I saw a post today discussing palpitations after COVID. Folks, what I tell my patients is: if you get palpitations in the weeks to months after COVID, call your doc and get seen. Here’s why — palpitations after COVID are common, and one prevalent cause is atrial fibrillation. This is often detected by a wearable event recorder such as a Holter monitor, because a 1-time ECG (as if often done in the ER) is worthless if you aren’t in a-fib at the time. A-fib dramatically increases stroke risk.
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Common? Patients who have had COVID have only a 20% increased risk of AFib post infection. Thats hardly "common" that would make it fairly rare.
> but to what end?
Largely my concern is fear mongering (perhaps unintentional). There has been a great deal of over-hyping COVID and has caused people to be dispreportionaltly scared of the disease and its consequences. While it is of course a serious disease people have heard so much disinformation to make it sound scarier than it is that people are often irrationally afraid of it relative to the risks.
Saying its common makes people think most people who catch it will start having heart problems when in fact a very very small portion of people who catch it will. So that needs pointing out.
@freemo up to 30% of people who get COVID get some form of post-COVID syndrome. Estimates vary widely on the number who experience cardiovascular complications, but there are entire clinics dedicated the problem, so it isn’t exactly a rare presentation to healthcare. I agree that there is overhyping of some of the risk, but overall, I would argue that in fact the risks associated with infection have been downplayed quite a bit.
See this is what I'm talking about. An actual review of the literature would show the prevelance of post-covid syndroms is not yet known, the studies we do have range from <10% to 30%/35% at the absolute highest end. Yet you are 1) quoting it as if its well established, it is not 2) picking from the highest end of the spectrum (fear mongering).
Couple this with the fact that there is a great deal of fear, and an impossiblity to test for this in a double-blind fashion you get a recipe for disaster one would expect highly inflated numbers due to the placebo effect alone.
As a COVID Research scientist myself, and you as a doctor, we need to hold ourselves to higher standards when we state things as fact. You cant just cherry pick a study that gives the number you want, we have to be mindful of the consensus and the body of literature and leave our personal biases out of it.
Sorry my tone may be a bit on the harsher side than you deserve. But you get my point.
@freemo while the prevalence is not well established, the estimates of long COVID range from 10-80%, with most studies I’ve seen landing somewhere around 30%. Arrhythmias are a commonly cited concern, and prevalence there again is variable, but 10-20% is a pretty reasonable slice of the published literature. The intro to this Nature review pretty well sums up the concerns…
Sorry but thats just not true. I will try to find it for you but the last attempt i saw at finding a mean for the prevalence among existing studies produced a value from 11% to 16%. Couple that with the fact, again we cant remove the placebo effect from the reality the actual numbers are almost certainly skewd quite a bit below this.
@freemo the CDC study I posted specifically cites a range from 10-80% for PCS, and the Nature review also shows a range up to 70% (the higher estimates are for people who were hospitalized, which is obviously not the same as ambulatory cases). Literally right there in the papers I cited, one of which is a recent and broad review in Nature…
Thats not how science is done. The existence of low-confidence studies that produce outliers is not the same as saying a literature review has consensus within that range.
No reasonable person would look at the literature on this and assert that ANY of the numbers have enough confidence to start telling the general public figures. The only responsible response is "We dont know what the figures are but the highest confidence studies are in the 15% and less range, and almost all studies show very little consensus"
I just double checked your study... its worse than I thought, you are even misrepresenting the study in what your saying here now.
You are citing upwards of an 80% figure, that is NOT what the study says. It says that in patients who were hospitalized with covid (so people who had extremely unusually bad casis) have upwards of the 80% figure. That is NOT saying 80% of all people with covid.
So turns out this was a much worse and damning misrepresentation on your part than I first thought. Given your credentials I'd go so far as to say its a lie and deceptive the way you stated it based onn the very source you used.
@mcnado That said I do think you are unintentionally sharing disinformation, which is why I am engaging you to encourage you to be a bit more conscious of it.
@freemo I think you have an opinion that COVID isn’t a big deal, when in fact, for some folks, it’s a problem. We have a poor understanding of the long term sequelae of it, but as I initially and repeatedly have noted, post COVID symptoms are not rare, and even at a conservative estimate of 10%, are a concern. Palpitations are a common ER complain, and we see folks after COVID with this not infrequently, some of whom are told not to worry, when in fact they haven’t had adequate workup.
@freemo so, as I posted initially, palpitations can be a problem, they may be a-fib, and people should in fact be aware of that, and seek appropriate testing. In any event, I wish you luck on your quest to discredit any discussion of risks of COVID as misinformation.
Why would someone who is 1) a COVID Researcher 2) a published COVID Scientist 3) An inventor of the fastest way int he world to detect COVID 4) someone who explicitly stated covid is serious.... why would someone fitting that description give yout he impression that I think COVID isnt serious.
I will be clear and state again. COVID is a serious disease.
YEs I do agree that post-covid symptoms are a legitimate concern. But there is no solid consensus on how common it is, in fact the complete lack of consensus, combined with lack of being even able to do a double-blind controlled study, and with the very high fear factor, we have absolutely no idea how common it is. So any assertion of any number, even 10% is highly irresponsible IMO. We cant even be certain long-covid exists yet, let alone how common it is. There needs to be a lot more research before any doctor should be asserting numbers around how common long covid is. The only thing we should be saying is "there isnt scientific consensus yet and it remains an area of concern"
@mcnado @freemo It did spread for a few years and took out the most susceptible.
Long term data would be nice even if it's blatantly falsified like the death data.
We can't have a control group because nearly everyone was exposed. We don't have a healthy non jabbed group because the government and the public persecuted these people.
Being in the latter group, it's difficult to show empathy as anything other than mockery. Problems quoting inaccurate data? Corruption dragged its fat sack of influence and manipulation over your profession. Medicine will have to regroup and reform to get back to some level of integrity. That's going to be a long fight.
The death data wasnt falsified. It was misunderstood though by many.
> We can't have a control group because nearly everyone was exposed. We don't have a healthy non jabbed group because the government and the public persecuted these people.
ITs more complex than that. a person knows when they are sick, so you cant make a virus like this double blind even if you wanted to. When you add in the inability to control for the placebo effect, plus the huge amount of fear that went along with it, its a recipe for wildly inaccurate data even with the best of intentions.
@freemo @mcnado The Death Data was falsified by some facilities due to the financial assistance offered to assist with the additional money spent on combating covid. It was fraud and elderly care facilities were able to get away with it. A family friend died from Alzheimer's and he was reported as having died from COVID around 2 months later. He was cremated. My family reported it but it fell on deaf ears.
About the data for Medicine, I've made Mathematical models for outbreaks. I'm not an expert at it but we would have to limit variables and environmental factors. Even then it would take about as many revisions as a TeX document to get some level of accuracy. Then again with so many limits on data, I couldn't consider it accurate.
With actual data it could prove useful. The long term effects of COVID are not known, the long term effects of the jabs are unknown and the combined effects of both are certainly unknown. Is it actually important? Nope. The data will be collected and processed anyway thanks to our benevolent government.
@AmpBenzScientist While I dont doubt there were a few examples of someone engaging in inflated numbers to get aide as was pointed out overall when you consider all the effects that create inaccurate numbers overall the numbers were under reported not over
@AmpBenzScientist @freemo while some cases of inaccurate reporting may have occurred, there was not any significant effect of that on the numbers overall. COVID aid was not related to cases or deaths. Hospitals did not make any more money treating COVID than anything else, and indeed many hospitals went broke during the pandemic due to need for extra staffing, expensive PPE, and inability to run lucrative elective surgical cases.
You do realize that doesnt advance your argument that the numbers were over-reported?
As was pointed out the numbers have consistently be shown to be more or less accurate. In fact if anything they were likely underreported.
@freemo @mcnado That was in reference to the government aid to hospitals and nursing homes. During that time, there were some acquisitions by larger healthcare providers.
The death toll from COVID-19 is likely somewhere around 1 million in the US over the 4 years of circulating. It's not all due to the virus, the government dropped the ball so many times. If you want to include suicides, overdoses and homicides from people who lost work, faced years of discrimination from the jabbed hive mind and poor economic conditions. I would say that perhaps I agree with that but it doesn't give the proper attribution.
If there are problems with a dataset, the results will be inaccurate no matter how accurate models are because we would likely not know. If crafted false assumptions are assumed, anything can be proven. The level of integrity I'm looking for, which likely doesn't exist, is made worse by skewed data. I'm assuming that any and all sides are using damned lies and statistics to push an ideology.
Do I believe you are wrong? Not necessarily, but I believe more tampering occurred with the data. It's all about the data. According to what I suspect your criteria is, you are correct. According to my criteria, I'm humbled and still believe the data to be wrong.
@AmpBenzScientist @freemo in the US at least, the mortality data were not falsified despite reports to the contrary. Indeed, two papers by the same authors looking at mortality suggested a ~20-30% undercount during the early pandemic (higher early on, lower later on). This was most likely due to poor test availability, out of hospital deaths, and shoddy reporting early on.
You are absolutely correct here, Agreed. Thank you for setting him straight.
@mcnado @freemo After reviewing the CDC reporting, the complications possibly caused by infection would result in the stated cause of death to be from COVID-19. It further points out that the long term effects resulting in death would be considered a COVID-19 death.
The situations leading to death weren't properly addressed. Regardless of proper classification, the likely damage from the virus was rightfully included. I suppose I was expecting ARS to be the cause of the deaths and, to a lesser degree, cardiovascular issues.
It seems more inclusive for contributing factors of a COVID death but not necessarily represented correctly. The car example was dismissed incorrectly. According to the guidelines, if COVID-19 contributed to the circumstances then it would indeed be reported as a COVID-19 death even if the subject could have lived if they weren't driving. It's these small things that make me question the data.
Cause, Contributing factor and the Others should be separated. It sounds like the virus directly killed so many people. It just seems misleading to call them all COVID deaths when it would be better to describe them as Covid and common complications deaths.
@AmpBenzScientist @freemo perhaps, but it is in line with how we classify deaths by other causes. For instance, when I fill out paperwork for a death certificate, it includes questions about tobacco smoking history.
It should be noted as well that despite the concerns you raise here, the all-cause excess mortality data for the US has consistently been well above the COVID excess deaths, suggesting we are missing a huge number of COVID deaths in our counting (an undercount).
I agree wi5h your statements about death being accurate compared tonusual practices.
The assumption about excess death rate is a bit of a leap, we may find many other secondary effects that arent covid are at play to explain the difference.
@mcnado @freemo@qoto.org
Neither 5-30% nor 11-16% is low risk, in practice, for something people seem to catch 1-2× per year
Is my kid going to end up with a temporary or permanent disability during the course of K-12?
None of the numbers are good
@freemo I never (and have never) said that the 80% number is representative. What I said, and is the case, is that estimates run that high in some studies. The higher bounds tens to be in much higher risk populations, in studies from early waves, and in studies with high risk of selection bias. Similarly, low bound estimates in the single digits are likely underestimates.
And that is a lie... This is **NOT** the high end estimate.. There is **no** study that estimates 80% of people with COVID will have longCOVID symptoms, not one. You read the study you quoted wrong, or you intentionally misrepresented it. I dont know which.
The 80% number cited int eh study you linked was not the upper estimate from studies and the fact you have asserted it as such now twice is very concerning to say the least.
@mcnado @freemo
Just wanted to point out a potential skew you both might be missing here: Long COVID isn't very thuroughly defined, because it's not yet even understood as anything beyond "symptoms after infection has cleared due to damage."
This could include the type of permanently crippling nervous system damage that I have, but it could, in some studies, include ANY symptom which lingers for more than a couple weeks after infection.
Could it be possible that 80% of patients who test positive and end up in the study haven't fully recovered by a month later? Could it be that the study only includes more severe cases?
Agreed, and no i didnt miss it, that is kinda part of my point. i am arguing there is nothing remotely approaching consensus or high quality studies on this topic as of yet. As you point out it isnt even well defined in a useful way. So any assertion about long covid being real or its prevelance is negligent. The only honest answer any doctor or scientist can give right now is "we just dont know"
@freemo @Raccoon is it? Here’s the study (linked below). It’s a meta-analysis from earlier in the pandemic, which looked at studies that included hospitalized and ambulatory patients. The study concludes jn multiple places that 80% of people with COVID will experience one or more long-term symptoms. Do I think that’s representative? No. Is it what the study says, yes.
Didnt miss it, not concluding anything different than the authors. You however did misrepresent the paper and the authors, they did not say what you keep asserting they said. They are not saying 80% of people who get COVID will likely have long-COVID. You are trying to claim they are saying something they very much are not saying.
Explain to me what it is you are getting from this that is different than what the authors repeatedly conclude.
Absolutely nothing. What I conclude is exactly the same as what the authors conclude and is exactly the same as what you have posted here.
It is you who are disagreeing with the authors and dont know it. I have explained to you three times now exactly what your misunderstanding and you just ignore it and keep repeating yourself. Again this is not appropriate for a medical doctor.
I will explain to you again, in this study “the patients with COVID” are specifically explained to NOT be a random sampling of the population of people with COVID. It is not meant to be representative of the COVID population. It is specifically only people who have unusually bad cases and wind up hospitalized. Therefore it is only representative of hospitalized COVID infected people, it is NOT representative of COVID infected people in general.
is it? Here’s the study (linked below). It’s a meta-analysis from earlier in the pandemic, which looked at studies that included hospitalized and ambulatory patients.
Yes that is what the study is on. In other words.
The study concludes jn multiple places that 80% of people with COVID will experience one or more long-term symptoms.
No that is NOT what the study concluded. The Study concluded that Of people who have severe COVID, to the point of hospitalization, those people have an 80% chance of showing long term symptoms.
What it is NOT saying is that 80% of people who get COVID will have long term symptoms. These are two entierly different assertions.
You are trying to generealize a statement specifically made about hospitalized patients to apply to everyone who has ever had the disease. That is disinformation or negligence, im not sure which. You should have been taught better in school than to make that leap.
Do I think that’s representative? No. Is it what the study says, yes.
Then you are wrong and it is negligence, that is very much not what the study says.
And did you read the part where they said that among studies that included all covid patients the range was up 10% to 35%.. they explicitly state the 80% was only limited to the hospitalized group.
So again, saying people with covid show up to 80% prevelance is disinformation.
I quoted this earlier do I need to go find it again?
@freemo @Raccoon here’s the text of the study cited by the CDC abstract. Go find that part for me in it, I’ll wait.
The CDC abstract quoted earlier, and the recent Nature review, both concluded what you reference. That, however, is not the same as telling me that the cited paper (linked below) did not show an 80% rate in the study population, which included all severities and non-hospitalized patients.
@Raccoon @mcnado @freemo@qoto.org It’s frankly impossible to have a narrow definition for Long Covid. Why? Because it uses ACE2 to enter cells, and almost all cells in the body express ACE2.
Hence, it can nerf nearly any system, and hence a very wide range of symptoms, and hence differntial diagnosis will not be useful except in the most common patterns.
@freemo I said palpitations are common (10-20% of folks with post-COVID syndromes have them). A-fib is one of the many causes of this, and I would argue is not all that rare compared to many things we consider quite serious in Emergency Medicine, particularly since a-fib has a significant stroke risk associated with it. We can quibble over what exact cutoff makes something a concern I suppose, but to what end?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9959721/