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.
@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?
> 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.
@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.
@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.
@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.
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.
Even the screen shotted quotes more or less agree with me if you read them carefully. The last screen shot for example talks about how quite a few of the studies in their meta analysis, nearly half, were limited to hospitalized patients. So no suprise that some of the studies in their metanalysis showed 80% figures.. again this is not intended by the study authors to be making the claim you seem to be saying it makes.
For what its worth I decided that you are probably operating in good faith at this point. I think you mean well. I also think its less about incompetance so much as crippling bias/agenda that may impede your competence. Understandable as you probably have seen the very real harm from the disease.
@freemo @mcnado
As someone who was actually crippled by the disease, I do think that you underestimate how serious a situation things were in 2020, especially when you say there was overreaction and panic. There were people in the government literally arguing that we should allow the entire population to be infected so that we could move on as quickly as possible, while doctors were screaming at them that there was no evidence that people couldn't have repeated serious infections, and that we didn't know what the long-term consequences would be.
The people who wanted to let the entire population get infected called the doctors "alarmist".
We now have a dozen variants, 10 to 20% of people who got it have serious long-term consequences, and managed to develop a vaccine to prevents those consequences within months. If it had been taken more seriously until the vaccine was out, as the "alarmist" doctors wanted us to, we would not be where we are now.
As someone who was actually crippled by the disease, I do think that you underestimate how serious a situation things were in 2020, especially when you say there was overreaction and panic.
I am sorry you’ve been crippled by the disease. :(
I didnt say it was overhyped at the start of the disease. Depending where in the timeline of the disease we are talking there were points where I would agree, particularly in the early days, it was at times under-hyped. It wasnt until it became political that the misinformation and over-hyping kicked in, which didnt come until later in the disease lifecycle.
More quarantine was not the answer, never was. But better hospital care and supporting care certainly would have saved lives. There is always room for improvement.
There were people in the government literally arguing that we should allow the entire population to be infected so that we could move on as quickly as possible, while doctors were screaming at them that there was no evidence that people couldn’t have repeated serious infections, and that we didn’t know what the long-term consequences would be.
Actually I am one of the scientists that invented one of the algorithms that is fairly instrumental in this part of the discussion. I worked on a model for the DoD many years ago that models disease proliferation in populations. It can model the effect of vaccine, quarantine, and natural immunity.
To be clear, no doctors were not screaming for more quarantine, I was literaly one of those people part of the discussion (and fairly well known in the scientific community a a result). I can tell you as an authority as one of those Scientists, no we werent all screaming for more quarantine. In fact it was far more nuanced than that.
One prime example I can give to the nuance is your statement about variants. You seem to be under the false impression that quarantines would have resulted in fewer variants around today. The reality is quarantines can in fact increase the number of variants due to the conditions needed for new variants to become established in the population, which is assisted by small isolated groups of people more than large interconnected populations where there is no isolation.
It again comes down to the nuance of how new variants come into existence and become established, its not as simple as people think where it just happens spontaneously and then it exists. Variants usually require multiple mutations occurring in a series and need to become established so they must locally out compete the dominant strain and reach critical numbers before being released to the general population.
Keep in mind this is very different than other types of viruses, where recombination can occur in a single step.
@freemo @Raccoon Dude. You are not reading the same paper. You are so tied up on being right that you are confused. Again, READ the source I am citing which is NOT that Nature paper. Fuck…
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8352980/