What A Day - The Long And Short Of Long COVID with Dr. Ashish Jha

Episode Date: September 27, 2021

As many as one in five people who became ill with COVID-19 have reportedly developed long-term symptoms that last well after they’ve recovered from the initial infection. Informally called “Long COVID,” the condition is associated with chronic fatigue, brain fogginess, headaches, and more. We interview Dr. Ashish Jha from the Brown School of Public Health, who’s launched a new study to look at Long COVID’s effects on people, health care, workplaces and more.And in headlines: Germany holds a parliamentary election, the World Health Organization resuscitates the investigation into COVID-19’s origins, and Biden gets an even bigger victory margin in Arizona’s GOP-led 2020 election audit.Show Notes:Brown School of Public Health: “Global Epidemics: Long COVID” – https://bit.ly/3ibhiJlFor a transcript of this episode, please visit crooked.com/whataday

It's Monday, September 27th. I'm Gideon Resnick. And I'm Josie Duffy Rice. And this is What A Day, where we're working through our feelings about Elon Musk and Grimes breaking up by asking strangers if we can drive their Teslas. Yeah, maybe it helps. Maybe it doesn't. Either way, we get to drive a very nice electric car. On today's show, Germany holds parliamentary elections, plus a hamster is making more successful investments than most humans. Yeah, the jokes write themselves. But first, we look at one of the more confounding aspects of COVID-19's effects on the body, long COVID. So you've probably heard of this so-called condition. You may have known people in your life who have experienced it or have even experienced it yourself. But the CDC has defined long COVID as a set of symptoms a person experiences four or

more weeks after being infected, a length of time that is atypical. And anecdotally, they can range from fatigue to headaches, loss of smell, and what is often described as brain fog. But there's still a lot left to learn about why this is happening, how many people it's happening to, and what can be done at a societal level for it. Yeah, and this is a topic of a great deal of research at the moment. Just a few days ago, Francis Collins, the director of the National Institutes of Health, described the symptoms as a, quote, deep mystery. And he talked about a study involving 30,000 COVID-19 survivors. That's all according to Bloomberg. And then earlier this month, the Brown School of Public Health announced a new initiative to study the impact of long COVID on people, economies, and societies, and then to try to help guide policy

recommendations based on those findings. So last week, I then to try to help guide policy recommendations based on those findings. So last week, I spoke with Dr. Ashish Jha, the Dean of the Brown School of Public Health, about that initiative. And we started with what he is hoping to accomplish with it. Long COVID has become something that I think a lot of people fear. There is more and more evidence that there is a proportion of people who end up really suffering quite a bit from COVID even after they've recovered from their original illness. And we also don't really have a good sense of what kind of impact it's going to have on our society. And my hope from this work is both to kind of help pull together the clinical evidence, the epidemiologic evidence, but also to begin to provide guidance to policymakers. Like, how should we be thinking about long-term disability?

How should we be thinking about helping people get back to work? What are they going to need? All those societal impacts, not just the clinical ones, I just had a sense that that wasn't really being looked at and we needed to get going on that work. And what is your sense of why we are so in the dark about it at this point? I think there are a couple of things. I mean, one is we're still in the middle of an acute kind of crisis with thousands of Americans dying every day. And so when that happens, it makes sense that the attention turns towards saving lives and managing the most critically ill people.

Second is I think there's been a lot of denialism about COVID, kind of COVID minimization by members of our community, by a lot of people out there. And that means that we've focused only on death. We talk about mortality rate a lot. We don't talk about the suffering that COVID is causing. And we've got to look at this much more holistically. Yes, death, of course, awful, very, very centrally important. But there's a lot of suffering out there that we have not paid attention to because we've been focused too much on mortality alone. In terms of that other suffering, what is most typically common in people who say that they are experiencing long COVID symptoms at this point? It's really a broad range of stuff. I mean, probably the most common thing people talk

about is fatigue and really profound fatigue. So we're not talking about, oh, I feel a little extra tired today. Like we all have fatigue some days. We're talking about people who are debilitated with that fatigue. People who were functional, who worked long hours, could do all sorts of things, who now are really struggling to get through the day. That's probably one of the more common things. A lot of people describe what people colloquially talk about as brain fog,

just a sense of they're not as clear in their thinking. They're struggling with problems that they could handle pretty effectively before they got infected. Wide range of other stuff. Some people have persistent fevers. That's less common. Other people have problems breathing. It's really a large mix. And one of

the things that we've got to do clinically is sort this out. Is this all one condition? Are these multiple different conditions? We don't know yet. We're going to have to figure that out. And do we know, is long COVID different for different age groups? Is it contingent on other factors like how frequently a person may have been exposed to the virus, maybe occupationally? Unfortunately, we don't know the answer. And part of the reason we don't know is we haven't done the careful epidemiologic studies. My guess, but again, we don't want to be in a guessing situation, but my guess based on what we know so far is we may very well see very different manifestations for different demographic groups,

for people with different underlying conditions. But we have to sort this out. And even the mechanism by which you get long COVID, is it immunologic? Is it persistent virus? Is it something else altogether? That may also determine what kind of symptoms you have. But there's a lot more we don't know than what we do know with this disease. I know that there was a concern from people that mild symptoms that could have been developed via a breakthrough case could lead to long COVID. I think that there are some encouraging studies indicating that that's not necessarily the case so far, but what is known there? Yeah, so right. So this is a big question for all of us who are vaccinated, right? The question is, can you still get long COVID if you have a breakthrough infection? And I think the short

answer is you can, but what we know so far is you're far less likely to get long COVID if you've been vaccinated and have a breakthrough infection. So it's just much, much less common. And then when it happens, it's much milder. And it actually clinically makes sense because when you've gotten a vaccine, you've got immunologic training, you've trained your immune system against this virus, and then we have a breakthrough. Your immune system is going to be far more effective at clearing the virus and not overreacting. And that combination should leave you in better shape in terms of long COVID. What sort of impact is the presence of people with long COVID going to have long term? And that could be along a lot of the fronts that you were mentioning that you want to study.

The first and foremost, I think one of the things we're going to want to do is make sure the weak knowledge of suffering that's out there. A lot of people with long COVID feel invisible. They feel like they've gone to talk to their doctor, they've talked to other people and aren't getting much acknowledgement for what they're going through. There is going to be this very substantial, I think, financial cost to long COVID. And again, I don't want to turn this too much into money, but people obviously need care. That's going to be expensive. There are going to be people who are going to be disabled by this, and we're going to want to support them through disability payments. All of that needs sorting out, but it says to me that as we recover from this pandemic, we will realize that the cost of the pandemic certainly is in all the lives of the

people we have lost, but also in the lives of so many people who've really suffered and have emerged from it, you know, with real challenges. And Dr. Jassim, WOD listeners who identified personally as having long COVID themselves reached out to us. Here's what one of them wanted to ask you. Are you less likely to have long-term impacts if you have breakthrough COVID?

So the answer to that is yes. But again, based on all the data we have, several studies on this, you're less likely to get long COVID. And if you have a breakthrough infection, as opposed to infection when you're unvaccinated. And then if you do get long COVID, it tends to be milder and more short-lived. Look, we don't know about how short-lived it's going to be because breakthrough infections are relatively new. They've only been happening for the last

few months. But my suspicion, based on all that I know about immunology and clinical medicine, is that most people who have a breakthrough infection will not end up getting long COVID, or if they are unfortunately unlucky and do, it'll be mild and short-lived. And this might be kind of hyper-specific to this particular listener, but they were talking about basically having the long COVID symptoms and then wondering, could the actual vaccination eliminate the symptoms that they had had before? Is there something that physiologically is happening there to actually bring an end to those symptoms? It's a really good question. And again, there are now several studies, lots of anecdotes,

but several studies that seem to suggest that for people who've had long COVID, getting vaccinated is a good thing. It's a good thing because, first of all, again, depends on the mechanism of long COVID. For some people, it's these, what we talk about viral reservoirs. So you still have a little bit of virus left somewhere that hasn't been eliminated by your immune system. When you get the vaccine, you give your immune system a nice kick, it kicks in and can eliminate that viral reservoir. For other people, it's this autoimmune problem. And vaccines help you sort of do immunologic training. So most immunologists I know, and I'm speaking to, think that vaccines should help, not everybody,

but will help many people with long COVID. And so it comes up a lot when I talk to patients with long COVID. They say, should I get vaccinated? Will things get worse? And the best evidence we have right now says it'll probably get better. It'll probably help. Well, Dr. Josh, thank you so much again for your generous time. Really appreciate it, as always. It was my pleasure.

Thank you for having me here. Yeah, and also, Josie, Ja later told me that his team is actually going to roll out new conclusions as the research continues. So we can check back in as that comes out. Great. I'm glad that they're on it. And it makes us feel a little bit better about the future of what we learn about this disease. So thanks to our own listeners as well

for sending in your questions and please keep them coming. We'll also link to Dr. Jha's work in our show notes so you can read more, but that's the latest for now. It is Monday, Watt Squad. And for today's Temp Check, we are talking about creative approaches to personal finance. A hamster has been trading cryptocurrency since June using a cage that is rigged to buy and sell tokens. And he is allegedly doing better than Warren Buffett and the S&P 500. The hamster's name is Mr. Gox, and his initial investment was about $390 US. He does, in fact, come from wealth.

As of last night, he'd made a 16.6% return on that investment. His all-time high was a few weeks ago when his portfolio hit $580. It's impressive. To initiate the trades, Mr. Gox goes into a cage called his Gox Box. He runs in a hamster wheel to pick between about 30 different cryptocurrencies. Then he runs through one of two tubes, which are labeled buy and sell. Mr. Gox's adventures in crypto are documented on his Twitter, at Mr. Gox,

and on Twitch at Mr. Underscore Gox, and on the show. So Josie, the big question, could you do better than Mr. Gox and would you trust him with your personal finances? There's absolutely no way I could do better than Mr. Gox. And I've actually

already sent him all my bank login information. I don't actually have any of my own investments, but I'm hoping he can take like, you know, the $26 of my bank account and do something amazing with it. What do you think? Yeah, I don't think that I could surpass what he's doing here. Because by the transitive property, we're talking about being better investors than Warren Buffett or the S&P 500, if I'm understanding this correctly. And I would not go so far as to say that I have any sort of understanding

of cryptocurrency to be able to do something like that. So this seems like the best way to go about something that makes absolutely no sense is have a hamster run it for you. Totally. Also, maybe if we got you your own Gox box, you could call it the Gid box. You know, maybe that's what you need. Interesting. It's an interesting idea.

Okay, so the options here for me to make money are to either have Mr. Gox do it or have me do what Mr. Gox does. Big, big things are about to happen here to my money and also my credibility as a human on this earth. Just like that, we have checked our temps. Invest with a hamster in a Gox box if that's what you want to do. And we'll be back after some ads. Let's wrap up with some headlines. Germany held its parliamentary elections yesterday. And as of our recording, the country's left-leaning Social Democratic Party has a razor-thin lead, with Angela Merkel's party, the Christian Democratic Union, close behind it. Merkel is stepping down after 16 years as chancellor, and she leaves with high marks for steering Germany through a number

of crises. But if the Social Democrats hold onto their lead, then it's possible that they can form a government with their own candidate, Olaf Scholz, as Merkel's successor. Whoever takes her place will have to continue to steer the country through the pandemic recovery as well as tackle issues such as climate change. But after yesterday's close election, it could take weeks or months for these political parties to negotiate and end up announcing what Germany's new coalition government will look like and who will officially be the next chancellor. Our obsession with sequels and reboots has now reached the world of public health. The World Health Organization is assembling a new team to head its previously

stalled investigation into the origins of the coronavirus. The team will consist of 20 specialists in the fields of laboratory safety, biosecurity, genetics, and animal diseases. This announcement comes after much pressure from the Biden administration to renew the inquiry into the virus's origin for fear of important biomedical evidence expiring or being thrown out, further obfuscating the conditions that may have led to the global outbreak. The WHO's previous report, which was put together after a team of 10 foreign experts visited Wuhan with limited access, was criticized after its release in March of 2021 for leaving critical questions unanswered. Just the little questions like when and where and how the virus began spreading. As of now, it is unclear whether China would accommodate the WHO's team with access to

Wuhan and the data and research necessary to complete their investigations. The initial probe was delayed several times and strictly limited by China, which saw the investigation as an attempt to assign blame for the outbreak. In the vacuum of information, I'm sure only good conclusions will be made. Sure. Absolutely. These are all very trustworthy. Nothing to lose, you you know nothing at all so the summer may be over but the politics are still piping hot in arizona on friday the several month long hand count of every vote cast in the state for the 2020 general election finally came to a close the recount that was led by a florida cyber security firm that's named after the number

one most desired career for little boy cousins everywhere, Cyber Ninjas, affirmed Biden's around 10,000 vote win in the state, actually adding 360 votes to Biden's overall tally. Despite the results of the audit broadly confirming the accuracy of the initial tally, Cyber Ninja CEO Doug Logan still took the opportunity to point out, quote unquote, anomalies in the vote counts. Most of his claims were immediately and publicly debunked by Maricopa County officials. But sure, Doug Logan, adult man and CEO of the company Cyber Ninjas, we will listen to you. Also from the Grand Canyon State, on Saturday, Arizona Democrats passed a resolution that guarantees a no confidence vote against Senator and Lululemon brand ambassador Kyrsten Sinema if she were to vote against Biden's reconciliation bill

or refuse to back filibuster reforms. Despite 91% of the Arizona Democratic Party State Committee calling for an immediate elimination of the filibuster, Sinema has been a vocal opponent of abolishing the 60-vote threshold, advocating in op-ed pieces for a concept from fiction that is known as, quote-unquote, bipartisanship. You gotta hand it to her, you know, she sticks by her completely useless and harmful principles. No matter what. Non-British

citizens have been given a once in a generation opportunity to describe themselves professionally as lorry drivers. Officials announced this weekend that they would issue 5,000 temporary visas to foreign nationals who could drive trucks amid a supply chain crisis in the country. The truck driver shortage is acute in the United Kingdom, causing shipping delays that created long lines at some gas stations and closed others over the weekend. About 100,000 drivers are needed, according to one industry group. So even with these emergency measures, grocery stores might not receive food on time and British toddlers will have even fewer chances than before to yell toot toot at their beloved lorries. It's true. This is a tragedy. Most agree that Brexit has made global supply chain disruptions even more severe in the UK since it's that much harder for them to recruit workers from the EU.

Britain also needs extra poultry workers to process turkey dinners for Christmas, and it will offer 5,000 temporary visas. British turkeys, you should act now. You will never have better odds at mounting a successful bird revolution than you do at this moment. Yeah, if you all band together, I guarantee you there's some people that are going to be as afraid of you as I am. Birds are scary. Birds are scary. I agree, Gideon. And we'll leave you with that. That's the final word. And those are the headlines. That is all for today. If you like the show, make sure you subscribe, leave a review,

invest with a savvy crypto hamster, and tell your friends to listen. And if you are into reading and not just the Lorry Driver application for foreign nationalists like me, What A Day is also a nightly newsletter. Check it out and subscribe at crooked.com slash subscribe. I'm Josie Duffy Rice. I'm Gideon Resnick. And let us know where to leave your Tesla.

Yeah. We'll definitely return it for sure. What a Day is a production of Crooked Media. It's recorded and mixed by Charlotte Landis. Jazzy Marine is our associate producer with production help from Jossie Kaufman. Our head writer is John Milstein and our executive producers are Leo Duran and me. Our theme music is by Colin Gilliard Thank you.