"We've arranged a global civilization in which most crucial elements profoundly depend on science and technology. We have also arranged things so that almost no one understands science and technology. This is a prescription for disaster." — Carl Sagan
Although many Canadians act as though the pandemic has ended, the airborne virus that causes COVID-19 continues to evolve at an amazing pace with devastating consequences for both individuals and the public at large.
The pandemic may no longer be a major conflagration but it still kills about 140 Canadians a week while morphing into a steady viral blaze sustained by dirty air, waning immunity and overt political indifference.
What was once a giant wave of acute illness has become a series of often unpredictable wavelets driven by ever-changing variants that can cause chronic illness. Long COVID, a disabling health event that can affect multiple organs and destabilize the immune system, now affects millions and continues to claim new victims.
A 2023 Danish study recently confirmed that about 50 per cent of those diagnosed with long COVID fail to improve 18 months after infection regardless of the variant.
Long COVID has taken a huge toll among health-care workers. Anywhere from six to 10 per cent of Quebec’s health-care workforce, for example, has been derailed by long COVID.
Seventy-one per cent of health-care workers impaired by long COVID reported that their state of health now interferes with their ability to function. Another 16 per cent said that they are often unable to work. Multiply this data across the country and then ask: How sustainable is this trend?
The cost of living in a ‘viral soup’
While the media focus concern on the potential next big nasty viral wave, evolutionary biologist T. Ryan Gregory says that threat seems less likely than before, but the current reality is nothing like normal.
“We are not dealing with Omicron-like waves but a viral soup,” Gregory told The Tyee. “We are seeing a near-constant high level of hospitalizations that falls just below overwhelming them but is nonetheless unsustainable. More health-care workers are getting sick and that just adds to the strain on the whole system.”
What worries Gregory, an expert on the evolution of COVID variants at the University of Guelph, “are the long-term effects of multiple infections and the sustained pressure on the health-care system and well-being.”
Yet the current impact of COVID — measurably higher than at some previous points during the pandemic — remains largely ignored or poorly reported.
Tara Moriarty, a University of Toronto infectious disease expert and co-founder of COVID 19 Resources Canada, recently tallied the imperfect data, and it is bracing. She calculates that about one in every 23 Canadians is now infected with COVID. We are not at the low point of the pandemic in Canada. To the contrary, compared with a previous time during the pandemic, infections are 25 times higher and the rate of long COVID is 19 times higher. Meanwhile the hospitalization rate is 13 times higher and deaths are 25 times higher.
In the middle of October, Moriarty calculated that COVID patients occupied about nine per cent of intensive care beds and 21 per cent of hospital beds across the country. (The average hospitalization rate during the pandemic has been seven per cent.) The estimated cost of this sustained viral assault is $274 million a week.
Governments peddling denial
Most governments seem intent on diminishing or hiding these realities. They avoid any talk about the effectiveness of masking in public places or the value of improved ventilation and filtration in schools and workplaces. It’s a demonstrated fact that the virus travels through the air in tiny smoke-like aerosols that can infect people at much greater distances than six feet, but the natural responses to this reality are not encouraged by our leaders.
Alberta, for example, now pretends that COVID is just another mild respiratory disease and reports its doings along with influenza and RSV activity.
Despite this push for “normalization,” only one disease stands out as a routine killer and dominant occupant of hospital beds on the province’s “respiratory virus dashboard.” And that’s COVID. COVID also dominates outbreaks in Alberta’s hospitals and long-term care facilities where masking and attention to ventilation have become haphazard practices.
Lumping COVID in with other respiratory diseases is also patently misleading. A recent Swiss study compared hospitalized patients infected with COVID and those infected with the flu. Those with COVID had a 1.5-fold higher risk of dying in hospital up to 30 days after infection than patients infected by influenza A. The death rate was even higher for unvaccinated people.
A 2023 Swedish study also found the death rate from Omicron greatly surpassed that of influenza patients.
And next comes the increased risk of cardiovascular problems. Medical researchers have long observed strokes and acute myocardial infarctions in patients after respiratory infections, such as influenza. But COVID breaks the mould here. Compared with patients with the flu, the risk of stroke is more than sevenfold higher in COVID-19 patients.
This is likely tied to the fact that COVID can inflame the vascular system through which the body’s blood travels. New non-peer-reviewed evidence suggests that even a mild infection can temporarily damage endothelial cells that line the interior of blood vessels.
COVID may begin with the symptoms of a cold or flu for most people, but it often ends as thrombotic or vascular disease in a small percentage for reasons researchers don’t clearly understand. The virus can therefore infect multiple organs from the brain to the kidneys.
Immune systems and long COVID
These findings make all the more illogical the current, widespread blasé attitude towards the ever-evolving virus.
Let’s begin with diabetes, which itself stresses the immune system and makes it less effective.
Early in the pandemic, researchers suspected there might be a connection between having COVID and later developing diabetes. Now it’s confirmed. Earlier this year the Smidt Heart Institute at Cedars-Sinai organization in Los Angeles found that a COVID infection dramatically increases the risk for developing Type 2 diabetes and that this risk continues with Omicron variants.
“The trends and patterns that we see in the data suggest that COVID-19 infection could be acting in certain settings like a disease accelerator, amplifying risk for a diagnosis that individuals might have otherwise received later in life,” noted Susan Cheng, a senior author of the study and a professor of cardiology.
Another study found that the incidence of diabetes in Black and Hispanic youth has increased by 62 per cent since the pandemic. The authors noted that COVID can bind to receptors in the pancreas, resulting in damaged cells.
A Canadian study also found steep increases in diabetes after COVID infections. University of British Columbia researchers examined a large population of British Columbians (more than 600,000) and discovered that people infected with COVID had a 17 to 22 per cent higher risk of developing diabetes within a year compared with uninfected people.
Concluded the researchers: “SARS-CoV-2 infection was associated with a higher risk of diabetes and may have contributed to a three per cent to five per cent excess burden of diabetes at a population level.”
Related research has also demonstrated that COVID infection can trigger or lead to a variety of autoimmune disorders.
One recent Lancet study that looked at nearly a million people who were unvaccinated between 2020 and 2021 found that COVID cases experienced much higher incidence of autoimmune disease than non-infected people.
These autoimmune conditions included rheumatoid arthritis, systemic lupus erythematosus, vasculitis (inflamed and swollen blood vessels), inflammatory bowel disease and Type 1 diabetes mellitus.
A similar German study, which has not yet been peer reviewed, evaluated a cohort of 640,701 unvaccinated individuals with PCR-confirmed COVID infection during 2020 for the risk of autoimmune conditions. The researchers identified “a 42.6 per cent higher likelihood of acquiring an autoimmune condition three to 15 months after infection” compared with a group of 1,560,357 individuals who weren’t infected.
The researchers also found that a COVID infection “increased the risk of developing another autoimmune disease by 23 per cent” in individuals with pre-existing immune conditions.
The autoimmune studies confirm that COVID can be a significant immune deregulator. The Yale University immunologist Akiko Iwasaki, who has dedicated her lab to studying long COVID, notes that “there's misfiring of the immune response happening in the severe COVID patients that lead to pathology and lethality.” Even a mild infection can lead to this misfiring and long COVID, and this group tends to be women between the ages of 30 and 50.
Reinfection is no trifle
The autoimmune studies, of course, don’t tell us anything about the current crop of variants and what autoimmune or cardiovascular diseases they might trigger in the future. But the precautionary principle would suggest avoiding infection.
The highly regarded U.S. epidemiologist Ziyad Al-Aly, who also studies long COVID, has been very clear about the hazardous consequences of reinfection in terms of chronic disease such as diabetes, brain inflammation and heart disease: “Two infections are worse than one and three are worse than two.”
His most recent research shows that people with mild infections are still at risk for chronic disease two years after the fact. Patients who were hospitalized with COVID were at even greater risk for chronic complications.
“The concern here is that this pandemic will generate a wave of chronic disease that we did not have before the pandemic,” Al-Aly, chief of research and development at Veterans Affairs St. Louis Health Care System, recently told Euronews Next.
“Even when the pandemic abates and is in the rear-view mirror, we will be left with it after the fact in the form of a chronic disease that for some people may last for a long time or even a lifetime,” added Al-Aly.
The Tyee has repeatedly reported evidence that immunity to COVID from natural infection or vaccination is not long-lasting because of the nature of the virus.
The research now confirms that infections can even leave some people more vulnerable to reinfection. A startling Canadian study published this year looked at 750 vaccinated elders at long-term care facilities where COVID deaths continue to be high. They found infection with Omicron in its first wave actually made these residents more susceptible to reinfection in subsequent waves. Counterintuitively, these people were more prone to reinfection than patients who had never experienced COVID.
“Our current vaccine schedules are based on the assumption that having had an infection provides some level of protection to future infections, but our study shows that may not be true for all variants in all people,” noted Dawn Bowdish, an immunologist and one of the study’s authors.
What our health leaders should be saying
The implications of these findings are plain enough. The pandemic has a long tail, and it can be found in a growing population of people experiencing chronic disease. Therefore, limiting transmission is still the most important public health goal.
We know how to do that but are reluctant to employ the tools. Masking in crowded public spaces or poorly ventilated buildings during periods of high infection is a proven viral risk reducer. Cleaning dirty air in workplaces and schools removes the virus and other pollutants such as wildfire smoke and should be an urgent public health crusade.
We might all take inspiration from what happened at one Australian school. Concerned parents studied airflow and then installed HEPA filters with the result that improved air circulation stopped COVID transmission dead.
Rigorous surveillance testing is also essential to inform citizens of the advancing or retreating COVID risks.
Vaccinations play a role because they can significantly reduce the risk of hospitalization, death and long COVID. But current vaccines will not stop transmission. Or end the pandemic.
In a recent study a group of U.S. researchers modelled a variety of paths that COVID might take in the future.
If repeat infections and vaccinations actually work to improve immunity and dent the pandemic over time, then models suggest infections and the incidence of long COVID should decline too.
But as Omicron demonstrated, community immunity is unlikely to be achieved via existing vaccines and especially at a time when vaccine hesitancy is rising.
In one pessimistic scenario the researchers posited that “a first infection may provide partial protection against a second infection” but the combination of new variants and complexities surrounding immune responses “could then increase the susceptibility to tertiary and quaternary infections.”
That means a good proportion of the population could end up with long COVID in the absence of effective public health measures and the development of a durable, transmission-blocking vaccine.
“More pessimistic assumptions on host adaptive immune responses illustrate that the longer-term burden of COVID-19 may be elevated for years to come,” added the researchers.
Public health leaders might want to ponder that sober message.