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Done With COVID? It’s Just the Overture

This pandemic is only the start of a new era of viral spread.

Crawford Kilian 10 May 2022TheTyee.ca

Tyee contributing editor Crawford Kilian blogs about infectious diseases.

Just when almost every government in the world has decided it’s done with COVID-19, several new animal and human disease outbreaks seem to be underway. We know enough about them to be scared. But what scares me is that if they turn really serious, we’ll give up and let them roll over us.

H5N1 avian flu has been spreading around the world for a year now, according to the World Organization for Animal Health. It’s a serious problem for both wild birds and domestic poultry. Since 1997 it’s emerged, vanished, and then reappeared as a new strain several times.

The latest version has spread all over the world, including Canada. The Canadian Food Inspection Agency estimates that by the second week in May, H5N1 has “impacted” 1,740,500 birds. B.C. flocks have lost 53,000 birds so far. In 2004, a related virus, H7N3, caused the destruction of over 19 million birds in the Fraser Valley. H5N1 could have similar catastrophic effects.

Rare but dangerous

Just two people have tested positive for H5N1 in recent weeks, and it rarely infects humans. Still, the World Health Organization says 864 people have been infected with it since 2003, and 456 of them died. That’s a 52 per cent case fatality rate; if COVID were that lethal, B.C. would have lost about 189,000 people by now instead of 3,000. And 1.9 million Canadians would have died of COVID instead of 39,000.

So H5N1 poses an immediate economic and food security threat to nations around the world, and a potential long-term threat of catastrophic mortality if it ever mutates into a strain that can jump easily from birds to humans and then from humans to other humans.

Long COVID’s lasting impact

A British study found that almost 50 per cent of COVID patients had still not recovered a full year after becoming ill. Long COVID is becoming a serious consequence of contracting even a mild case.

But its effects seem unpredictable. The five most frequent symptoms (out of many) reported in the study were fatigue, memory problems, shortness of breath, sleep problems and joint pain. Many cases were ongoing a year after infection, and my Twitter timeline is full of people reporting themselves still very ill after two years.

Meanwhile, three recent European studies indicated that women with mild infections were more than twice as likely as men to develop long COVID. But the studies also found that 32 per cent of patients who had been in intensive care had become longhaulers. Just six per cent of hospitalized patients developed long COVID, and only one per cent of outpatients.

Clearly, we have much to learn about long COVID and its effects on different populations.

A new form of long COVID

Yet another outbreak may be a new form of long COVID, perhaps acting with another virus.

Late in 2021, hospitals in the U.S. and Europe began to report unusual cases of severe hepatitis in children. So far, five children have died, and 18 have received liver transplants. Case numbers have risen to around 300, spread over more than 20 countries. On May 9, Indonesia reported 15 cases, 4 of them fatal.

Many of the children had had COVID-19, and some tested positive for adenovirus 41, a completely different infection. It’s uncertain whether either or both are responsible for this “fulminant” hepatitis. Researchers are already quarrelling about the possible causes. It may be caused by SARS-CoV-2, or by some other virus altogether.

Scientists quarrelling about science

This uncertainty points to another problem exposed by this pandemic: scientists and health-care workers seem unable to agree on the science, let alone follow it. A recent article in The Lancet Respiratory Medicine noted with some exasperation that researchers can’t even agree on a name for long COVID. That’s the name its victims have for it, but turf-guarding scientists prefer “COVID-19 consequences” or “post-COVID condition.”

Nor can everyone agree on the symptoms, or whether long COVID is a form of myalgic encephalomyelitis — also called chronic fatigue syndrome. Scientists always debate new diseases, their causes, and their treatments, but in the third year of the pandemic their debates on social media have become bitter and acrimonious.

Whatever follows COVID, and something will, it will find us seriously unready for another pandemic.

Health-care workers and researchers are already exhausted and burned out. With China a stubborn holdout, most governments around the world have adopted the Trump Doctrine: if you don’t count cases, cases don’t count. The politicians seem to have decided that we had better learn to live with COVID, and those who can’t will just have to die of it. Even public health officials have ditched the whole idea of public health and left us to choose our own response — without even the information we need.

Before COVID-19, we were told we had excellent pandemic preparedness. We know better now, and it’s unlikely that Canada will have a plan for the next pandemic or the means to carry it out.

The public health institutions that we thought would save us in 2020 have turned out to be clumsy at best and dangerous at worst. Their political masters have called the shots while claiming to “follow the science” — at a respectful distance of 200 years. The public itself is sharply divided between maskers and anti-maskers.

A grievous undercount

Early in May, WHO reported that the true death toll of COVID-19 was not 6 million, but almost 15 million — including those who died of other diseases and conditions that went untreated in the first two years of the pandemic. Johns Hopkins University estimates over half a billion cases, and that number too is surely an undercount.

Whether they have long COVID or not, those who have survived severe cases of COVID-19 now appear to have suffered cognitive impairment equivalent to aging 20 years. We think of COVID as a respiratory disease, but it also attacks the nervous system and perhaps even the brain itself.

But even if we all survive this pandemic with our wits intact, it’s just the overture. More diseases, familiar and new, will break out around the world. The war in Ukraine has already triggered food shortages around the world; hungry people get sick more easily, and so do refugees. Vaccine-preventable diseases like measles and chicken pox will return if anti-vax parents decide on principle to reject all vaccines.

To top it all off, a recent article in the journal Nature asserts climate change will cause far more spillover of viruses from animals to humans than we have ever seen: “We predict that species will aggregate in new combinations at high elevations, in biodiversity hotspots, and in areas of high human population density in Asia and Africa, driving the novel cross-species transmission of their viruses an estimated 4,000 times.”

The researchers find this “ecological transition” is already underway, and even if we keep global heating below 2 C, we can expect attacks by viruses we now know nothing about — attacks on our crops and domestic animals as well as us. We might jerry-rig an early warning system with careful viral surveillance and tracking of climate-sensitive species (especially of bats).

But that supposes very well-funded programs staffed by experts and operating freely all over the world. It also supposes that COVID-battered health-care systems can reorganize themselves to respond to new outbreaks, and that both the public and politicians will trust one another to follow some very depressing science — while also responding to wars, trade disruptions, economic and political upheaval, and weather disasters.

We may think we’re done with COVID, but COVID isn’t done with us. And countless new viruses haven’t even got started with us yet.  [Tyee]

Read more: Health, Coronavirus

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