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https://www.telegraph.co.uk/global-health/science-and-disease/long-covid-can-really-grim-rarer-think/

Ongoing symptoms to substantial end-organ dysfunction

https://jamanetwork.com/journals/jama/fullarticle/2771581?guestAccessKey=6c60fb00-1424-47b5-abc9-0b502a194f46&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=100520

Post-Acute COVID

Persistent severe symptoms, beyond 3 weeks

Chronic COVID-19

Beyond 12 weeks

Common complaints

https://www.bbc.co.uk/news/health-54296223

Crippling fatigue

Breathlessness

Persistent cough

Joint pain

Muscle aches

Chest pain

Hearing and eyesight problems

Headaches

Loss of smell and taste

Damage to the heart, lungs, kidneys and gut

Depression

Anxiety

Struggling to think clearly

Not directly related to severity of acute phase

Some cases may be related to pneumonia

Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19

https://pubmed.ncbi.nlm.nih.gov/32730238/

US CDC

Random sample of 292 adults who had tested positive

35% of 274 symptomatic respondents, not returned to usual health 14 – 16 days after testing

18 – 34 year olds

N = 85, 26%. (74% returned to normal)

35-49 years

N = 96, 32% (68% returned to normal)

50 and older

N = 89, 47% (53% returned to normal)

Post–intensive care syndrome

6 – 12 months, cognitive, mental health, physical function

Persistent Symptoms in Patients After Acute COVID-19 (JAMA, July 2020, Rome)

https://jamanetwork.com/journals/jama/fullarticle/2768351

143 patients discharged from the hospital

18 patients (12.6%) were completely free of any COVID-19–related symptoms after a mean of 60 days

Therefore 87.4 not returned to full normal

Manifestations

None of the patients had fever or any signs or symptoms of acute illness

Worsened quality of life, 44.1%

Pathogenesis

Direct tissue invasion by the virus

The virus cleares from most of the body, but lingers in some small pockets

If there’s long-term diarrhoea then you find the virus in the gut, if there’s loss of smell it is in the nerves – so that could be what’s causing the problem (Tim Spector)

Metabolic effects

New-Onset Diabetes in Covid-19

https://www.nejm.org/doi/full/10.1056/NEJMc2018688

COVID induced diabetes

Profound inflammation and cytokine storm

Immune system does not return to normal

https://www.immunology.org/sites/default/files/BSI_Briefing_Note_August_2020_FINAL.pdf

Ongoing immunological effects

Organ damage

Seen in MERS and SARS

https://www.medicaljournals.se/jrm/content/abstract/10.2340/16501977-2694

Lung function abnormalities

Psychological impairment

Reduced exercise capacity

Brain alterations

Cerebral Micro-Structural Changes in COVID-19 Patients. An MRI-based 3-month Follow-up Study

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30228-5/fulltext

Hypercoagulable state

Blood vessel damage

https://www.bbc.co.uk/news/health-54296223

Possible inflammation of coronary arteries

The Post-hospitalisation COVID-19 study (PHOSP-COVID)

https://www.phosp.org

MRC study under Professor Chris Brightling

Following up 10, 000 people post COVID

Develop trials of new strategies for clinical care

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Dynamic Change of COVID-19 Seroprevalence among Asymptomatic Population in Tokyo during the Second Wave (Tokyo and Boston)

https://www.medrxiv.org/content/10.1101/2020.09.21.20198796v1.full.pdf

Population 127 million

Cases, 89,650

Deaths, 1,631

Fatality rates, low compared to Western Countries

Decreased despite the absence of lockdown

? low infection prevalence

? low IFR

Seroprevalence among asymptomatic employees, Tokyo

May 26 to August 25

Healthy volunteer workers, n = 1,877

IgM and IgG antibodies, test repeated at a month

Symptomatics excluded

Seroconversion

Seroreversion

Results

615 healthy volunteers received at least one test

Seroprevalence increased from 5.8 % to 46.8 % over summer

Paralleling the rise in daily confirmed cases within Tokyo

Exclusion of individuals with clinical symptoms, probable underestimation

Peaked on August 4

Peaked with the peak of the second wave

Out of the 350 individuals who completed both offered tests

21.4 % who tested seronegative became seropositive

Seroreversion was found in 12.2 % of initially seropositive participants

81.1% of IgM positive cases at first testing became IgM negative in approximately one month

IgM+/IgG- was the least common, 0.4% (3/700 total tests)

Short time frame between developing IgM then developing IgG

None of the seroconverted individuals were hospitalized or died

Conclusions

COVID-19 infection may have spread widely across the general population of Tokyo

Despite the very low fatality rate

Temporal correlation between the rise in seropositivity and the decrease in reported COVID-19 cases

How to explain?

Local observations

Masks culture

Non-tactile culture

Quite culture

Ventilation culture

App use

Limited international travel

Supervised quarantine, 14 days

Diet

Why Is the Obesity Rate So Low in Japan and High in the U.S.? (Research Gate)

https://www.researchgate.net/publication/23519385_Why_Is_the_Obesity_Rate_So_Low_in_Japan_and_High_in_the_US_Some_Possible_Economic_Explanations

BMI over 30, international standard for obesity

Japan, 3.6%

US, 32.0%

BMI over 25, overweight

Japan, 24.7%

US, 66.5%

The average person in Japan consumes over 200 fewer calories per day than the average American

Drive less, walk more, use more public transport

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