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Surges and kids: Up to 30% of children infected will develop long-haul Covid, expert says

If vaccination rates among adults and kids 12 and older keep lagging amid increased spread of the Delta variant, the youngest members of the population will be most affected, said Dr. Peter Hotez, a vaccinologist and dean of the National School of Tropical Medicine at Baylor College of Medicine.
“Transmission will continue to accelerate … and the ones who will also pay the price, in addition to the unvaccinated adolescents, are the little kids who depend on the adults and adolescents to get vaccinated in order to slow or halt transmission,” he said.
In 46 states, the rates of new cases this past week are at least 10% higher than the rates of new cases the previous week, according to data from Johns Hopkins University.
In Los Angeles County, the country’s most populous, there has been a 500% increase in cases over the past month, according to the county’s latest health data.
As cases increase, only 48.1% of the population is fully vaccinated, according to data from the US Centers for Disease Control and Prevention. And though many may brush off the risk of low vaccination rates to children, citing their low Covid-19 mortality rates, Hotez said they are still at risk for serious complications.
In Mississippi, seven children are in intensive care with Covid-19, and two are on ventilators, State Health Officer Dr. Thomas Dobbs tweeted Tuesday evening.
Many more adolescents could become hospitalized, Hotez said, adding up to 30% of children infected will develop long-haul ovid.
Scientists are now learning about neurological consequences to long-haul covid, Hotez added. Some studies have shown impacts on the brain of people who have been infected with the virus. One study in April found 34% of Covid-19 survivors received a diagnosis for a neurological or psychological condition within six months of their infection.
“What you’re doing is your condemning a whole generation of adolescents to neurologic injury totally unnecessarily,” Hotez said. “It’s just absolutely heartbreaking and beyond frustrating for vaccine scientists like myself to see this happen.”

Debate over vaccine mandates

With experts stressing the importance in vaccinating a majority of Americans against the virus, some officials are debating whether to mandate vaccinations at the local level.
Some schools and employers have already implemented measures requiring students and employees to be vaccinated before returning.
Last month, Morgan Stanley announced unvaccinated employees, guests and clients would be banned from its New York headquarters. In April, Houston Methodist, a network of eight hospitals, said it would require all of its employees to get vaccinated. Of the 26,000 employees, 153 resigned or were fired as a result of refusing the vaccine.
That same month, the American College Health Association issued a policy statement recommending Covid-19 vaccination requirements for all on-campus college and university students for the upcoming fall semester, where state law and resources allow.
But many states are moving to block such requirements.
A CNN analysis found that at least seven states — Alabama, Arkansas, Florida, Indiana, Montana, Oklahoma and Utah — have enacted legislation this year that would restrict public schools from requiring either coronavirus vaccinations or documentation of vaccination status.
Such legislation can hurt the nation’s 48 million Americans under the age of 12, former Secretary of Health and Human Services Kathleen Sebelius said Tuesday.
Currently, Covid-19 vaccines are only available in the US to people 12 and older. Vaccine trials are currently underway for children 6 months through 11 years old.
“If we start with a lens on the children and wanting children to get back to school, which is what we all say is the priority, then we have to get more serious about employers and schools and universities stepping up and saying ‘it’s great if you don’t want to be vaccinated. But if you don’t, you really can’t have access to places that will put you in contact with folks who can’t get vaccinated,'” Sebelius said.
One thing the federal government can do to support vaccine mandates is expedite the full authorization of the available vaccines, she said.
“Getting full approval — getting out of the emergency use authorization and into full approval — is something that will clear up any legal questions that private employers may have,” Sebelius said.

What surges could mean for the school year

Most officials and health experts have stressed the importance of students being able to safely return to school in the new academic year, but vaccine hesitancy could impact how districts move forward.
Only a quarter of Americans age 12 to 15 are fully vaccinated against Covid-19, according to data published Tuesday by the CDC, making them the age group with the lowest rate of vaccination.
California’s K-12 schools were directed Monday to turn away students from campuses for refusing to wear face coverings in class, but the rules were revised just hours later to give schools more leeway in implementing protocol.
Despite the initial guidance stating, “Schools must exclude students from campus if they are not exempt from wearing a face covering under [California Department of Public Health] guidelines and refuse to wear one provided by the school,” spokesman for Gov. Gavin Newsom’s office, Alex Stack, insists the intent was not to turn away students.
“The way [the guidance] was written didn’t accurately reflect the intent, so it was rewritten,” Stack told CNN, acknowledging the statement came across as “banning kids.” “It’s important to get this right so parents and students know what to expect going in to school year.”
New York City Mayor Bill de Blasio said the city’s guidance could change as the school year gets closer, but for now families should assume masks will still be worn in schools come September.
“We’ve been constantly working with the CDC, but we also in this case have been very careful given everything the city has been through … for now, we’re sticking with the idea that, you know, wearing the masks is the smart thing to do in schools,” De Blasio said.

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Long-Haul COVID Brings Long Road to Recovery

Thoughts of getting sick were the furthest thing from Paul Garner’s mind when symptoms of COVID-19 upended his life. “It knocked me sideways,” says Garner, a public health doctor specializing in infectious diseases. He says he never dreamed he would become a high-profile COVID-19 case documenting his struggle for a medical journal and talking about it on television.

Garner assumed he would probably feel ill for a few weeks and then recover. But 8 weeks later, he still felt like he’d been hit with a bat, with aches and pains, twitching muscles, a racing heart, and diarrhea. “It was like being in hell,” he says.


 

He started chronicling his painful illness from COVID in a series of blog posts for the BMJ. In one of his posts, he shared how mortified he was that he might have infected the staff at his workplace of more than 20 years. “I imagined their vulnerable relatives dying and never forgiving myself. My mind was a mess,” he wrote.

Garner couldn’t do most of the things he used to enjoy, and he cut back his work hours at the Liverpool School of Tropical Medicine in the United Kingdom. In the first 6 months of his illness, he wrestled with cycles of feeling better, doing too much, and then crashing again. He found the illness difficult to manage. He tried everything: Using his smartwatch to track his activities, measuring the time he slept, checking whether the foods he ate affected the sudden worsening of symptoms, but nothing worked.

The cyclical illness morphed into weeks of exhaustion when Garner couldn’t even read and had a hard time speaking. At 7 months, he wondered if he would ever recover. “I thought the virus had caused a biomedical change in my body and crippled my metabolism somehow,” he says. “I felt insecure and fearful of the future.”

The change came when someone in his professional network who had recovered from chronic fatigue syndrome offered help. “I learned about how the brain and the body’s stress response to infection can sometimes get disordered,” he explains, “and the symptoms I was experiencing were actually false fatigue alarms.

“These explanations that made sense, along with sensitive coaching to change my beliefs about my illness, really helped.”

He realized there was probably no physical damage to his tissues, so he needed to stop constantly monitoring his symptoms, find diversions when he felt unwell, and look forward to his recovery and getting his life back.

COVID took Garner to the brink and dangled him over a precipice of terrifying unknowns, but he’s found his equilibrium again. “There is life post-COVID. People find their own paths, but they get better. There is hope,” he says.

Life After COVID

Garner is not alone in his coronavirus journey. At least 33 million Americans have been infected with COVID-19, and some still have symptoms more than 4 weeks later, according to the CDC.

A preprint study of half a million people in the U.K., where Garner lives, reports that 1 in 20 people with COVID-19 are dealing with persistent symptoms. Roughly 6% of the people in the study — which has not yet been peer-reviewed — said their recovery was delayed by at least one symptom that persisted for 12 weeks or more.

Breathlessness and fatigue are among the most common issues reported after COVID-19. Even people who do not have any symptoms when they are first infected can feel unwell after the fact.

Congress is providing $ 1.15 billion to the National Institutes of Health (NIH) to fund research into symptoms that persist after COVID-19.

“Given the number of individuals of all ages who have been or will be infected, the public health impact could be profound,” NIH Director Francis Collins, MD, said in a statement when the funding was announced in February. “Our hearts go out to individuals and families who have not only gone through the difficult experience of acute COVID-19, but now find themselves still struggling with lingering and debilitating symptoms.”

A wide range of physical and mental health consequences are related to long-haul COVID-19, according to the CDC, and people are reporting different combinations of many symptoms.

Possible Symptoms After COVID Infection

• Tiredness or fatigue

• A hard time thinking or concentrating

• Headache

• Loss of smell or taste

• Dizziness on standing

• Fast-beating or pounding heart

• Chest pain

• A hard time breathing or shortness of breath

• Coughing

• Joint or muscle pain

• Depression or anxiety

• Fever

• Worsening of symptoms after physical or mental activities

Although most people infected with COVID-19 are never hospitalized, many have life-threatening symptoms and traumatic events without any health care support.

COVID-19 disproportionately affects communities of color, and it stands to reason that will be the case for post-COVID conditions as well, says Sabrina Assoumou, MD, of the Boston University School of Medicine.

It will be crucial to address health care disparities as post-COVID cases mount. Diversification of the workforce will be vital, she explains, because diagnoses can depend on how well a doctor listens to patients describe their symptoms.

The persistent symptoms can be vague, Assoumou says, and some people who never received a diagnosis, for whatever reason, are now having post-COVID effects.

“Long COVID will force us to go back to the basics, like really listening,” she says. “We’re definitely going to need to be more empathetic.”

Why Is This Happening?

Scientists are studying the many people who continue to have symptoms or develop new ones after infection. They are looking for the cause of prolonged illness, trying to understand why some people are more vulnerable to long COVID than others, and assessing whether COVID-19 triggers changes in the body that increase the risk for other conditions, such as heart or brain disorders.

The best defense is to get vaccinated and not get COVID-19, according to the CDC. But when people report illness that persists, doctors are being asked to consider measures of well-being beyond objective lab findings and to focus treatment on specific symptoms.

COVID rehabilitation clinics are opening at medical centers across the United States. But will efforts to help be obstructed by the lack of a clear explanation for symptoms that won’t go away? And will people feel disbelieved by a health system that’s not ready to address something it cannot really measure?

Early indications suggest this is the case, according to Greg Vanichkachorn, MD, a family doctor and founder of the COVID-19 Activity Rehabilitation Program at the Mayo Clinic in Rochester, Minnesota.

“If there’s one universal truth amongst all the patients I’ve interviewed, it’s that they’re often brushed aside, pigeonholed, or, frankly, abandoned,” he says.

Some experts believe doctors should screen patients for mental health symptoms after the initial phase of COVID and offer early and ongoing care.

Early mental health help with therapy could play “an important role,” says Mauricio Castaldelli-Maia, MD, of the Department of Epidemiology at the Columbia University Mailman School of Public Health in New York City.

“It’s important we acknowledge the symptoms are real, imagined, or the result of stress,” Garner says. “And too much rumination on the illness and constant searching for a biomedical cause can be detrimental.


 

“Fear that I would not recover was a huge barrier to dealing with the symptoms. Conversations with others about their symptoms also simply reminds you of them and can reinforce an identity as a sick person. Just let go. Find good things in life — positive thoughts really helped me — but it takes time, there can be setbacks. It is not easy.”

Garner says he found his way forward by listening to others who had recovered.

“I couldn’t do this alone,” he says. “I had lots of friends, people who had recovered from fatigue syndromes and viral infections and help from professional colleagues.”

Garner dusted off his bicycle and started cycling around his favorite parks in Liverpool. And now, he’s running again and is leaving COVID behind.

Author: Allison Shelley
This post originally appeared on Medscape Medical News