April 28, 2021
Dear Members of the Baylor College of Medicine Community,
Today, I want to focus my message on two populations; young adults who are not yet vaccinated, and people – young and old – who have already had COVID-19, but do not feel like they are fully recovered.
Last week, I attempted to debunk this myth: "I am young, COVID-19 won't hurt me, I don't need to be vaccinated". To review from last week, looking at the simplest and easiest to define of outcome measures – mortality – the rate of death in young adults is much lower than those more senior, but it is not inconsequential. Happily, the risk is almost entirely preventable with vaccination and safe practices.
As the demand for vaccinations appears to be waning, we need to focus on getting the young adult population vaccinated, both from a public health perspective, and to protect their personal health and well-being.
Let us look at the public health issue first. The news on our local disease metrics is relatively good. Last week our local rate of new cases, hospitalizations and death all continued to decline, mirroring the overall national experience (the total US death rate ticked up slightly). Although demand for vaccination is weakening, our efforts remain strong.
Nationwide, 42% of the population has received at least one dose of vaccine. Let us compare that rate to a country that is doing well, and one that is doing more poorly. Israel has led the world in their vaccination efforts; currently 62% of their population has received at least one dose. On the other extreme, India – which is currently being ravaged by COVID-19 – has inoculated about 9% of their population.
The current daily case rate in the United States (per 1,000,000 population) is 167.
The case rate in minimally vaccinated India? 240.
In highly vaccinated Israel? 15.
Correlation is not causation and the differences in case rates are multifactorial. However, it is highly encouraging to see a country with high vaccine uptake driving disease rates to very low levels. This is what we all want to see in the United States. To get this degree of vaccine uptake, we need to engage younger adults. This is our fastest potential path back to the true normality everyone craves.
With regard to personal health of young adults, as we have vaccinated older people and those at higher risk, there is a definite trend developing. The composition of hospitalized COVID-19 patients has clearly shifted to a younger population, many of whom have severe disease. The trend is perhaps most severe in Michigan, which is experiencing a very high disease prevalence.
This is not a benign common cold. Even in young adults, it can – and does – cause death. It can – and does – cause severe illness. More insidiously, it appears to be an unwanted gift that keeps on giving.
Over the past few weeks, as I have talked to people who have had COVID-19, I have made a habit of asking them how long it was before they felt they had returned to normal. In my non-scientific poll, about one in three people, the answer is "months."
We now have a yet another new acronym: PASC (Post-Acute Sequelae of SARS-CoV-2 Infection), or "Long-COVID". It has become very clear that a significant proportion of people recovering from COVID-19 – ranging from 5-30% in a growing number of case series – suffer from weeks to months of potentially debilitating symptoms.
Common symptoms include fatigue, breathlessness, diminished exercise tolerance, psychological distress similar to post-traumatic stress disorder and cognitive impairment (so-called "brain fog"). Some COVID survivors also seem to be experiencing new onset or worsening of chronic disease affecting multiple organ systems: the heart (heart failure, abnormal rhythms), pancreas (an aggressive form of diabetes), and gastrointestinal tract (liver and digestive disorders). The mechanism of organ system damage is not clearly defined but could be the result of direct viral tissue invasion, secondary immune system mediated inflammation or micro-thromboses.
If you have recovered from COVID-19, are experiencing Long-COVID symptoms after a few weeks, I would encourage you to seek out assessment from one of a number of emerging "Long-COVID" clinics, which you will find in many academic medical centers and health systems. Baylor College of Medicine has a well-designed clinic that has already scheduled almost 200 people. (See below).
Given the complex nature of this condition, Long-COVID clinics need to mobilize a wide range of medical and behavioral health specialists. Ideally, these clinics should also be actively engaged in systematic academic work to answer key questions. What symptoms are attributable to COVID-19 and with what frequency? Are there symptoms that are more prevalent in individuals from different demographic groups? What is the natural history of recovery of organ damage and symptom resolution? How do medical and rehabilitative interventions enhance recovery? What impact do persistent Long-COVID symptoms have on emotional well-being, return to work and quality of life?
An ounce of prevention is worth a pound of cure. The best way to avoid Long-COVID symptoms is not to contract COVID-19 in the first place. Get vaccinated. Use common sense when out in public (especially in crowded indoor environments). If you need help, seek help.
To those in our community with friends and family in India and other parts of the world experiencing the frightening full impact of the pandemic, our prayers (and hopefully soon our vaccine) are with you.
James T. McDeavitt, M.D.
Senior VP & Dean of Clinical Operations
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Are you experiencing Long-COVID symptoms? To seek help at the Baylor College of Medicine Post COVID Care Clinic, go to our website or call (713) 798-2400.