Long Covid

Did Lockdown Drive Putin Mad?

According to the Council for Foreign Relations in the U.S., Vladimir Putin may have lost his marbles due to a combination of Long Covid and prolonged bouts of isolation during lockdown. MailOnline has more.

With the eyes of the world on Vladimir Putin, questions are being asked about the Russian leader’s state of mind after he announced the invasion of Ukraine in “rambling, terrifying, apocalyptic” fashion.

Rumours surrounding the Russian leader’s health have been swirling for years, with repeated reports suggesting that he is suffering from cancer and Parkinson’s disease.

On top of that, the impact of the COVID-19 pandemic on both the President’s physical and mental health can’t be underestimated, and it’s been suggested that brain fog as a result of Long Covid could be impairing his cognitive function.

Although it’s not clear if he’s had the virus, the Sputnik vaccine is not known to be reliable and after isolating in September after members of his inner circle tested positive he disappeared from view for a long period in October.

The US think tank the Council For Foreign relations has speculated that, after behaviour and statements that are “off” and “not right”, he is suffering brain fog induced by Long Covid.

What’s more, the isolation caused by the pandemic itself could have left the 69 year-old even further detached from reality, with one neuropsychologist claiming the ‘progressive isolation’ could have led to hubris syndrome, which “diminished his ability to weigh up risk”.

It is commonly associated with a loss of contact with reality and an overestimation of one’s own competence, accomplishments or capabilities.

It is characterised by a pattern of exuberant self-confidence, recklessness and contempt for others, and is most particularly recognised in subjects holding positions of significant power.

Surrounded by Russian cronies who are terrified to tell him no, Putin is hardly a world leader who could be associated with being the most grounded or level headed.

But in televised addresses leading up to the invasion of Ukraine, he’s been by turns rambling, terrifying and apocalyptic while yesterday he gave a chilling warning to its allies in the West, promising there would be dire consequences for any foreign state that ‘interferes’.

Professor Ian Robertson, a neuropsychologist at Trinity College Dublin, has suggested he could be suffering from hubris syndrome.

Speaking to the I, Robertson said Putin’s political trajectory “is as much personal as political, because once the hubris syndrome takes hold in the brain, the personal and the national are identical because the leader is the nation and its destiny”.

Alternatively, he may just be a psychopath.

Worth reading in full.

Is Long Covid Just Another Example of Post-Freudian Hysteria?

We’re publishing today a piece by Eduardo Zugasti, which looks at the history of syndromes “without clinical explanation” and asks whether Long Covid should be understood in this context, as being primarily psychogenic or sociogenic. Here’s an excerpt.

It would be a great mistake to assume that the modern extinction of tarantism, or of the picturesque – to us moderns – medieval epidemics of dancers (pictured), is simply the end of sociogenic illness and the disorders formerly known as neurasthenic or hysterical. Post-traditional society, with its new avenues for digital information and (dis)information, the empowerment of ‘civil society’ and the fragmentation of medical authority, seems to multiply the opportunities for the flourishing of ‘medically unexplained diseases’ in recent decades. According to Abigail A. Dumes from the University of Michigan: “What was understood as neurasthenia from the mid-19th to early 20th century came to be understood as hypoglycaemia in the 1960s, Briquet’s syndrome in the 1970s, chronic fatigue syndrome in the 1980s, and, by the late 1980s and early 1990s, multiple chemical sensitivity, Gulf War syndrome and chronic Lyme disease, among others.”

For Elaine Showalter, the feminist scholar and medical historian, these are ‘hystories’, epidemics of post-Freudian hysteria. Modern syndromes would be characterised by the expression of individual and social stress, powerlessness and physical or sensory symptoms without clinical explanation, but often attributed – by patients and activist doctors – to an unidentified external cause. The new ‘tarantula bites’ range from physical candidates such as viruses, environmental toxins, products of Big Pharma, electromagnetic waves or chemical warfare, to such fantastic agents as satanic conspiracies, in the case of the false memory syndrome or extra-terrestrial infiltration, in the case of ‘abduction syndrome’. The ‘hystories’ – for Showalter – have three basic ingredients: “a doctor, or other authority to define, name and publicise a disorder; unhappy patients with vague symptoms; and a supportive cultural environment”, starting with the USA itself, the “hot zone of psychogenic illnesses” and the true genesis of the new biomedical labels.

Worth reading in full.

Heart Problems After Covid Are Much Worse for the Vaccinated, Nature Study Shows – But It’s Hidden in the Appendix

Nature published a comprehensive study this week on cardiovascular risk including a total of over 11 million patients that has made a few headlines. The aim was to identify the cause of increased cardiac pathology. It should have been a very simple study comparing four groups:

  1. Not infected and never vaccinated 
  2. Not infected and vaccinated 
  3. Infected but not vaccinated
  4. Infected and vaccinated 

It is hard to believe the authors did not look at these groups, but whatever was found when comparing them remains a mystery.

Instead, the following groups were compared:

  1. Not infected and never vaccinated data from 2017
  2. Not infected, including vaccinated and not vaccinated
  3. Infected but not vaccinated
  4. Infected with vaccinated people included but using modelled adjustments

When studies with huge datasets use modelling and fail to share data prior to their adjustments alarm bells should start ringing. Therefore, I took a deeper dive to see what else was questionable.

There were serious biases in the paper which need addressing but first let’s look at the critical question of myocarditis (heart inflammation).

Because of the known risk of myocarditis from vaccination it is worth looking particularly closely at the data presented on this. Oddly, for the issue of the day, the data on myocarditis was all hidden in the supplementary appendix to the paper.

The risk of myocarditis appears to be an autoimmune (the immune system attacking the heart after interaction with the spike protein) rather than direct damage by the virus/vaccine spike protein. Therefore, myocarditis could result from the virus or the vaccine. The key question that needs answering is whether vaccination protects or enhances the risk from the virus.

The authors report 370 per million risk of myocarditis after Covid infection in the unvaccinated. The contemporary control rate was 70 per million and the historic one was 40 per million. What was wrong with the contemporary controls?

Most Covid Patients Discharged from ICU Make a Good Recovery, Study Finds

Mounting evidence suggests that long Covid is not the great danger it was initially claimed to be. Research by the ONS indicates that, 12 weeks after infection, the percentage of people still reporting symptoms is only 2.5 points higher than the background rate.

What’s more, several studies have found little or no difference in rates of long Covid between those who were seropositive and those who were seronegative. One French study found that believing you’d had Covid was a better predictor of long Covid symptoms than actually testing positive for Covid antibodies; the only exception being anosmia.

This suggests that many, perhaps most, cases of long Covid are psychosomatic. Thanks to all the media attention on long Covid, people may have been inclined to exaggerate their symptoms; to report things they normally wouldn’t have done.

Fortunately, the vast majority of people who catch Covid get only mild symptoms; at worst, they’re bed-ridden for a few days with a nasty cold. However, a small percentage do end up in hospital, or even the ICU. And most of these individuals experience debilitating symptoms for the rest of their lives – right? 

Apparently not, finds a new Italian study. Alberto Zangrillo and colleagues identified all the Covid patients admitted to their hospital in Milan during the first wave, who’d spent at least one day on a ventilator. Of these 116 patients, 53% survived. The authors followed up 56 of the 61 survivors one year later, and asked them to complete a questionnaire.

Note: none of the survivors died during the intervening year; 5 simply refused to answer the questionnaire. Among those who did answer, the average age was 56 and 89% were male. 

So what did the researchers find? The great majority of patients reported good quality of life. 82% had no difficulty walking; 95% had no difficulty washing or dressing; and fully 84% had no difficulties with their usual activities.

Non-trivial fractions did report some pain/discomfort and feelings of anxiety/depression. However, these patients were in the minority. Overall, 61% reported no pain or discomfort; and 64% had no feelings of anxiety or depression.

And note: some of the patients who did report these things may have experienced them before they got Covid. We can’t be sure the fractions reporting no symptoms would be 100%, or even close to 100%, in the absence of a pandemic. For example, 52% of patients in the sample had at least one pre-existing health condition.

36 out of 56 patients were given a chest CT scan, to assess the extent of lung damage. Only 4 had signs of pulmonary fibrosis (severe lung damage). Though it should be noted that other studies have reported higher rates of lung damage at one year follow-up. 

Zangrillo and colleagues’ findings should be encouraging to those who’re recovering from severe Covid. One year after admission to the ICU, only a minority of patients had symptoms serious enough to affect their day to day life.

Of course, there’s much that can and should be done to prevent people landing in the ICU, such as voluntary vaccination and precision shielding. But it’s reassuring to know that many of those who do wind up there, and are subsequently discharged, can expect to make good overall recoveries.    

French Study Suggests That Long Covid is Mostly Psychosomatic

Long Covid was initially believed to affect one in every ten people who catch the virus. However, estimates have since come down considerably. In September of this year, the ONS published research indicating that only 2.5% of people still report symptoms after 12 weeks.

As I noted in a write-up for the Daily Sceptic, even this 2.5% figure is probably an overestimate, since it assumes that every participant reported their symptoms accurately. Due to media attention surrounding long Covid, some participants might have been inclined to exaggerate their symptoms – to report things they normally wouldn’t have done.

A new study published in JAMA Internal Medicine suggests that the 2.5% figure is an overestimate. Joane Matta and colleagues analysed data on a sample of about 27,000 French people, who were given serology (i.e., antibody) tests between May and November of 2020.

The same individuals took a questionnaire between December 2020 and January 2021. In that questionnaire, they were asked, “Since March, do you think you have been infected by the coronavirus (whether or not confirmed by a physician or a test)?”

Respondents who answered “Yes” were also asked when they caught the virus. Those who indicated that they caught it after their serology test were excluded from the analysis. Additionally, all respondents were asked to say whether they had experienced each of 18 different symptoms since March of 2020.

The main results are shown in the table below. There are four columns, corresponding to different combinations of belief and serology. The two on the left correspond to a negative test, while the two on the right correspond to a positive test. The belief columns indicate whether respondents believed they had been infected.

There are two main things to notice. First, if we compare the column on the left (for people with a negative test who believed they had not been infected) to the two columns on the right (for people with a positive test), we see that the percentages are about the same. The only exception is anosmia, shown in the final row.

In order to do this, you have to compute a ‘mental weighted average’ of the two columns on the right. For example, 7.3% of people in the first column had joint pain, while the corresponding percentage for the last two columns is 6.5% (the weighted average of 4.2 and 8.2).

These comparisons indicate that respondents who tested positive for Covid antibodies were not, in general, more likely to report symptoms than those who tested negative. (The only symptom they were more likely to report was anosmia.)

The second thing to notice is that, if we compare the two “Belief +” columns to the two “Belief –” columns, we see that the percentages tend to be higher in the former. This indicates that people who believed they had been infected reported were more likely to report symptoms, regardless of whether they actually had been infected.

The researchers estimated multivariate models that controlled for characteristics like age, sex and education, and observed the same pattern of results. Believing that one had had Covid was associated with reporting symptoms, but actually having had Covid was not (with the exception of anosmia).

Matta and colleagues’ findings are consistent with earlier studies based on young people, which found little or no difference in symptoms between those who were seropositive and those who were seronegative. Long Covid, it seems, is mostly psychosomatic.

Is Covid Caused by More than One Virus?

We’re publishing a guest post today by John Collis, a recently retired nurse practitioner and a regular reader of the Daily Sceptic. He thinks that people presenting with Covid symptoms may be infected with more than one virus, not just SARS-CoV-2. Could the herpes family of viruses – such as mononucleosis/glandular fever – also be playing a part?

Over the course of the last two years, as different symptoms were being reported for Covid, long Covid and vaccine reactions, there seemed to be a pattern emerging that rang a few bells with me. To put this into context, for the past 15 years I was a nurse until I retired earlier this year. During that time I worked on a neurology ward and in the Emergency Department. I encountered patients who developed neurological and clotting problems a few weeks after having a viral infection, typically a stomach bug.

The reports of vaccine trial participants developing neurological problems made me think of an autoimmune response initially, but I thought nothing more about it until the symptoms of long Covid were being described, particularly fatigue. Initially, I shrugged this off as a normal post-viral reaction, until I recollected the long term effects of infective mononucleosis/glandular fever.

I knew that some members of the Herpes family of viruses never actually leave the body but lie dormant. The classic example is the virus that causes chicken pox; under certain circumstances a person who has had chicken pox may develop the painful condition shingles.

After researching the herpes family of viruses I discovered that each one of them adopts a dormant state in different types of cells in the body. For example the virus responsible for cold sores (Herpes simplex) and that responsible for chicken pox (Varicella Zoster) reside in neurons. There are others that reside in the B-cells and T-cells of the immune system. These viruses are pretty much ubiquitous across the adult population, around 90% for all but one member where the prevalence is around 15%. Fifty per cent of five year-old children already have the virus responsible for glandular fever, Epstein-Barr virus (EBV), although its designation is the somewhat uninspiring HHV-4.

Besides the well known diseases associated with these viruses, I discovered that they can cause respiratory complications such as pneumonia, one even producing “ground glass” images on CT or X-ray; cardiac problems including myocarditis; neurological problems such as Guillain-Barré syndrome, and, in the case of EBV, Multiple Sclerosis; clotting disorders and endocrine disorders.

Long Covid Is Even Less Common Than Previously Thought

In a post on long Covid back in July, I said that “estimates of the chance of reporting symptoms after 12 weeks range from less than 1% to almost 12%”. That 12% figure came from the ONS, who found that individuals who tested positive were 12 percentage points more likely than controls to report at least one symptom 12 weeks after infection.

In my post, I argued that 12% is probably an overestimate on the grounds that some people who tested positive might have been inclined to exaggerated their symptoms – to report things they normally wouldn’t have done (thanks to all the media attention on long Covid).

And I noted that a study published in Nature Medicine had observed a much smaller percentage of people still reporting symptoms 12 weeks after infection, namely 2.3%.

A new analysis by the ONS has obtained a figure almost identical to that observed in the Nature Medicine study, namely 2.5% (the difference between the blue and green lines in the chart below). This is clearly much lower than its previous estimate.

Interestingly, the reason for the discrepancy with the earlier figure isn’t the one I suggested (i.e., that some people who tested positive were inclined to exaggerate their symptoms). Rather, it’s a statistical issue.

In both their original and updated analyses, the ONS defined symptom discontinuation as two consecutive visits without reporting any symptoms. (Participants in the ONS’s survey were visited at regular intervals for the purpose of data collection.)

This means that someone would be classified as ‘having symptoms’ if they’d gone one, but not two, visits without reporting any symptoms. However, in their original analysis, participants were only followed for a median of 80 days (less than 11 weeks).

As a result, some participants who would have been classified as ‘not having symptoms’ if they’d been followed a little bit longer were still classified as ‘having symptoms’ at the end of their observation period. (In the jargon, their follow-up time was ‘right-censored’.) This is shown in the diagram below, taken from the ONS:

In the ONS’s updated analysis, which followed participants for a median of 204 days, individuals in the situation of Participant D above were correctly classified as ‘not having symptoms’ before the end of their observation period.

Using this revised method, the ONS found that less than 1% of children aged 2-11 continue to report symptoms 12 weeks after infection, with the figure rising to just 1.2% for those aged 12-16. Hence long Covid is particularly rare in children, further undermining the case for vaccinating that age-group.

While the ONS deserves credit for being completely transparent about the limitations of their original analysis, their updated analysis is still open to the criticism I mentioned above. This means that 2.5% should probably be considered an upper bound on the chances of getting long Covid, the true figure being somewhat lower.

More than Half of People ‘With’ Long Covid Might Not Have… Long Covid, According to New Research

New research by the Office for National Statistics (ONS) suggests that more than half of those who are suffering ‘from’ long Covid might not actually have it and could simply be suffering from normal bouts of ill health. The Telegraph has the story.

The ONS surveyed nearly 27,000 people, who tested positive for Covid, in the U.K. Coronavirus Infection Survey and used three different methods to estimate the prevalence of long Covid.

In one analysis, they found that 5% reported at least one symptom 12 to 16 weeks after their infection.

However, the study also found that 3.4% of people who had not been diagnosed with Covid also reported the same long Covid symptoms.

Kevin McConway, Emeritus Professor of Applied Statistics at the Open University, said: “That’s not all that much less than the 5.0% for the infected people, which does show that having one or more of these symptoms isn’t uncommon regardless of Covid.”

Long Covid symptoms are fever, headache, muscle ache, weakness/tiredness, nausea/vomiting, abdominal pain, diarrhoea, sore throat, cough, shortness of breath, loss of taste and loss of smell.

However, the ONS said that such conditions were experienced regularly within the general population.

A second analysis found that just 3% of people reported continuous symptoms for at least 12 weeks after an infection, compared to 0.5% of the control population.

However, in a third analysis, when the group was asked to self-identify as suffering from long Covid, 11.7% said that they believed they had the condition, with 7.5% saying the condition limited their day-to-day activities.

When confined to only people who had suffered symptomatic Covid, the number saying they suffered from the condition rose to 17.7%.

Previous studies have suggested up to a fifth of people catching Covid will suffer from long-term after-effects.

The ONS said that depending on which measure was used, the data showed between three and 11.7% of Covid cases still had symptoms 12 weeks after an infection.

Worth reading in full.

Professor Sir Terence Stephenson Spins His New Study to Exaggerate Long Covid and Trivialise the Impact of Lockdowns in Children

The latest findings of the world’s biggest study into ‘Long Covid’ in children and young people (CYP) – the CLoCk study from University College London – have been published as a pre-print.

Surveying 11 to 17 year-olds who tested positive for COVID-19 in England between September and March, the researchers found that the condition is not common in children and young people. This is in line with other studies into Long Covid.

As with earlier studies, symptoms were prevalent in those who tested negative as well as those who tested positive, complicating the picture of the condition which the authors acknowledge lacks clear definition.

Further confusion was sown by the fact that reported symptoms increased rather than decreased after three months, leaving the authors puzzling over the explanation.

Three months after the SARS-CoV-2 test, the presence of physical symptoms was higher than at the time of testing. This finding emphasises the importance of having a comparison group to objectively interpret the findings and derive prevalence estimates. Although 64.6% of test-positives reported no symptoms at time of testing (compared to 91.7% of test-negatives), they did not continue to remain asymptomatic, with only 33.5% of test-positives (and 46.7% of test-negatives) reporting no symptoms at three months. This finding warrants further exploration and could be due to self-selection into the study because they were experiencing on-going symptoms, recall bias, external factors relating to the pandemic such as returning to school and exposure to other sources of infection, and the actual trajectory of the illness, although this wouldn’t explain the high prevalence among test-negative CYP.

In terms of physical symptoms – tiredness, headaches, shortness of breath, loss of smell, and so on – the researchers found there was a somewhat elevated prevalence of these among the test-positive compared to the test-negative, though both had increased over the three month period.

Three months after the SARS-CoV-2 test, the presence of physical symptoms was higher than at baseline in both groups; 66.5% of test-positives and 53.4% of test-negatives had any symptoms whilst 30.3% of test-positives and 16.2% of test-negatives had 3+ symptoms. The symptom profile did not vary by age: for both 11-15 year-olds and 16-17 year-olds the most common symptoms among test-positives were tiredness, headache and shortness of breath and, among test-negatives, tiredness, headache and the unspecified category of “other”. Again, the prevalence of tiredness and headache was consistently higher in the test positives, 39.0% and 23.2% versus 24.4% and 14.2% in negatives, respectively. Prevalence was higher for 16-17 year-olds; for example, 46.4% of test-positives reported being tired compared to 29.6% of test-negatives.

The 14% difference reported here between the 30% of test-positives and the 16% of test-negatives who had three or more symptoms at three months is likely to be the study’s most accurate estimate of the prevalence of Long Covid in the sample population.

However, as the BBC’s Nick Triggle notes, the low response rate and selection bias towards the unwell in the survey may mean the true prevalence of Long Covid is more like 2%.

A Doctor Asks: The Data Is Looking Good, So Why the Doom-Mongering?

There follows a guest post from our in-house doctor, formally a senior medic in the NHS, analysing the latest NHS England data packet.

Once a month, the NHS releases a more detailed summary of COVID-19 related data than provided in the regular daily updates. Although the data set is far from complete, the monthly packets provide a better impression of what is really happening in hospitals than the daily snapshot. I find this month’s information particularly interesting. Apologies in advance to readers for reverting to a more data-driven ‘chart fest’ format for my latest contribution – but stick with it, because there are some important messages here which have not been widely reported so far.

Take a look at Graph One. This rather complicated graphic shows daily admissions in the vertical orange bars and paired daily discharges in the vertical blue bars. Readers will notice that on every day between April 7th and June 30th, there were more discharges than admissions.

The grey line with the secondary y-axis to the right of the chart shows the total number of ‘COVID-19’ patients in hospital on each given day. For the first period from April 7th to May 25th, this was on a falling trend – that’s what one would expect if there were more discharges than admissions each day.

From May 26th to the end of June, however, the total number of patients in hospital ‘with COVID-19’ was on an upward trend – but on each day of the series, there were still more discharges than admissions. How can that be?

I’ve discussed this issue with colleagues and there are only three interpretations we can think of. One is that there are a very large number of patients contracting COVID-19 in hospital who came into hospital without the virus. The second is that some of the ‘discharges’ are in fact patients who were never admitted to hospital at all, but seen in A&E and then sent home. The other is that the data quality is very poor and gives a misleading impression of the true picture.