms may think they got off easy, 0:00:24.640 --> 0:00:29.080 but we're learning now that even those people can suffer serious, 0:00:29.560 --> 0:00:35.600 long lasting consequences from the virus. But first, here's what 0:00:35.720 --> 0:00:45.240 happened in virus news today. The US is watching New 0:00:45.320 --> 0:00:49.239 York closely, as it's the last large school district in 0:00:49.240 --> 0:00:53.000 the country to say it will send students back to 0:00:53.080 --> 0:00:59.360 school this fall. Today, Governor Andrew Cuomo confirmed that, based 0:00:59.360 --> 0:01:03.000 on infection rates around the state, every school district can 0:01:03.040 --> 0:01:08.399 reopen in September. Governor Cuomo said every region in the 0:01:08.480 --> 0:01:12.840 state falls below the three percent infection rate threshold that 0:01:12.959 --> 0:01:17.959 had been established. He also said school openings would be 0:01:18.080 --> 0:01:24.800 revisited if infection rates spiked. Thailand will allow schools to 0:01:24.880 --> 0:01:29.959 fully reopen starting next Thursday. The Southeast Asian nation has 0:01:30.040 --> 0:01:34.240 not had a locally transmitted case for more than two months. 0:01:35.680 --> 0:01:39.839 All schools will be allowed to function without any capacity 0:01:39.880 --> 0:01:46.560 limits or social distancing rules. According to the Education Minister. Finally, 0:01:46.760 --> 0:01:51.120 in India, the country's all female army of contact tracers 0:01:51.440 --> 0:01:56.880 is going on strike. Months of harassment, low pay, and 0:01:57.200 --> 0:02:01.080 lack of protection from infection has wish them to the 0:02:01.160 --> 0:02:06.240 breaking point. About six hundred thousand of the country's one 0:02:06.360 --> 0:02:11.600 million accredited social health activists will strike today and tomorrow. 0:02:12.680 --> 0:02:15.840 They want better and on time pay, as well as 0:02:15.840 --> 0:02:21.440 a legal status that ensures minimum wages. Losing the asha's 0:02:21.560 --> 0:02:26.080 would not only threaten India's virus containment effort, but also 0:02:26.120 --> 0:02:30.760 impact the other essential health services they provide, from child 0:02:30.880 --> 0:02:38.040 vaccinations to tuberculosis control. The country's catastrophic coronavirus outbreak is 0:02:38.080 --> 0:02:46.720 now the third largest in the world. And now for 0:02:46.760 --> 0:02:51.920 today's main story. The coronavirus has been spreading worldwide for 0:02:52.160 --> 0:02:56.560 over seven months now, and more than eighteen million people 0:02:56.919 --> 0:03:01.040 are known to have been infected by it over that time. 0:03:01.280 --> 0:03:05.320 We've come to understand that in most people, the virus 0:03:05.360 --> 0:03:09.639 causes mild symptoms or none at all, at least at 0:03:09.680 --> 0:03:14.519 the time they have the virus, but even asymptomatic patients 0:03:14.800 --> 0:03:20.320 may suffer lingering effects. It's yet another of the pandemics mysteries. 0:03:21.639 --> 0:03:26.200 Bloomberg Senior editor Jason Gale explains it may contribute to 0:03:26.240 --> 0:03:35.720 the pandemics significant long term social and economic costs. First 0:03:35.880 --> 0:03:39.520 was like typical flu, like syndrome, but no shortage or 0:03:39.600 --> 0:03:44.760 breath particularly it's with fever and extreme fatigue basically. Dr 0:03:44.760 --> 0:03:49.120 Peter Piot is one of our generation's most celebrated microbiologists. 0:03:49.560 --> 0:03:51.480 In the mid ninet seventies, he was part of the 0:03:51.480 --> 0:03:54.520 team that isolated the bolivirus and to help control the 0:03:54.560 --> 0:03:57.760 first outbreak in what was then Zaire. Later he helped 0:03:57.800 --> 0:04:00.760 lead to fight against AIDS as President of International Aid 0:04:00.800 --> 0:04:04.440 Society and executive director of u n AS. For almost 0:04:04.520 --> 0:04:06.880 a decade it has been director of the London School 0:04:06.920 --> 0:04:10.280 of Hygiene and Tropical Medicine. So it was big news 0:04:10.440 --> 0:04:13.440 when he needed to be hospitalized for COVID nineteen almost 0:04:13.480 --> 0:04:17.080 five months ago. And that was ironically, after having spent 0:04:17.200 --> 0:04:20.560 most of my professional life fighting viruses. It was the 0:04:20.600 --> 0:04:25.120 first time ever I not seriously ill because my situation deteriorated. 0:04:25.200 --> 0:04:28.520 I was admitted to the hospital with my oxygen saturation 0:04:28.760 --> 0:04:34.080 was like eighty three on admission and thanks to oxygen 0:04:34.200 --> 0:04:37.279 I made it through seven days there. Peter is speaking 0:04:37.360 --> 0:04:40.000 in an interview with the New England Journal of Medicine. 0:04:40.440 --> 0:04:43.120 He told the journal last week that he developed pneumonia 0:04:43.279 --> 0:04:47.080 complicated by an aberrant hyper inflammatory response to this sas 0:04:47.200 --> 0:04:52.400 cove To virus, and it illustrated that COVID nineteen is 0:04:52.600 --> 0:04:54.440 far more than either you have a bit of the 0:04:54.480 --> 0:04:58.280 flu or you end up in intensive care and die. 0:04:58.320 --> 0:05:00.520 And then they often say, oh, that's people who are 0:05:00.560 --> 0:05:04.440 over seventy and or pre existing conditions, as if we 0:05:04.480 --> 0:05:06.479 don't count, you know, there are lots of people in 0:05:06.520 --> 0:05:11.560 between with this chronic condition and this long tail of 0:05:11.760 --> 0:05:16.800 in my case, pneumonia, of mutual fibrillation, extreme tachycardia all 0:05:16.800 --> 0:05:19.920 the time. Peter had an irregular and often rapid heart 0:05:20.000 --> 0:05:23.320 right that persisted for months after his acute illness. He's 0:05:23.520 --> 0:05:26.039 seventy one and he managed a five kilometer job the 0:05:26.040 --> 0:05:29.640 morning he was interviewed. Even still he gets fatigued. He 0:05:29.680 --> 0:05:34.880 says the ordeal changed his perspective. One viruses particularly sounds two. Well, 0:05:34.920 --> 0:05:37.880 first of all, it's something to avoid at all costs. 0:05:37.960 --> 0:05:39.839 I mean it's a bit of a lottery in a 0:05:39.920 --> 0:05:45.640 sense whether you'll develop an asymptomatic infection or serious illness 0:05:45.640 --> 0:05:48.039 like what I had. Of course there are risk factors 0:05:48.080 --> 0:05:51.440 being old, having diabetes hypertension, but I didn't have any 0:05:51.480 --> 0:05:54.960 of these underlying factors, and even young people today can 0:05:55.000 --> 0:05:57.359 die from it. There are many more and more examples, 0:05:57.400 --> 0:06:00.640 and that's particularly important to realize now that a lot 0:06:00.680 --> 0:06:03.400 of the infections are happening in young people, and the 0:06:03.440 --> 0:06:07.159 scientific evidence suggests a proportion of these patients may endure 0:06:07.360 --> 0:06:11.200 decades of chronic diseases. Doctors refer to these conditions as 0:06:11.360 --> 0:06:15.120 sequel I. When they persist in younger patients, the impact 0:06:15.160 --> 0:06:18.000 on society is much larger because people have to live 0:06:18.040 --> 0:06:21.560 longer with their disabling effects. The physician who treated UK 0:06:21.640 --> 0:06:25.800 Prime Minister Boris Johnson could COVID nineteen this generation's polio. 0:06:25.839 --> 0:06:29.360 Because of the physical, cognitive, and psychological disability, the illness 0:06:29.360 --> 0:06:33.280 will lead requiring long term healthcare. I think we will 0:06:33.560 --> 0:06:38.520 be faced as a medical community also were probably soon 0:06:38.680 --> 0:06:41.920 hundreds of thousands, if not millions, of people ultimately with 0:06:43.040 --> 0:06:46.680 chronic conditions with long term sequality, and I think it's 0:06:46.720 --> 0:06:50.880 important that we are prepared for the fallout of chronic 0:06:50.920 --> 0:06:54.760 illness mental health issues, and of course, in my particular case, 0:06:54.839 --> 0:07:03.960 I'm double motivated to defeat this epidemic. The coronavirus target 0:07:04.000 --> 0:07:07.040 cells line in the airway, sometimes triggering an overzealous immune 0:07:07.080 --> 0:07:10.600 response like what Peter Pond experienced that can weaken the 0:07:10.680 --> 0:07:13.360 muscles used for breathing and called scarring in the lungs 0:07:13.400 --> 0:07:16.920 of patients who experience even a mile about of COVID nineteen. 0:07:17.360 --> 0:07:20.080 The question is how will that affect lung capacity of 0:07:20.160 --> 0:07:23.280 the long term and what other lasting disabilities will COVID 0:07:23.360 --> 0:07:27.360 nineteen survivor's face. Dr Thomas Filets, President of the Infectious 0:07:27.400 --> 0:07:30.200 Diseases Society of America. He says, we can look for 0:07:30.240 --> 0:07:33.040 clues among people who were sickened by severe acute respiratory 0:07:33.040 --> 0:07:36.400 syndrome or SARS almost twenty years ago. We do know 0:07:36.680 --> 0:07:41.280 from studies about that infection that people who have had 0:07:42.040 --> 0:07:46.680 particularly long scarring from a STARS, that they can have 0:07:47.080 --> 0:07:51.000 persistent symptoms for years. And we're of even one study 0:07:51.120 --> 0:07:53.760 that looked at fifteen years later and some of these 0:07:53.760 --> 0:07:58.360 patients still had abnormalities of their lungs. And so this 0:07:58.440 --> 0:08:00.720 is something that we're going to have to whine closely, 0:08:01.120 --> 0:08:05.000 but I think we're already seeing it. We're seeing effects 0:08:05.560 --> 0:08:07.880 on the lungs We're seeing effects on the heart, on 0:08:08.240 --> 0:08:13.520 the neuro neurologic system, the emotional system, psychological system. So 0:08:13.600 --> 0:08:16.800 this is gonna have I think a significant burden on 0:08:16.840 --> 0:08:21.239 our health care system for years to come. In Wuhan, 0:08:21.360 --> 0:08:24.240 the Chinese city where saskovit too emerged late last year, 0:08:24.640 --> 0:08:27.200 more than a third of severe COVID nineteen patients had 0:08:27.200 --> 0:08:31.360 complications such as stroke, acute kidney injury, and post traumatic 0:08:31.400 --> 0:08:35.040 stress disorder. As the pandemic spread across the world, doctors 0:08:35.040 --> 0:08:38.559 have reported similar problems. For example, one center in Italy 0:08:38.559 --> 0:08:41.079 found that almost nine out of ten patients reported the 0:08:41.080 --> 0:08:44.560 persistence of at least one symptom some sixty days later. 0:08:44.880 --> 0:08:48.280 Where they looked at patients who had all been hospitalized, 0:08:48.320 --> 0:08:51.319 so these are all fairly sick patients, uh, And they 0:08:51.400 --> 0:08:54.880 found that literally eighties seven percent of these patients still 0:08:54.960 --> 0:08:59.640 had significant symptoms, multiple symptoms quite honestly, two months later 0:08:59.720 --> 0:09:02.960 after they're onset of symptoms, even after they were discharged 0:09:03.200 --> 0:09:07.520 from the hospital. Thomas's post traumatic stress disorder could be 0:09:07.559 --> 0:09:10.920 another disturbing product of the pandemic. They're already beginning to 0:09:10.920 --> 0:09:14.800 see some patients who have been released from the hospital 0:09:14.840 --> 0:09:17.920 and some patients quite honestly, who never were sick enough 0:09:17.920 --> 0:09:20.440 to come in the hospital, but yet they're It really 0:09:20.480 --> 0:09:25.840 concerns them about what's happening with, you know, their long 0:09:25.920 --> 0:09:29.160 term health status. We do know that it can affect 0:09:29.600 --> 0:09:34.000 the brain, for example, and it can have neurocognitive considerations, 0:09:34.240 --> 0:09:37.280 and so I think post traumatic stress disorder is going 0:09:37.320 --> 0:09:40.360 to be an issue that the psychologist psychologists are going 0:09:40.400 --> 0:09:43.560 to have to deal with. Thomas's heart problems may also manifest. 0:09:44.080 --> 0:09:47.120 There was a recent study showing that there's this UH 0:09:47.480 --> 0:09:53.160 stress associated heart issue where patients coming in with looks 0:09:53.200 --> 0:09:56.560 like heart attacks, but when they do coronary artery um 0:09:56.880 --> 0:10:01.280 and geograms they really don't see particular coronary odor is, 0:10:01.320 --> 0:10:04.120 but yet they do have heart damage. And so there 0:10:04.280 --> 0:10:08.680 is this issue about the psychological issue and the stress 0:10:09.120 --> 0:10:13.120 mental stress that can be associated with the UH sort 0:10:13.120 --> 0:10:18.400 of physical finding. The CDC two weeks ago published a 0:10:18.440 --> 0:10:21.800 survey of two hundred and seventy non hospitalized adults who 0:10:21.840 --> 0:10:24.600 tested positive for COVID. About a third of them said 0:10:24.640 --> 0:10:27.120 they hadn't returned to their normal health two to three 0:10:27.120 --> 0:10:30.120 weeks later. Among eighteen to thirty four year olds with 0:10:30.160 --> 0:10:33.439 no chronic medical conditions, one in five went back to normal. 0:10:34.120 --> 0:10:36.480 The authors of the report so that, in contrast, over 0:10:37.360 --> 0:10:40.800 our patients with influenza recovered within about two weeks of 0:10:40.840 --> 0:10:44.120 testing positive for fluid. A COVID symptom study, which has 0:10:44.160 --> 0:10:46.480 gathered data from millions of people in the US, UK 0:10:46.600 --> 0:10:51.000 and Sweden, suggests ten percent of fift of people, including 0:10:51.040 --> 0:10:55.160 some mild cases, don't recover quickly. We're beginning to become 0:10:55.200 --> 0:10:59.840 aware of increasing percentage of patients who have had symptoms 0:10:59.840 --> 0:11:03.320 and even who are asymptomatic quite honestly, who may have 0:11:03.760 --> 0:11:07.360 long term health issues. And certainly this seems to be 0:11:07.559 --> 0:11:10.440 much different than other respiratory viruses. The fact that people 0:11:10.480 --> 0:11:13.880 who have no apparent COVID nineteen symptoms can still have 0:11:13.960 --> 0:11:18.600 health problems highlights their insidious nature of sounds. Two. There's 0:11:18.640 --> 0:11:21.600 two studies now that have come out to show that 0:11:21.640 --> 0:11:26.240 patients who have had even asymptomatic infection, and these are 0:11:26.280 --> 0:11:29.679 patients who are identified either through contact tracings. And then 0:11:29.679 --> 0:11:33.800 the other group are patients who had come from cruise 0:11:33.840 --> 0:11:37.080 lines or cruise ships and we're quarantined for a while 0:11:37.520 --> 0:11:41.240 and we're tested but never developed symptoms. And a group 0:11:41.280 --> 0:11:45.240 of them um did studies imaging studies of their lung 0:11:45.760 --> 0:11:49.520 and found scarring on their lungs. This could mean that 0:11:49.640 --> 0:11:52.839 they're going to have some decreased lung function, which may 0:11:52.880 --> 0:11:55.880 not be sort of physically evident now because they have 0:11:56.000 --> 0:11:59.400 good lung capacity, but as they get older, or if 0:11:59.400 --> 0:12:02.920 they have other conditions asthma or whatever, it could be 0:12:03.240 --> 0:12:07.920 a significant consequences down the line. So this is going 0:12:07.960 --> 0:12:11.240 to be an issue. It's almost five months since the 0:12:11.240 --> 0:12:14.680 World Health Organization declared COVID nineteen the pandemic. We have 0:12:14.760 --> 0:12:18.800 no effective treatment, no vaccine, and we're still yet to 0:12:18.880 --> 0:12:23.959 fully understand the prognosis. The global contagions immediate threat is obvious, 0:12:24.559 --> 0:12:27.520 but the one we can't yet fathom might tenant to 0:12:27.559 --> 0:12:42.160 be just as catastrophe. That was Jason Gale and that's 0:12:42.200 --> 0:12:44.880 it for our show today. For coverage of the outbreak 0:12:44.920 --> 0:12:48.520 from one and twenty bureaus around the world, visit Bloomberg 0:12:48.600 --> 0:12:52.920 dot com slash coronavirus and if you like the show, 0:12:53.440 --> 0:12:56.000 please leave us a review and a rating on Apple 0:12:56.120 --> 0:12:59.600 Podcasts or Spotify. It's the best way to help more 0:12:59.679 --> 0:13:04.600 or less nurs find our global reporting. The Prognosis Daily 0:13:04.720 --> 0:13:09.840 edition is produced by Topher foreheads Jordan Gospourey, Magnus Hendrickson 0:13:09.960 --> 0:13:14.680 and me Laura Carlson. Today's main story was reported by 0:13:14.760 --> 0:13:19.679 Jason Gale. Special thanks to the New England Journal of Medicine. 0:13:20.360 --> 0:13:24.480 Original music by Leo sidran Our. Editors are Rick Shine 0:13:24.520 --> 0:13:29.240 and Francesca Levi. Francesca Levi is Bloomberg's head of podcasts. 0:13:29.840 --> 0:13:30.679 Thanks for listening.