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Long COVID: who is at risk?

Long-lasting symptoms appear unrelated to how bad your infection was, though women appear more affected than men.

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For most people, infection with SARS-CoV-2 – the virus that causes COVID-19 – leads to mild, short-term symptoms, acute respiratory illness, or possibly no symptoms at all. But some people have long-lasting symptoms after their infection – this has been dubbed “long COVID”.

Scientists are still researching long COVID. It’s not well understood, though our knowledge about it is growing. Here I take a look at what we’ve learned about it so far – who is at risk, how common it is and what its effects are.

In defining who is at risk from long COVID and the mechanisms involved, we may reveal suitable treatments to be tried – or whether steps taken early in the course of the illness might ameliorate it.

Broad vulnerability

Long COVID is characterised by a constellation of symptoms, including – variably – shortness of breath, marked fatigue, headache, and loss of ability to taste and smell normally. A relatively large study of 384 individuals ill enough to be admitted to hospital with COVID-19 showed that 53% remained breathless at a follow-up assessment one to two months later, with 34% having a cough and 69% reporting fatigue.

Indeed, early analysis of self-reported data submitted through the COVID Symptom Study app suggests that 13% of people who experience COVID-19 symptoms have them for more than 28 days, while 4% have symptoms after more than 56 days.

Perhaps unsurprisingly, people with more severe disease initially – characterised by more than five symptoms – seem to be at increased risk of long COVID. Older age and being female also appear to be risk factors for having prolonged symptoms, as is having a higher body mass index.

Those using the app tend to be at the fitter end of the population, with an interest in health matters. So it is surprising that such a high proportion have symptoms one to two months after the initial infection. Generally, these aren’t people who are highly vulnerable to COVID-19.

A woman in a park in exercise clothes bends down to rest
Even highly fit people are being stopped in their tracks by long COVID. Rido/Shutterstock

Another piece of early research (awaiting peer review) suggests that SARS-CoV-2 could also have a long-term impact on people’s organs. But the profile of those affected in this study is different to those reporting symptoms via the app.

This research, which looked at a sample of 200 patients who had recovered from COVID-19, found mild organ impairment in 32% of people’s hearts, 33% of people’s lungs and 12% of people’s kidneys. Multiple organ damage was found in 25% of patients.

Patients in this study had a mean age of 44 years, so were very much part of the young, working-age population. Only 18% had been hospitalised with COVID-19, meaning organ damage may occur even after a non-severe infection. Having a disease known to lead to more severe COVID-19, such as type 2 diabetes and ischaemic heart disease, wasn’t a prerequisite for organ damage either.

Finding out what’s going on

There are many reasons why people may have symptoms months after a viral illness during a pandemic. But getting to the bottom of what’s going on inside people will be easier for some parts of the body than others.

Where symptoms point to a specific organ, investigating is relatively straightforward. Clinicians can examine the electrical flow around the heart if someone is suffering palpitations. Or they can study lung function – tissue elasticity and gas exchange – where shortness of breath is the predominant symptom. To determine whether kidney function has deteriorated, components in a patient’s blood plasma are compared to those in their urine to measure how well the kidneys are filtering waste products.

Rather harder to explore is the symptom of fatigue. Another recent large-scale study has shown that this symptom is common after COVID-19 – occurring in more than half of cases – and appears unrelated to the severity of the early illness.

What’s more, tests showed that the people examined didn’t have elevated levels of inflammation, suggesting that their fatigue wasn’t caused by continued infection or their immune system working overtime. Risk factors for long-lasting symptoms in this study included being female – in keeping with the COVID Symptom App study – and, interestingly, having a previous diagnosis of anxiety and depression.

A woman sitting up in bed with head in hand.
Fatigue is the most common long COVID symptom. Stock-Asso/Shutterstock

While men are at increased risk of severe infection, that women seem to be more affected by long COVID may reflect their different or changing hormone status. The ACE2 receptor that SARS-CoV-2 uses to infect the body is present not only on the surface of respiratory cells, but also on the cells of many organs that produce hormones, including the thyroid, adrenal gland and ovaries.

Some symptoms of long COVID overlap with menopausal symptoms, and hormone replacement using medication may be one route to reducing the impact of symptoms. However, clinical trials will be essential to accurately determining whether this approach is both safe and effective. Applications to launch such research have been made.

With so much having happened over the last year, we will need to tease apart which impacts stem from the virus itself versus which might be the consequence of the massive social disruption wrought by this pandemic. What is clear, however, is that long-term symptoms after COVID-19 are common, and that research into the causes and treatments of long COVID will likely be needed long after the outbreak itself has subsided.

Frances Williams receives funding from Versus Arthritis and the Kennedy Trust to investigate long COVID.

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February Employment Situation

By Paul Gomme and Peter Rupert The establishment data from the BLS showed a 275,000 increase in payroll employment for February, outpacing the 230,000…

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By Paul Gomme and Peter Rupert

The establishment data from the BLS showed a 275,000 increase in payroll employment for February, outpacing the 230,000 average over the previous 12 months. The payroll data for January and December were revised down by a total of 167,000. The private sector added 223,000 new jobs, the largest gain since May of last year.

Temporary help services employment continues a steep decline after a sharp post-pandemic rise.

Average hours of work increased from 34.2 to 34.3. The increase, along with the 223,000 private employment increase led to a hefty increase in total hours of 5.6% at an annualized rate, also the largest increase since May of last year.

The establishment report, once again, beat “expectations;” the WSJ survey of economists was 198,000. Other than the downward revisions, mentioned above, another bit of negative news was a smallish increase in wage growth, from $34.52 to $34.57.

The household survey shows that the labor force increased 150,000, a drop in employment of 184,000 and an increase in the number of unemployed persons of 334,000. The labor force participation rate held steady at 62.5, the employment to population ratio decreased from 60.2 to 60.1 and the unemployment rate increased from 3.66 to 3.86. Remember that the unemployment rate is the number of unemployed relative to the labor force (the number employed plus the number unemployed). Consequently, the unemployment rate can go up if the number of unemployed rises holding fixed the labor force, or if the labor force shrinks holding the number unemployed unchanged. An increase in the unemployment rate is not necessarily a bad thing: it may reflect a strong labor market drawing “marginally attached” individuals from outside the labor force. Indeed, there was a 96,000 decline in those workers.

Earlier in the week, the BLS announced JOLTS (Job Openings and Labor Turnover Survey) data for January. There isn’t much to report here as the job openings changed little at 8.9 million, the number of hires and total separations were little changed at 5.7 million and 5.3 million, respectively.

As has been the case for the last couple of years, the number of job openings remains higher than the number of unemployed persons.

Also earlier in the week the BLS announced that productivity increased 3.2% in the 4th quarter with output rising 3.5% and hours of work rising 0.3%.

The bottom line is that the labor market continues its surprisingly (to some) strong performance, once again proving stronger than many had expected. This strength makes it difficult to justify any interest rate cuts soon, particularly given the recent inflation spike.

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Spread & Containment

Another beloved brewery files Chapter 11 bankruptcy

The beer industry has been devastated by covid, changing tastes, and maybe fallout from the Bud Light scandal.

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Before the covid pandemic, craft beer was having a moment. Most cities had multiple breweries and taprooms with some having so many that people put together the brewery version of a pub crawl.

It was a period where beer snobbery ruled the day and it was not uncommon to hear bar patrons discuss the makeup of the beer the beer they were drinking. This boom period always seemed destined for failure, or at least a retraction as many markets seemed to have more craft breweries than they could support.

Related: Fast-food chain closes more stores after Chapter 11 bankruptcy

The pandemic, however, hastened that downfall. Many of these local and regional craft breweries counted on in-person sales to drive their business. 

And while many had local and regional distribution, selling through a third party comes with much lower margins. Direct sales drove their business and the pandemic forced many breweries to shut down their taprooms during the period where social distancing rules were in effect.

During those months the breweries still had rent and employees to pay while little money was coming in. That led to a number of popular beermakers including San Francisco's nationally-known Anchor Brewing as well as many regional favorites including Chicago’s Metropolitan Brewing, New Jersey’s Flying Fish, Denver’s Joyride Brewing, Tampa’s Zydeco Brew Werks, and Cleveland’s Terrestrial Brewing filing bankruptcy.

Some of these brands hope to survive, but others, including Anchor Brewing, fell into Chapter 7 liquidation. Now, another domino has fallen as a popular regional brewery has filed for Chapter 11 bankruptcy protection.

Overall beer sales have fallen.

Image source: Shutterstock

Covid is not the only reason for brewery bankruptcies

While covid deserves some of the blame for brewery failures, it's not the only reason why so many have filed for bankruptcy protection. Overall beer sales have fallen driven by younger people embracing non-alcoholic cocktails, and the rise in popularity of non-beer alcoholic offerings,

Beer sales have fallen to their lowest levels since 1999 and some industry analysts

"Sales declined by more than 5% in the first nine months of the year, dragged down not only by the backlash and boycotts against Anheuser-Busch-owned Bud Light but the changing habits of younger drinkers," according to data from Beer Marketer’s Insights published by the New York Post.

Bud Light parent Anheuser Busch InBev (BUD) faced massive boycotts after it partnered with transgender social media influencer Dylan Mulvaney. It was a very small partnership but it led to a right-wing backlash spurred on by Kid Rock, who posted a video on social media where he chastised the company before shooting up cases of Bud Light with an automatic weapon.

Another brewery files Chapter 11 bankruptcy

Gizmo Brew Works, which does business under the name Roth Brewing Company LLC, filed for Chapter 11 bankruptcy protection on March 8. In its filing, the company checked the box that indicates that its debts are less than $7.5 million and it chooses to proceed under Subchapter V of Chapter 11. 

"Both small business and subchapter V cases are treated differently than a traditional chapter 11 case primarily due to accelerated deadlines and the speed with which the plan is confirmed," USCourts.gov explained. 

Roth Brewing/Gizmo Brew Works shared that it has 50-99 creditors and assets $100,000 and $500,000. The filing noted that the company does expect to have funds available for unsecured creditors. 

The popular brewery operates three taprooms and sells its beer to go at those locations.

"Join us at Gizmo Brew Works Craft Brewery and Taprooms located in Raleigh, Durham, and Chapel Hill, North Carolina. Find us for entertainment, live music, food trucks, beer specials, and most importantly, great-tasting craft beer by Gizmo Brew Works," the company shared on its website.

The company estimates that it has between $1 and $10 million in liabilities (a broad range as the bankruptcy form does not provide a space to be more specific).

Gizmo Brew Works/Roth Brewing did not share a reorganization or funding plan in its bankruptcy filing. An email request for comment sent through the company's contact page was not immediately returned.

 

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Government

Walmart joins Costco in sharing key pricing news

The massive retailers have both shared information that some retailers keep very close to the vest.

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As we head toward a presidential election, the presumed candidates for both parties will look for issues that rally undecided voters. 

The economy will be a key issue, with Democrats pointing to job creation and lowering prices while Republicans will cite the layoffs at Big Tech companies, high housing prices, and of course, sticky inflation.

The covid pandemic created a perfect storm for inflation and higher prices. It became harder to get many items because people getting sick slowed down, or even stopped, production at some factories.

Related: Popular mall retailer shuts down abruptly after bankruptcy filing

It was also a period where demand increased while shipping, trucking and delivery systems were all strained or thrown out of whack. The combination led to product shortages and higher prices.

You might have gone to the grocery store and not been able to buy your favorite paper towel brand or find toilet paper at all. That happened partly because of the supply chain and partly due to increased demand, but at the end of the day, it led to higher prices, which some consumers blamed on President Joe Biden's administration.

Biden, of course, was blamed for the price increases, but as inflation has dropped and grocery prices have fallen, few companies have been up front about it. That's probably not a political choice in most cases. Instead, some companies have chosen to lower prices more slowly than they raised them.

However, two major retailers, Walmart (WMT) and Costco, have been very honest about inflation. Walmart Chief Executive Doug McMillon's most recent comments validate what Biden's administration has been saying about the state of the economy. And they contrast with the economic picture being painted by Republicans who support their presumptive nominee, Donald Trump.

Walmart has seen inflation drop in many key areas.

Image source: Joe Raedle/Getty Images

Walmart sees lower prices

McMillon does not talk about lower prices to make a political statement. He's communicating with customers and potential customers through the analysts who cover the company's quarterly-earnings calls.

During Walmart's fiscal-fourth-quarter-earnings call, McMillon was clear that prices are going down.

"I'm excited about the omnichannel net promoter score trends the team is driving. Across countries, we continue to see a customer that's resilient but looking for value. As always, we're working hard to deliver that for them, including through our rollbacks on food pricing in Walmart U.S. Those were up significantly in Q4 versus last year, following a big increase in Q3," he said.

He was specific about where the chain has seen prices go down.

"Our general merchandise prices are lower than a year ago and even two years ago in some categories, which means our customers are finding value in areas like apparel and hard lines," he said. "In food, prices are lower than a year ago in places like eggs, apples, and deli snacks, but higher in other places like asparagus and blackberries."

McMillon said that in other areas prices were still up but have been falling.

"Dry grocery and consumables categories like paper goods and cleaning supplies are up mid-single digits versus last year and high teens versus two years ago. Private-brand penetration is up in many of the countries where we operate, including the United States," he said.

Costco sees almost no inflation impact

McMillon avoided the word inflation in his comments. Costco  (COST)  Chief Financial Officer Richard Galanti, who steps down on March 15, has been very transparent on the topic.

The CFO commented on inflation during his company's fiscal-first-quarter-earnings call.

"Most recently, in the last fourth-quarter discussion, we had estimated that year-over-year inflation was in the 1% to 2% range. Our estimate for the quarter just ended, that inflation was in the 0% to 1% range," he said.

Galanti made clear that inflation (and even deflation) varied by category.

"A bigger deflation in some big and bulky items like furniture sets due to lower freight costs year over year, as well as on things like domestics, bulky lower-priced items, again, where the freight cost is significant. Some deflationary items were as much as 20% to 30% and, again, mostly freight-related," he added.

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