Why You Should Care About Covid

The World Health Organization declared the pandemic emergency "over" in May 2023. They did this for political and economic reasons (lockdown is expensive), the rise of vaccines and treatments like paxlovid, and because Covid has mutated into a bunch of different strains that are less likely to immediately kill you. Covid remains capable of causing long-term health problems, which the rest of this essay is about.

Covid was the THIRD leading cause of death in America in 2023 (1) and remains the 4th leading cause of death in 2024 (2) , even after hospitals are no longer required to report Covid data (3). That's more than stroke, diabetes, kidney disease, Alzheimer's, or liver disease.

Anyone infected with Covid sheds copies of the viral genome when they shit, shower, wash their hands, or do their laundry. This all goes into the sewage system, where treatment plants take samples and scientists analyze these samples to calculate just how much virus is circulating in the population.

See: https://www.cdc.gov/nwss/how-wws-works.html

Cases are on the rise in NJ (4) and nationwide.

Cases are growing or likely growing in 39 states, and they don't appear to be declining in any state, according to the latest (Centers for Disease Control and Prevention data)(https://www.cdc.gov/forecast-outbreak-analytics/about/rt-estimates.html).

We can cross-reference historical wastewater data with historical infections data (back when that was being kept track of) to estimate how many people are infectious at any given time. You can find a video explaining how these calculations are made here: https://www.pmc19.com/data/index.php

Based on these calculations, 1% of the population is actively infectious. I think this is a pretty reliable estimate considering that according to the CDC, 0.9% of people visiting the ER test positive for Covid (5), considering that the current strains of Covid are less lethal.

Using statistics, we can calculate the likelihood that any one person is infectious based on this number. So if you're on a plane with 100 people, the chance that anyone has Covid is 2/3rds. If you're in a restaurant with 20 people, the chance that anyone has Covid is 20%.

Source: https://www.pmc19.com/

Let's take a closer look at this wastewater data. The minima or lulls in Covid infection and transmission have steadily increased since the start of the pandemic. Covid is not going away on its own. It is out there, and you need to avoid it, because...

See: https://www.cedars-sinai.org/newsroom/covid-19-surges-linked-to-spike-in-heart-attacks/

The spikes in heart attack deaths have tracked with surges of COVID-19 infection—even during the presumed less-severe Omicron phase of the pandemic. Furthermore, the data showed the increase was most significant among individuals ages 25-44, who are not usually considered at high risk for heart attack. ... By the second year of the pandemic, the “observed” compared to “predicted” rates of heart attack death had increased by 29.9% for adults ages 25-44, by 19.6% for adults ages 45-64, and by 13.7% for adults age 65 and older.

... The possible explanations, Yeo said, include that COVID-19 may trigger or accelerate the presentation of preexisting coronary artery disease, even in younger adults. 

Reasons for the spike in heart-related conditions could also be related to psychological and social challenges associated with the pandemic, including job loss and other financial pressures that can cause acute or chronic stress leading to cardiac disease. 

The research team members say they have long known that infections such as the flu can increase risk for heart disease and heart attack, but the sharp rise in heart attack deaths is like nothing seen before. 

“There is something very different about how this virus affects the cardiac risks,” said Susan Cheng, MD, MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute and senior and co-corresponding author of the study. “The difference is likely due to a combination of stress and inflammation, arising from predisposing factors and the way this virus biologically interacts with the cardiovascular system.”

How: https://www.nih.gov/news-events/news-releases/sars-cov-2-infects-coronary-arteries-increases-plaque-inflammation

SARS-CoV-2, the virus that causes COVID-19, can directly infect the arteries of the heart and cause the fatty plaque inside arteries to become highly inflamed, increasing the risk of heart attack and stroke ...

In the study, researchers focused on older people with fatty buildup, known as atherosclerotic plaque, who died from COVID-19. However, because the researchers found the virus infects and replicates in the arteries no matter the levels of plaque, the findings could have broader implications for anybody who gets COVID-19.

GGO (ground glass opacity), a characteristic feature of several lung pathologies with a high risk of developing cancer, is seen in computerized tomography (CT) scans of patients with COVID-19. (5)

Covid was found to cause ground-glass opacities at a rate of 93% among asymptomatic cases, including young people:

A total of 44 asymptomatic cases with COVID-19 pneumonia between March 20, 2020 and May 23, 2020 were enrolled. All patients had a history of exposure to SARS-CoV-2 or recent travel history. All patients had no symptoms. ... MSCT (multi-slice computer tomography) chest scans showed abnormalities in all patients. In our study, we noted that ground-glass opacity was the predominant radiological finding (41, 93%). (6)

What is ground-glass opacity?

GGO refers to gray areas that can show up in lung (CT scans)(https://www.medicalnewstoday.com/articles/153201).

Normally, the lungs appear black in X-ray and CT scans. This indicates that they are free of any visible blockages.

However, gray areas indicate increased density, meaning that something is partially filling the air spaces inside the lungs. This could be due to:

• the air spaces becoming partially filled with fluid, (pus)(https://www.medicalnewstoday.com/articles/249182), or cells

• the walls of the alveoli, which are the tiny air sacs in the lungs, thickening
• the space between the lungs thickening

Basically, it means you can't breathe as well!

Covid can also cause pulmonary fibrosis -- lung tissue scarring and damage -- even following mild or asymptomatic infection (7):

There has been an unprecedented spurt in the cases of pulmonary fibrosis following the COVID-19 pandemic. Although it is a known complication in severe COVID-19 pneumonia, the possibility of lung fibrosis secondary to an asymptomatic or mild COVID-19 infection is also probable.

Some studies have amply demonstrated pulmonary function impairment after 4 months ... even in asymptomatic COVID-19 cases, as characterized by diffusion impairment, reduced total lung capacity, and forced vital capacity.

One study found that 4 months after a mild Covid infection, people saw an average 20% decrease in DLCO values (a test for how well your lungs can absorb oxygen into your blood) when running (8).

"‘Unusual’ cancers emerged after the pandemic. Doctors ask if covid is to blame." See: https://www.washingtonpost.com/health/2024/06/06/covid-cancer-increase-link/

It was 2021, a year into the coronavirus pandemic, and as he slid into a chair, Patel shared that he’d just seen a patient in his 40s with cholangiocarcinoma, a rare and lethal cancer of the bile ducts that typically strikes people in their 70s and 80s. Initially, there was silence, and then one colleague after another said they’d recently treated patients who had similar diagnoses. Within a year of that meeting, the office had recorded seven such cases. ...

The idea that some viruses can cause or accelerate cancer is hardly new. Scientists have recognized this possibility since the 1960s, and today, researchers estimate 15 to 20 percent of all cancers worldwide originate from infectious agents such as HPV, Epstein-Barr and hepatitis B. ...

“We are completely under-investigating this virus,” said Douglas C. Wallace, a University of Pennsylvania geneticist and evolutionary biologist. “The effects of repeatedly getting this throughout our lives is going to be much more significant than people are thinking.” ...

A Lancet Oncology paper analyzed a national registry showing increases of Stage 4 disease — the most severe — across many cancer types in late 2020. Baptist Health Miami Cancer Institute, UC San Diego Health and other large institutions have released data showing continued increases in late-stage cancers. ...

Pathologists from the University of Arkansas for Medical Sciences reported in 2021 in the journal Communications Biology that SARS-CoV-2 proteins fueled the replication of a herpesvirus considered one of the major viruses leading to cancer. Other studies have implicated the coronavirus in helping to stimulate dormant breast cancer cells.

Covid weakens your immune system, which contributes to cancer (9):

The immune system performs an essential role in defending against tumor cells. As a result, the occurrence of malignancy is significantly higher in immune-compromised hosts.

It should also be noted that CD4+ T lymphocytes play a central role in the induction of anti-tumoral and anti-viral immunity. ... severe cases of COVID-19 are associated with profound depletion of CD4+ T- and NK cells.

Covid damaging the immune system is not restricted to just severe cases. In one study, researchers found that "CD8 T cell expression of exhaustion markers increased in nonhospitalized individuals over time" (10).

What is CD8 T cell exhaustion?

CD8+ T cells are important for protective immunity against intracellular pathogens and tumors. In the case of chronic infection or cancer, CD8+ T cells are exposed to persistent antigen and/or inflammatory signals. This excessive amount of signals often leads CD8+ T cells to gradual deterioration of T cell function, a state called "exhaustion." (11)

Another study concluded: "These findings suggest that SARS-CoV-2 infection damages the CD8+ T cell response, an effect akin to that observed in earlier studies showing long-term damage to the immune system after infection with viruses such as hepatitis C or HIV." (12)

Adults (18+) in England were subjected to a battery of cognitive tests and it was found that those who had gotten Covid had worse scores, across age brackets (13):

In this observational study, we found objectively measurable cognitive deficits that may persist for a year or more after Covid-19. ... The memory, reasoning, and executive function (i.e., planning) tasks were among the most sensitive to Covid-19–related cognitive differences.

People who tested positive for Covid were compared against people who only had a cold or the flu. 4-5 months later, their brains were scanned. Those who had Covid had worse functional connectivity (ability for brain bits to connect and communicate with each other when completing a task) (14).

Individuals with COVID-19 had lower temporal and subcortical functional connectivity relative to controls. A greater number of ongoing post-COVID symptoms was also associated with altered functional connectivity between temporal, parietal, occipital and subcortical regions.

Brain shrinkage equivalent to 1-10 years of aging has also been found in people even following mild cases of Covid (15).

Read: https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-covid-19-reinfection

Dr. Rouhbakhsh said: “We know from a pretty elegant study that was recently published in Nature Medicine that each subsequent COVID infection will increase your risk of developing chronic health issues like diabetes, kidney disease, organ failure and even mental health problems.”

Such evidence “dispels the myth that repeated brushes with the virus are mild and you don’t have to worry about it,” he added, noting that “it is akin to playing Russian roulette.”

From the study in question (16):

Fig. 5: Cumulative risk and burden of sequelae in people with one, two and three or more SARS-CoV-2 infections compared to noninfected controls. This study followed 5 million American veterans for 2 years and observed what happened to them relative to how many times they got Covid.

How to read this chart: being infected with Covid once means you're 2x as likely to be diagnosed with or report pulmonary (breathing) issues compared to someone who has never been infected in the following 6 months. Being infected twice means you're 4x as likely to get pulmonary issues. Being infected thrice means you're 4.5x as likely to get pulmonary issues.

Being infected with Covid once means you're 1.5x as likely to get kidney issues compared to someone who has never been infected. Being infected twice means you're 3x as likely to get kidney issues. Being infected thrice means you're 5x as likely to get kidney issues.

Now look at this chart:

Risk and 6-month excess burden of sequelae by organ system of SARS-CoV-2 reinfection versus no reinfection in 30-d intervals covering the acute and postacute phases of reinfection. Incident outcomes were assessed from reinfection to the end of the follow-up. Notice how the relative risk doesn't approach 1. It levels off after about 3 months, and it looks like the worst risk is in the first 30 days after infection. But the risk stays somewhere in the range of 1.5x for all of these issues.

This study was conducted on veterans, who tend to be older. The effects aren't AS severe for young people like you and me. What I'm trying to show is that reinfection stacks. A cold, you can get two a year no problem, no lasting effects. Getting Covid twice a year, on the other hand, is a serious problem.

Also, Mom, Dad, Lichen and some of your teachers are all pushing 60.

The increased rate at which long-term symptoms occur in those with COVID-19 infections is an observed phenomenon that sets the illness apart from other respiratory viruses, such as the flu.(17)

You've probably heard of Long Covid, or LC, or seen the term used a lot. You might have seen varying estimates of how likely it is, from 3 to 12% of the population or chances from 10% to 45%. It seems like numbers for the US converge at 10-20% for non-hospitalized cases. Including in children (18).

The WHO estimates the percentage of people who continue to have, or develop, at least one symptom more than three months after SARS-CoV-2 infection as 10–20%.

By contrast, a recent meta-analysis of 194 studies including 735,006 participants estimated that, at an average follow-up of 126 days (4 months), 45% of COVID-19 survivors had at least one unresolved symptom. (19)

"Long Covid" means any lingering symptoms after Covid. You can think of it as long-term symptoms or post-Covid conditions. These generally include:

• change in taste or smell (one of Kelly's friends can't stand the taste of meat or chocolate anymore, and she used to love meat)
• organ damage (like the heart, brain, and lung problems mentioned above)
• difficulty breathing
• immune system damage (like CD4 and CD8 cell depletion/exhaustion mentioned above)
• fatigue, confusion, memory loss, changes in mood or appetite (combined effects of the brain, heart, and lung damage, probably)

Think about this for one second. This is not normal. A cold does not do this to you. Even the flu doesn't do this. We should not act like repeat reinfection is normal, or desirable. It is a problem.

Because America's political leaders and policymakers are not exactly sane or smart, Covid is expensive to mitigate, and it's scary, which is why a lot of people don't like thinking about Covid in general.

Doesn't mean it's not here!

While I care about you, I understand that your individual health is ultimately your responsibility. You also have the opportunity to lead and protect your friends, family, classmates, and community from Covid. Not only directly (by avoiding infecting and exposing others), but also by taking action to create safer gatherings, as well as speaking up and educating others about the risks as well as what can be done to protect ourselves.

You said that your friends don't talk about Covid. They are just as likely to be infected by it and suffer long-term health effects as you are. They might have immunocompromised family members they care about who they don't want to get sick. You can be the first to break the silence and remind them about a health issue that exists in our communities and will continue to exist whether we ignore it or not.

Covid safety is about layers of protection, reducing reinfections, and reducing the severity of infections. The layers of protection include:

• Vaccines: Stay up to date on your Covid shots. These reduce the severity of infection.
• Air filtering: Air purifiers clean the air as you breathe. Start thinking about a small HEPA purifier for your teaching space, you can get them for <100$ on Best Buy. I can get this for you so long as you'll use it. Air purifiers are also good for indoor gatherings.
• Fresh air: Do more stuff outside.
• Masking/wearing a respirator: The Flo mask I got you is one of the best around. You can wipe down the inside with rubbing alcohol and a paper towel to clean it and avoid pimples.
• Nasal sprays, mouthwash: Xylitol and carrageenan nasal sprays have been found to reduce Covid infection, as well as CDC mouthwash.
• Probiotics: The probiotic Streptococcus salivarius was found to reduce the chance of catching Covid in at least one unaffiliated study (20) and a couple more affiliated/conflict-of-interest studies (21) (22) and has a lot of anecdotal support. Let me know if you want me to elaborate on any of these points.

Here's a Safer Gatherings Toolkit put together by doctors: https://peoplescdc.org/2022/11/17/safer-in-person-gatherings/

Absolutely:

• Wear the Flo mask on the plane, in the airport, on the train, in train stations, on the bus, or on the subway. Wear the Flo mask at concerts or raves, even outdoor ones.
• For 10 days before going to see Mom or live with her, avoid indoor dining and wear the Flo mask in all indoor settings that don't have air purification.

Highly recommended:

• Stay up to date on vaccinations. There'll be another Covid booster this fall.
• Take the BLIS K12 probiotic. I can get this for you to try out if you are interested. I already told Mom about it.
• Get a personal HEPA-grade air purifier. Again, I recommend one for your teaching studio, to keep in the house when you have friends over, or to bring to other people's houses for their parties so you don't get bitten by mosquitoes outside. You can get them for under 100$.
• Avoid indoor dining. Covid virus can persist and survive in aerosol form for up to 16 hours (23) Even if a restaurant looks empty, people may have been in there that you can't see and don't know about.
• Talk to your friends about Covid prevention. They might be worried about it more than it seems, hear other friends talking about it, or have annoying siblings like me :P
• Wear the Flo mask in outdoor settings where there's a lot of people milling around.
• For 10 days before going to see Dad or live with him, avoid indoor dining and wear the Flo mask in all indoor settings that don't have air purification. He might be healthier than Mom but he's still old.

Other recommendations:

• Test whenever you get sick. Covid symptoms look different now. UMD still does free Covid tests: https://health.umd.edu/HEAL

Here's a Yale Medicine article about "strategic masking": https://www.yalemedicine.org/news/can-strategic-masking-protect-against-covid-19-flu-and-rsv

The length of time that you expect to be in a “high-risk” situation, such as a crowded room, matters. Contact for longer than 15 minutes with a person who has COVID-19 is more likely to result in transmission than two minutes of contact, according to the CDC. “Many people are infected in social settings and in households when people are indoors, in close contact, and without masks,” Dr. Jubanyik says.

Thanks for reading until the end. Let me know if you have any questions 👍