Long-term cardiovascular outcomes of Covid-19
nature.com
nature.com
Even things like climbing stairs has become a chore. One top of that, I was experiencing syncope on standing which they sent me to a cardiologist for. I couldn't complete the treadmill test to anyone's satisfaction so now we have to explore this further.
None of this existed prior to getting Covid, and it's far past the point of "it's all in my head". With the fainting on standing, I would literally drop to my knees as the world faded to black. I've never experienced anything like that in my life.
The shortness of breath is just another one to add to a list of problems now.
Note I was double-vaxxed when I caught Covid. I'll have to assume Omnicron although I have no actual data on that. It was a breakthrough case and I had a 104 fever, cough, and shortness of breath (that's why they admitted me). It's been downhill since then.
Do you happen to know if your resting blood pressure has changed?
COVID-19
I had a bad case of pneumonia that put me in the hospital for a couple days a few years back (early 30s at the time) - and it was year plus before my lungs were back to "normal"... I'm asthmatic so even my normal isn't that great. Was having to do nebulizer treatments basically every day for months.
How did you do it? Just slowly rebuild lung capacity?
I need to do this ASAP now as if I speak for too long, I have to catch my breath. That is "no bueno".
I'm no exercise expert but what appears to be important is keeping your heart rate above 120bpm for long periods of time.
2 years down the line I can do 40k walk / hilly hike without even being bothered. But I still have trouble doing a 10k run. 5k is doable easily.
I've never had COVID and I'm still working on this...
Running is cheap and can be done any time I have time. So I started. I had to have music to make it not boring (still do but now mostly listen to podcasts).
I hated running but disliked being unfit more. Started with 2k and walked some of it. I made a big effort to go out and do it whenever I had time, 3 times a week. I can't stress this enough, but how far and fast I ran was not nearly as important as getting in the habit. Even if it was cold or a little wet. Building the habit is the only important thing for the first 6 months. Even on holidays I would bring my shoes and shorts. After a couple of months 5k was easy. I bought a heart rate monitor as a reward for getting to 5k. This was brilliant! I started getting self competitive and learned that running at a speed which kept my heart rate under 140 was the best for training. Slowly over the next two years I was able to do longer and longer distances, lost weight, slept better and found running very enjoyable and a great de-stresser. Time for myself away from the usual pressure of life and it was good for me. I enjoyed discovering the place in a new way. I got to half marathons once a month. I couldn't really believe it. Signed up for a marathon and while training for that was actually hard work and the marathon itself was crazy hard, I managed it under 4h.
Now this isn't a "look at me I'm great" story. The point is someone who couldn't run 5k at all can actually over a modest number of years get to marathon shape and enjoy it. Anyone (who doesn't have some condition) can do it. Running 5k three times a week is exceedingly good for your health and mental well being.
The key for me at least is habit. Getting into the habit is the only truly hard thing. When it's cold, windy, whatever, get out there for at least 5 minutes.
Just turned 50 and I built up to doing 5k every other day and I've been doing that consistently now for over 2 months.
Its gotten easier, I'm dragging ass in patches now rather than most of the second half.
Doubt I'm going to start marathoning, I'm going to try to stick to 5k for life more or less. I know eventually I'll want to push up to 8k to 10k occasionally to get my 5k times up. But generally I don't want much more than a 30 minute per day commitment.
And I started in the middle of winter in Seattle, so I've already run through all the wet and cold and windy. Could have used my scuba diving gear a few times...
And honestly the marathons and even half marathons are not important, imo. Getting over 10k regularly was very nice though. It's a different mental state at those distances.
Well, post-COVID that was happening without exercise. Fortunately, things went back to normal over time, my student insurance sends us to the "student health center" and they were convinced 120 was a normal resting heart rate for an otherwise healthy 26 y.o. who was used to half that a year before.
ps: cardio and lung go together, so don't forget to let your heart rise up to ensure good blood flow and blood pressure, it will help your lungs too. Taichi or yoga like poses (and walking) are wonder to bootstrap blood flow in weak health.
tc
Thanks this is exactly what I need.
It's so surreal to just have a slightly long sentence in front of a group of people, only to end up catching your breath, to realize how vitally important this all is.
I will take all the suggestions offered, thanks.
i should add, anxiety level can influence this system a lot, and when you start to have issue (covid context not helping) it might also play a role. i'm no doctor again, but i've read that capillaries have microscopic valve on both ends to control blood flow, anxiety -> nervous system -> shut capillaries.. so even if you try to breath, oxygen doesn't reach cells properly. That sort of things.
relaxation, good oxygen (maybe you can get O2 intake sessions), patience, and of course check for covid related data regarding lung damage (hopefully it's just temporary inflammation)
tc^2
The interesting thing is I have very low anxiety, I actually am taking this whole Covid thing in stride. I'm more of the "if it's my time, it's my time" sort of thinker. But when you stand up from a prone position and then world starts fading to black, it's not anxiety related!
I often forget this can even happen (it's not in the back of my mind), and when it happens again, I find it "extremely annoying", if you can believe that, rather than scary.
Good luck for your recovery.
Beside the natural tricks, I'm also considering fasting, maybe cannabinoids (thx is said to trigger cell recycling in alveoli) and mayyybe tricks related to mitochondrial health (if doable outside medical facilities)
ps: even simple ground floor poses where your posture helps blood flow (head and heart at the same height) are super useful.
Can you elaborate?
Nor do they disprove it.
Someone that was healthy with no symptoms contracting a disease and, afterwards, displaying severe symptoms would, logically, require that the causal link be explored. It could have been a coincidence, but COVID is known to damage lungs and heart tissue.
I didn't go from very healthy to very sick after a stay in the hospital with Covid for no reason.
I don't honestly care if it establishes a "casual link", I wasn't passing out after standing up prior to Covid.
good luck, and i’m sorry for what you’re going through.
Have a link? I'm in NJ.
This isn't "talking up" my symptoms, it's real. I'd love to talk to anyone in this field.
I wrote the date and times of activities that drained me - and the recovery time of rest before I felt average.
This included phone conversations, which I found had about a 14 minute limit.
It was helpful in communicating with other health professionals a little, but immensely helpful in seeing a couple weeks go by and my activities got longer / further, and the recovery time got shorter.
This also helped with the feelings of dread and worry when in the middle of something, I felt complete exhaustion - knowing I could look at a clock and count on 2 minutes to go by and I would be mostly normal again.. Things like that had a huge impact for me.
After some months, looking back on where things were, I feel that I am doing okay, and better than I was, even if I am not where I'd like to be.
It was 8 months since last vaxx, and I was scheduled for a booster but Covid got me first.
These booster shots don't seem to help much with Omnicron anyway, isn't Pfizer and others working on a new vaccine to target this strain?
Difficulty breathing, heart palpitations, dizziness, muscle twitches, and the brain fog throughout the last year has had its toll on my mental health.
Covid has brought upon one of the most depressive/anxious periods of my life. I don't know if it was because of Covid, the damage it caused along the way out, or if I had a huge panic/anxiety attack because of the symptoms.
Whatever it is, I have really been working on reducing stress, focusing on my mental health, and many of these symptoms have faded away and only return when I'm a bit on edge.
It has somewhat unlocked a superpower of knowing when to slow down at work, be in the present with my kids, and take a deep breath. I never had this ability before it.
At the Gym, 3 weeks after testing positive the first time, I ran for 60s at 11km/h on the treadmill and my heart rate was 180bpm by the end.
For context, a 60s jog at that same speed prior to being afflicted would have resulted in a 130bpm heart rate.
Normally it would take running for 45 minutes to get to 180bpm..
But I got there (and felt awful) in 60s. I had to stop running.
https://www.abc.net.au/news/2022-01-18/returning-to-exercise...
I've definitely learned to take it a little easy for a while.
I think there is a psychological / confidence factor to running and if you're not meeting your target, it's easy to panic.
This happens to me when I run with other people, if they're faster than me, I often run slower because I panic that I can't keep up, which negatively effects my performance.
Which is why I wrote hard numbers instead of giving an account of how I felt.
I’m 32 and relatively healthy. A light jog should not feel like cardiac arrest after a minute - especially when I’m otherwise healthy.
Here's a quick look at my measurements over the past six months, would you like to guess when I tested positive for COVID? http://whiskyvangoghgo.com/images/v02max.jpeg
(this was a huge letdown, back in September I had started a jumprope program in hopes of driving this number up, despite reading that v02-max is nearly hard-wired to a individual’s physiology)
I have a Garmin watch and it does some pretty weird thing. My heart rate is super high apparently sometimes, it can tell me it's 180 during warmup when I'm hardly breaking a sweat, then go back down to 100 out of nowhere.
Maybe my heart is not working properly but I tend to think it's the "smart watch" doing funny things. The chest HRM seems more accurate but definitely not perfect because it relies on sweat for good conductivity.
I'm aware that none of this is medical-grade, but every chance I get, I'll compare the data to actual clinical measurements and I've never seen anything more than a fraction of a percent off. Furthermore, the numbers from the Watch show clear trends; if the data was scattered or random, I would think that's "doing funny things." A clear change in data mere days after a COVID diagnosis… that's not a coincidence, c'mon.
Honestly I am wondering if this is sampling bias. Have we ever paid this much concentrated attention to a disease? When you consider what a virus does to the body, it seems likely that many other viruses that have been endemic for millennia have been wreaking pernicious havoc on our bodies and we just... shrugged it off.
Anyplace the body heals from a significant physical injury, there is a scar. It's never a perfect restoration. It seems almost intuitive that the damage from a virus would be similar, and there is documented evidence that COVID will attack neurons.
That's not really what I said -- I'm not actually taking a stance on the conclusions of this paper. COVID has obviously been infecting massive numbers of people in the last couple of years, and if it is responsible for long-term cardiovascular sequelae as the paper concludes, of course it would be a more acute contributor over that period as compared to other historical causes simply by virtue of its pervasiveness.
Rather what I said is that the disease itself may not be causing "havoc" in the body at rates significantly different than other endemic viruses ("havoc" writ large: not only confined to cardiovascular sequelae, but among any long-term systemic harms). The bias that I am proposing is that we are _noticing_ these sequelae because A) so many people are getting sick at the same time, and B) because we are paying this much attention for the first time ever.
A) they are not pandemic, so the effect is of course much smaller
B) their impact is not necessarily primarily cardiovascular
Here's a non-exhaustive list of viruses with potentially overlooked sequelae.
Shingles (herpes zoster)
Rubella
Rotavirus
RSV
Norovirus
HPV
Hepatitis
Influenza
This is totally orthogonal to any possible defects in this study, which again I am not taking any stance on. It's merely a question of whether this study is anomalous for having been conducted in the first place. If we assume that the study is flawless, that means that COVID has long term health impacts -- fine -- but do we actually know if that's unusual for a virus?
There's a clear difference in health between the cohorts.
Supplementary table 1 breaks down the cohorts and summarizes co-variates. Disturbingly, the COVID cohort is significantly fatter than the contemporary control group:
https://static-content.springer.com/esm/art%3A10.1038%2Fs415...
54% of the COVID cohort has BMI > 30, vs 42% of the contemporary controls, and 40% of the historical controls. They also have a higher percentage in long-term care (4% vs. 0.6%), a higher percentage with cancer (8% vs. 6%), chronic kidney disease (19.5% vs 16.7%), lung disease (15% vs. 11%), dementia (6% vs. 3%), diabetes (32% vs 22%) and hyperlipidemia (34% vs 25%).
The Covid cohort is basically a much sicker population, in almost every way. Re-weighting the populations doesn't correct for this disparity.
The authors have attempted to hide this by burying the data in the supplementary material, and presenting an "absolute standardized difference" that makes it look smaller than it is.
What would be your preferred technique of accounting for the differences of characteristics in those groups?
This paper is discussing small differences in small numbers, and the single biggest difference between groups is the baseline level of health for the study participants. About the only thing you can say from this is that old, sick people are sicker after Covid-19 severe enough to put them in the hospital.
Thankfully, even though I likely had an early variant(Dec 2020), mine was not very extreme. I was constantly cold (like 45 minutes hot showers to get warm) and lost taste/smell, but I felt decent enough to run a 5k with it (probably stupidly, but at least it warmed me up), but the after effects have got me worried, especially the tingling in extremities which doesn't show any sign of going away.
But yeah mine is mostly my arms and when I wake up. Hopefully it goes away quickly for you!
Part of doing science also means having looked at enough papers and conclusions to know which questions merit further research and which questions are of little relevance to public health. It is extremely unlikely that you'll find any surprises here, and considering the open questions of long covid and long-term health effects on the population on COVID, I'd much rather the focus be on the more important questions.
We have enough information to form an educated guess. But your attitude here is exactly why public health authorities have damaged their credibility and that of science itself in the past two years. They have repeatedly misrepresented their educated guesses as scientific fact - and then turned out to be wrong.
https://www.medrxiv.org/content/10.1101/2021.12.27.21268278v...
> We found an increased transmission for unvaccinated individuals, and a reduced transmission for booster-vaccinated individuals, compared to fully vaccinated individuals.
And their definition of unvaccinated includes partially vaccinated (1-shot) and probably includes recovered individuals. See table 2 for their results which finds that boosters do significantly reduce transmissibility and susceptibility, but it is just very far from the perfect effect everyone would have hoped and wished for.
Vaccines are probably still more effective than masking in preventing transmission (given the average person's adherence to masking guidelines) and the effect would intuitively (to me anyway) seem likely to stack.
Where has that happened for this? Every study that has shown disease severity correlated with vaccine usage has shown the same results, over and over, for each variant: vaccination correlates with symptomatic disease severity which correlates linearly with long-term effects, in every observed metric.
This has appeared again and again and again in dozens of studies, to the point where it is the null hypothesis; you'd need to make a real case with novel, contradictory evidence to show that this is not the case.
In every domain of medicine there is some degree of guessing and basing off of historical data for a cohort; you can't test every patient for every possible thing that could ever affect them. Instead you pick and choose the most significant factors and use that as your guidelines. Research efforts for COVID are very large, but also limited; there is no evidence to contradict this and it's not worth researching.
If you actually kept up with domain experts during the pandemic, you'll see that there were many open questions over which they kept interest, and many open questions where they did not care much. The reason for that has to do with the acquired knowledge of having studied hundreds of other diseases and similar cases; they tell you how to explore the domain, seeing where things are likely to be different, and where they are not.
1) This article is not an experiment and doesn't establish that COVID-19 is the causative agent here. They do a variety of statistical tricks to get a little closer to causality. I am particularly worried about this part:
"To adjust for the difference in baseline characteristics ... variables were selected based on prior knowledge1,7,24,25. The pre-defined covariates included age, race (White, Black and Other), sex, ADI, body mass index, smoking status (current, former and never) and healthcare use parameters, including the use number of outpatient and inpatient encounters and use of long-term care. We additionally specified..."
That's nice, but it involves a lot of experimenter degrees of freedom and doesn't control for the main thing that strikes me as relevant here: behavior. It's not like people were randomly selected to get COVID or not, they were getting COVID or not largely as a function of their behavior. People who are more risk-tolerant and / or less norm-compliant are going to have different health outcomes.
EDIT: point 2 is wrong, I misread the data 2) The effects aren't large. For individual cardio conditions, max 1% increase. Overall, max 5% (many of which aren't serious).
EDIT: begin the part I still believe again: I'd like to see an analysis that looks at these outcomes merely on the basis of care setting. I.e., if you end up in the ICU for anything at all, how does your increased risk of $CARDIO_PROBLEM change relative to COVID specifically?
It's fun to talk anecdotes, but the data isn't ever as exciting as people would like to believe. I think it's very important to work against the hype machine because that's the only way we'll build real evidence-based progress.
I'm reading the graphs in the results section with the hazard ratios. All hazard ratios are above 1.5, which if I understand hazard ratio correctly means at least a 50% higher risk compared to regular population?
Am I misunderstanding hazard ratios? Or do you get the stats from elsewhere in the paper?
And thank you!
It was only in January that I started running or exercising intensely and noticed only a slight decrease in performance. Mainly that was due to not exercising for a month or so. However, overall I didn't notice that running/working out was significantly (>10%) harder but In my case, I took a very longer break than other. Just some food for thought
the kicker is that i feel better afterwards, due to the fever (i'm guessing) also clearing out a lingering cardiopulmonary issue (perhaps from a pneumonia bout a few years prior) that had gotten progressively worse during lockdowns (when gyms were closed for months).
getting covid was a net gain for me.
HR appears to be 'hazard ratio' which is simply a ratio between the two groups. The above example would have a hazard ratio of 3, as three times as many people presented with the outcome than expected.
The abstract states that "These risks and burdens were evident even among individuals who were not hospitalized during the acute phase of the infection", but I'd urge attention to the data as this implies only that there is a detectable change, it's not a judgement on the size of the risk.
The worst cases are in intubated patients that basically lost proper oxygen flow for extended periods of time.
"[long term] risks and burdens were evident even among individuals who were not hospitalized during the acute phase of the infection."
Though it does seem to make a distinction in grade ("these risks increased in a graded fashion according to the care setting during the acute phase (non-hospitalized, hospitalized and admitted to intensive care)"), it doesn't seem to support the idea that the impacts are limited to the hospitalized.
They're just very small. If you look at the data, the risk ratios are in the range of 1.0x-2.0x, on outcomes which in healthy individuals are extremely rare to begin with. Same with the excess figures.
The logical conclusion given the rest of the data is that these outcomes would be concentrated in those who were very ill but below the threshold of hospitalization.
The study itself doesn't bin the groups far enough to show the implication for the asymptomatic or those with very minor symptoms, but there's a clear exponential trend that associates acute severity with long-term severity supra-linearly.
That's for the entire cohort of non-hospitalized individuals, it's an average.
If you assume that they're uniformly distributed (e.g. if you assume that the relative risk of future myocarditis is identical for someone who has no symptoms, and for someone who's bedridden for a week with breathing difficulties but non-hospitalized), the figures show that if you're not hospitalized your risk of myocarditis and other heart issues is multiplied by about 2.
If the study were binned more finely I think you'd see a 5x multiplier if you have mild illness (mild in the clinical sense which simply means non-hospitalized but exhibiting symptoms) or no discernable effect if asymptomatic. I agree that there is no specific data for this, I'm extrapolating the curve.
> About half the people I know who got covid (and knew about it) had, or are currently having, a very unpleasant time.
We're not debating this point, this is a paper showing the correlation between the short term and long term effects of the disease.
Again, speaking from both personal anecdata and the wider scientific consensus - if you have symptomatic covid, it takes you a long time to feel "normal" again.
> if you have symptomatic covid, it takes you a long time to feel "normal" again.
The non-hospitalized group in this study includes both symptomatic and asymptomatic.
This comment thread is a bit weird, you seem to be attacking me on an emotional basis. I'm interested because I think this data shows a good correlation between severity of disease and severity of long term prognosis, that's all.
I have an interest in knowing this, as we all do, because like basically everyone else, I've had coronavirus, and if the data shows that this now means I have an elevated risk of heart issues I should be careful with things like heavy exercise. I don't think it does based on the correlation shown (I didn't have severe coronavirus), so it's actionable information.
If you disagree with my assessment that a 2x multiplier on a rare event is not worrisome, that's fine - that's just like, my opinion, man. :)
Your original comment reads as a much stronger statement:
> The meat of this seems to be in confirming that if you're not hospitalized the long-term effects are minimal. Not _zero_, but very small.
I think also 'the long-term effects are minimal' reads too broad since this study only covers a narrow set of long-term effects while your original comment can read as applying to all long-term effects.
> If you disagree with my assessment that a 2x multiplier on a rare event is not worrisome, that's fine - that's just like, my opinion, man. :)
I would want to look at the number of people effected a year before and after the change in order decide if it was worrisome or not.
Doubling of a very small number is not a "large statistical anomaly". Figure 5 shows that the difference is skewed strongly toward the hospitalized, and that the largest difference observed for the non-hospitalized cohort is measured at maybe 10 per 1,000 (1%) and most well-below that (single-digit difference per 1,000).
https://www.nature.com/articles/s41591-022-01689-3/figures/5
And 100% of the people I know who had it (measured in the tens; including myself) have had no lingering symptoms at all.
Anecdotes are not science. It is not "moving the goalposts" to note that lingering symptoms correlate with severity. The authors of the paper have already shown this, but didn't break it down enough.
Glad to see some science putting numbers on what the odds we're all against in terms of long-term damage.
Yes, I could get COVID and yes, I'd probably be fine, but the more information coming out around lingering effects give me serious pause about the "everyone will get it eventually" route.
I'd rather never get it, if that's possible, and honestly if the numbers continue to drop as they have been, I'm a few weeks away from that being actually possible in my area again.
https://www.businessinsider.com/delta-variant-made-herd-immu...
The trendline is heading towards Fall 2021 levels, which weren't great but still at my personal acceptable levels of risk. A few more weeks, hopefully.
[0] https://newrepublic.com/article/163186/youll-probably-get-co...
[1] https://time.com/6133419/should-i-try-to-get-omicron/
[2] https://www.reuters.com/business/healthcare-pharmaceuticals/...
It is really interesting to see this mental gymnastics, if someone is fat, gets virus and dies, it is "the plague". But here we have dozen people talking about "personal responsibility".
b) Some of the toughest workouts I’ve done were inside. You need to stop being so close minded.
Masks do not restrict oxygen flow, there are several studies to prove it! It is perfectly safe to wear double mask for entire day at work or at school!
I also like to do tough workouts inside, at gym! I do not have gear or space at home.
The other commenters are right in saying that there are excuses, and you seem to be full of them.
I agree about the gym - you can’t replace it at home unless you’re seriously rich, like many tens of millions of net worth. My gym has pools, lots of heavy weights, many odds and ends and equipment you’d never buy.
I can get a vastly better workout there than by doing pushups at home.
For various reasons, I don’t run, which leaves cycling and swimming for cardio. I also like to lift heavy - this means a large variety and quantity of weight. I need a gym.