6 ms·

With tens of thousands of publications on COVID, its absolutely amazing how few there are on the follow up of these patients. (ie what comes next after infectio

With tens of thousands of publications on COVID, its absolutely amazing how few there are on the follow up of these patients. (ie what comes next after infection). There is so little data we are flying blind (again). That said, there is evidence that the other coronaviruses that caused epidemics (SARS and MERS) can cause clinically meaningful myocarditis and heart failure as a result. In vitro and autopsy evidence suggests that SARS-CoV-2 directly infects myocardial cells. So it's plausible that there will be some cardiac sequelae of COVID, perhaps in many patients or maybe just in those at high risk. We just don't know. Assuming that myocarditis will be a major problem because 2 uncontrolled studies said so is as silly as assuming hydroxychloroquine works because of similar strength of evidence. But dismissing it out of hand (which I'm not suggesting GP is doing) is not smart either. We should be appropriately skeptical, but need to investigate further.

nostromo 6y ago
> That said, there is evidence that the other coronaviruses that caused epidemics (SARS and MERS) can cause clinically meaningful myocarditis and heart failure as a result. It'd be interesting to know how it compares to the flu. Here's an interesting study from just this year: > A CDC study looking at more than 80,000 adult patients hospitalized with flu over eight seasons found that sudden, serious heart complications were common, occurring in 12% of patients, or 1 in 8. https://newsroom.uw.edu/news/study-confirms-link-between-influenza-heart-complications https://newsroom.uw.edu/news/study-confirms-link-between-inf...
- vkou 6y ago
  If you have to be hospitalized for the flu, you are pretty close to death's door. It's not a very common occurance. Hospitalization for COVID is, unfortunately, quite common.
  - slg 6y ago
    Also the general population of adults (not even adults hospitalized with the flu) is going to be drastically worse in overall health before infection when compared to college athletes. So "this happens with the flu too" isn't too helpful without there being some comparison to how often it happens with COVID versus the flu.
  - timr 6y ago
    "Hospitalization for COVID is, unfortunately, quite common." Not in the demographic followed in this study. Amongst healthy 19-year-olds the flu represents about the same threat of both hospitalization and death, and flu is possibly a little bit worse than Covid: https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena... https://www.lung.org/getmedia/98f088b5-3fd7-4c43-a490-ba8f4747bd4d/pi-trend-report.pdf.pdf https://www.lung.org/getmedia/98f088b5-3fd7-4c43-a490-ba8f47...
    - mattigames 6y ago
      Yeah, is unfortunate the world is not made of healthy 19 year olds otherwise this would be a significant discovery.
      - mlyle 6y ago
        If we're concerned about the risk of COVID-19 to cause morbidity in youth, like these reports indicate could be a problem, it's reasonable to compare the frequency to other risks out there that we accept-- will it cause more morbidity in this population than a typical flu year? Less? About the same? It's a reasonable yardstick to use.
    - xorfish 6y ago
      I don't see how the provided links support your statements.
      - timr 6y ago
        It's pretty straightforward: they show fatality numbers for Covid and Flu in the specified age-brackets (19) that are comparable. Covid might be a bit higher. As I said.
        xorfish 6y ago
        They are not IFR numbers.
  - nradov 6y ago
    That really depends on the particular flu strain. All are dangerous to frail and elderly patients. Some stains are also likely to cause cytokine storms in young, healthy patients.
    - ajsnigrutin 6y ago
      > Some stains are also likely to cause cytokine storms in young, healthy patients. Wasn't this the case with the 1918 spanish flu? Kids had no issues, due to undeveloped immune systems, elder had little issues, due to old, shitty immune systems, and the 'middle' generations got fscked by the virus.
  - craydandy 6y ago
    Quite the opposite. Covid is dangerous for elderly and people having severe medical condition, much, much less dangerous for young and healthy. Flu is more dangerous to young people than Covid. Flu also causes hospitalizations in comparable amounts to Covid[1]. Note that we have a vaccine for flu, and it is still causing almost a million hospitalizations in bad seasons.
    - jonathanstrange 6y ago
      ...because people do not get vaccinated.
      - gridlockd 6y ago
        Keep in mind that the vaccine has, on average, efficacy of 50%.
        jonathanstrange 6y ago
        Yes, I bore that in mind when I made the statement. Especially the younger people the GP talked about do not bother getting flu shots. If everyone got vaccinated, the yearly influenza waves would result in way fewer deaths. Since you can get both influenza and Covid-19, even at the same time, German health authorities have strongly recommended getting flu shots and started the vaccination campaign earlier this year. It's good advice. Get your flu shot!
    - craydandy 6y ago
      And here's the missing reference: [1] https://www.cdc.gov/flu/about/burden/index.html https://www.cdc.gov/flu/about/burden/index.html
  - neilwilson 6y ago
    The problem is that far too many people are blasé about flu. Flu is a nasty disease, a killer with severe repurcussions for certain people. And it is very likely to kill and harm younger people. There’s a reason we have a vaccine for flu - despite it being monumentally difficult to produce one.
  - collyw 6y ago
    Flu kills a lot of old people every year. Covid isn't that much worse than a bad flu season. Hospitals were being over whelemed a couple of years ago. https://time.com/5107984/hospitals-handling-burden-flu-patients/ https://time.com/5107984/hospitals-handling-burden-flu-patie...

nostromo 6y ago

> That said, there is evidence that the other coronaviruses that caused epidemics (SARS and MERS) can cause clinically meaningful myocarditis and heart failure as a result. It'd be interesting to know how it compares to the flu. Here's an interesting study from just this year: > A CDC study looking at more than 80,000 adult patients hospitalized with flu over eight seasons found that sudden, serious heart complications were common, occurring in 12% of patients, or 1 in 8. https://newsroom.uw.edu/news/study-confirms-link-between-influenza-heart-complications https://newsroom.uw.edu/news/study-confirms-link-between-inf...

vkou 6y ago
If you have to be hospitalized for the flu, you are pretty close to death's door. It's not a very common occurance. Hospitalization for COVID is, unfortunately, quite common.
- slg 6y ago
  Also the general population of adults (not even adults hospitalized with the flu) is going to be drastically worse in overall health before infection when compared to college athletes. So "this happens with the flu too" isn't too helpful without there being some comparison to how often it happens with COVID versus the flu.
- timr 6y ago
  "Hospitalization for COVID is, unfortunately, quite common." Not in the demographic followed in this study. Amongst healthy 19-year-olds the flu represents about the same threat of both hospitalization and death, and flu is possibly a little bit worse than Covid: https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena... https://www.lung.org/getmedia/98f088b5-3fd7-4c43-a490-ba8f4747bd4d/pi-trend-report.pdf.pdf https://www.lung.org/getmedia/98f088b5-3fd7-4c43-a490-ba8f47...
  - mattigames 6y ago
    Yeah, is unfortunate the world is not made of healthy 19 year olds otherwise this would be a significant discovery.
    - mlyle 6y ago
      If we're concerned about the risk of COVID-19 to cause morbidity in youth, like these reports indicate could be a problem, it's reasonable to compare the frequency to other risks out there that we accept-- will it cause more morbidity in this population than a typical flu year? Less? About the same? It's a reasonable yardstick to use.
  - xorfish 6y ago
    I don't see how the provided links support your statements.
    - timr 6y ago
      It's pretty straightforward: they show fatality numbers for Covid and Flu in the specified age-brackets (19) that are comparable. Covid might be a bit higher. As I said.
      - xorfish 6y ago
        They are not IFR numbers.
- nradov 6y ago
  That really depends on the particular flu strain. All are dangerous to frail and elderly patients. Some stains are also likely to cause cytokine storms in young, healthy patients.
  - ajsnigrutin 6y ago
    > Some stains are also likely to cause cytokine storms in young, healthy patients. Wasn't this the case with the 1918 spanish flu? Kids had no issues, due to undeveloped immune systems, elder had little issues, due to old, shitty immune systems, and the 'middle' generations got fscked by the virus.
- craydandy 6y ago
  Quite the opposite. Covid is dangerous for elderly and people having severe medical condition, much, much less dangerous for young and healthy. Flu is more dangerous to young people than Covid. Flu also causes hospitalizations in comparable amounts to Covid[1]. Note that we have a vaccine for flu, and it is still causing almost a million hospitalizations in bad seasons.
  - jonathanstrange 6y ago
    ...because people do not get vaccinated.
    - gridlockd 6y ago
      Keep in mind that the vaccine has, on average, efficacy of 50%.
      - jonathanstrange 6y ago
        Yes, I bore that in mind when I made the statement. Especially the younger people the GP talked about do not bother getting flu shots. If everyone got vaccinated, the yearly influenza waves would result in way fewer deaths. Since you can get both influenza and Covid-19, even at the same time, German health authorities have strongly recommended getting flu shots and started the vaccination campaign earlier this year. It's good advice. Get your flu shot!
  - craydandy 6y ago
    And here's the missing reference: [1] https://www.cdc.gov/flu/about/burden/index.html https://www.cdc.gov/flu/about/burden/index.html
- neilwilson 6y ago
  The problem is that far too many people are blasé about flu. Flu is a nasty disease, a killer with severe repurcussions for certain people. And it is very likely to kill and harm younger people. There’s a reason we have a vaccine for flu - despite it being monumentally difficult to produce one.
- collyw 6y ago
  Flu kills a lot of old people every year. Covid isn't that much worse than a bad flu season. Hospitals were being over whelemed a couple of years ago. https://time.com/5107984/hospitals-handling-burden-flu-patients/ https://time.com/5107984/hospitals-handling-burden-flu-patie...