Long-Covid: Should We Be Worried?

It’s 2021, and, for many of us, it is starting to feel like we are getting past the toughest part of the Covid-19 pandemic. People are getting vaccinated, and while mask mandates are still encouraged and enforced in many areas, they are starting to become less prevalent in vaccinated populations. This is what we’ve all been wishing for since the pandemic first began. Unfortunately, this is not the case for many patients and victims of Covid-19. Long Covid: what is it, what causes it and who does it affect?

Long Covid typically refers to symptoms that persist past 12 weeks after infection. These symptoms range from mild to severe and can have a detrimental effect on the patient’s health, as some patients are left unable to accomplish simple tasks such as showering or sleeping properly. Other markers of Long Covid can include tiredness, shortness of breath, heart palpitations, chest pain, changes to taste or smell, problems with memory and concentration, or joint pain. Additionally, several studies have reported up to 200 varying symptoms [1].

Even more concerning, doctors are not completely sure of what causes these symptoms. Several possibilities and theories are swirling around the medical community. For example, one prevalent hypothesis holds that it is caused by the patient’s immune system working overdrive to try to fight off the virus, leading the immune system to attack normal tissue that helps us perform daily functions. This is a terrifying thought; our immune systems are supposed to defend our body and tissues, not be the reason we are getting sick. Another theory posits that part of the virus stays in our bodies for months after, causing these lasting effects known as Long Covid for some. It is still too early to specify the exact cause, and several doctors believe that it could be a combination of several possibilities. Preliminary data is showing that this could be the case [2].

Regardless, Long Covid is something to be fearful and aware of, as it could affect any Covid-19 patient. The effects of Long Covid seem to be prevalent within all age groups, however, it is not yet statistically known how Long Covid affects children versus adults. For example, it has been observed that children display fatigue, depression, shortness of breath and other long-haul symptoms [3], but this is something that warrants further study. In addition to physical symptoms, the severe mental toll of Covid-19 cannot be ignored.Whether it be due to isolation or actually contracting the virus, and what that means for one’s health, it is important to pay attention and take care of your mental health throughout this pandemic process.

Long Covid is a scary reality for all of us, and it is key to remember that no one is alone in this battle. We are all struggling. We are all trying to make the best out of a horrible situation. Long Covid may still be a mystery, but we are all faced with its possible implications.

References

[1] Schraer, R. (2021, September 17). Long covid: What is it and what are the symptoms? BBC News. Retrieved October 22, 2021, from https://www.bbc.com/news/health-57833394.

[2] Marshall, M. (2021, June 9). The four most urgent questions about long covid. Nature News. Retrieved October 22, 2021, from https://www.nature.com/articles/d41586-021-01511-z.

[3] Covid 'long haulers': Long-term effects of COVID-19. Johns Hopkins Medicine. (n.d.). Retrieved October 22, 2021, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-long-haulers-long-term-effects-of-covid19.

Disability, COVID 19, and the Medical System

People with disabilities represent the largest minority in the United States, yet coverage on the pandemic rarely considers an analysis of how disabled people were affected by COVID - 19. Broadly, this lack of coverage is just one way by which ableism, discrimination against disabled individuals, manifests. Broadly, the COVID - 19 pandemic demonstrates the way by which ableism manifests itself as a system of power both in general society within healthcare systems. It's critical the field of medicine interrogates itself and shifts the paradigm by which it views care.

COVID - 19 served to illuminate the broader structures of ableism. To see evidence, one only needs to take a look at their computer screens. Accommodations that disabled people have been fighting for years to be the norm, such as hybrid/virtual meeting options and the ability to work from home to circumvent the barriers of transportation, access, and physical and mental stamina, were immediately put into place when nondisabled folks needed them to continue working during the pandemic. And, while this was celebrated as an example of our flexibility, resiliency, and determination as a broader society in “these troubled times,” for folks with disabilities in years prior, fighting for accommodations was seen as an act of narcissism and ungratefulness. As Lennard Davis, internationally known author in disability studies and Distinguished Professor of English at the University of Illinois at Chicago, wrote in his article Bending over Backwards: Disability, Narcissism, and the Law, that individuals who seek accommodations are given the perception they are “ attempt[ing] to claim themselves as an exception to the rules of society, which allows them to overstep the bounds assigned to normal people.” Rather than accommodations being seen as something that helps bring individuals with disabilities achieve equity with their nondisabled colleagues, it's been framed as a “benefit” that allows disabled people to unfairly get ahead. And now, as the world begins to open up and people return to personhood, many of these accommodations will disappear as well - despite them being successful - leaving people with disabilities back to their original position: fighting for equitable accommodations despite being seen as ungrateful.

And, it's worth highlighting, it's not just through the hypocrisy of accommodations that COVID exposed ableism - it's found everywhere. Disability activist Imani Barbarin, explores how anti-vaccination movements use ableism in their discourse, not wanting their children to get the vaccine, lest they end up with autism. The public shame of not getting a vaccine often ignores people with disabilities who medically can’t get the vaccine or lack the means of access to go to a clinic, and can unfairly force individuals to reveal their medical illnesses and disability. COVID - 19 overwhelmingly killed individuals in institutions, nursing homes, and hopices - areas where people with disabilities are found.

Along with the general population during this pandemic, the medical field too has struggled with its approach to disability. The case of Michael Hickson demonstrates many of these problems so effectively: rather than be given comparable quality of care to a nondisabled patient, Hickson died after he was refused treatment for COVID - 19 as he was a disabled parapalegic, lacking sufficient “quality of life” and therefore was “taking” resources belong to someone else. During this pandemic especially, with healthcare workers being told to divert resources to patients who have the best possible outcome for care - a metric that excludes disabled people, who are often considered to have a worse quality of life by the simple virtue of having a disability, even though that is just not true. But it would be wrong to argue this was a one time situation brought on by the Pandemic. In her essay, Healthcare as Eugenics, Ani B. Satz, professor of law at Emory University, draws comparisons between the logics of past historical movements of eugenics, which sought to eliminate disability through state run programs of sterilization of disabled folks and the creation of disabled movements, and the current field of medicine. Both the field of medicine today and past eugenics movements were centered on eliminating disability, seeking to “cure” the population and push for typical forms of functioning, such as surgery, rather than look for atypical modes of function, power chairs, that may lead to the best outcomes for patients. Satz writes “Healthcare seeks to prevent, ameliorate, or eliminate disability with the goal of normalizing individuals.'' This creates the perception of associating disability with loss and stigma, sending a message that “the lives of individuals with disabilities are not as valuable as the lives of individuals who function typically.”

COVID- 19 has certainly exposed the ways which ableism manifests within society and healthcare, but it's deeper roots within modern healthcare signal a need for the medical field to shift its paradigm from one of a medical, cure focused approach of removing disability to a more social, patient centered model of care. This model doesn’t say that curing patients is flawed or wrong, but rather we refocus our care around what's best for the patient outcomes that fits what the patient desires. This approach begins at the medical school level, where adopting disability conscious medical training, which Dr. Quirici, Dr. Doebrich, and Dr. Lunsford describe as “draw[ing] on insights from intersectional disability justice activism” to “improve upon competency programs by utilizing disability studies and the principles of disability justice to guide us in the critique of norms, traditions, and institutions to more fully promote the respect, beneficence, and justice that patients deserve.”

References

1. Barbarin, Imani. "Death by a Thousand Words: COVID-19 and the Pandemic of Ableist Media," Refinery 29, https://www.refinery29.com/en-us/2021/08/10645352/covid-19-and-the-pandemic-of-ableist-media. Accessed 20 Oct 2021.

2. Davis, Lennard. “Bending over Backwards: Disability, Narcissism, and the Law.” March 2000. Berkeley Journal of Employment & Labor Laws. vol 21, Issue 1, 2000, Accessed 10 October 2021.

3. Doebrich, Adrienne, Quirici, Marion, and Lunsford, Christopher. ‘COVID-19 and the Need for Disability Conscious Medical Education, Training, and Practice’. 1 Jan. 2020 : 393 – 404.

4. Pulgrant, Andrew. “How The Disability Community Is Still Conflicted About COVID-19,” Forbes, https://www.forbes.com/sites/andrewpulrang/2021/08/31/how-the-disability-community-is-still-conflicted-about-covid-19/?sh=73bbe7d3517d. Accessed 20 Oct 2021.

5. Satz, Ani B. “Healthcare as Eugenics.” Duke University Goodson Law Library. Accessed 20 October 2020.

Vaccine Passports: Do We Need Them?

No one wants a new normal, but the presence of COVID-19 requires a new normal. Vaccines appear to be the first step in returning the world to its former state. Globally, 6.6 billion doses have been administered, and 23.17 million are distributed each day. As of October 14, 2021, over 187 million Americans, or 56.6% of the total U.S. population, have been vaccinated against COVID-19 [1]. The United Arab Emirates leads the world in vaccine rates, with 94.83% of their population being vaccinated, and Tanzania lies at the bottom of the list with only 0.97%. Countries like the UAE and the United States give the appearance of progress towards normalcy, but the majority of the world does not have access to the same resources. Only 2.5% of people in low-income countries have received at least one dose [2]. Inequity in vaccine distribution makes the idea of vaccine passports, certifications of vaccination that reduce public health restrictions for their bearers, unfair.

Governments argue that the purpose of vaccine passports is to allow people to travel, attend large gatherings, access public venues, and return to work without compromising personal safety and public health [3]. Vaccine passports make sense for international travel because all foreign visitors being inoculated against COVID-19 would help to keep both the country in question and the tourists safe. However, practical and ethical challenges prevent domestic vaccine passports from being implemented.

Nations that do not offer vaccination to all of their citizens but then introduce a vaccine passport for domestic use would be unfairly discriminating against chunks of society. It would only entrench inequities that favor citizens of high- and upper-middle-income nations. Aside from those who lack access to vaccines, some people remain unvaccinated on medical, religious, and philosophical grounds. While many people in other countries would get the vaccine if it were available to them, here are some statistics from Forbes about the Americans who refuse the vaccine: 18% of 18-29-year-olds, 18% of men, 40% of Republicans, 44% of white evangelical protestants, 20% of Fox News viewers, and 22% of people with less than a college degree [4]. ​​While not ideal, vaccine passports could incentivize members of the public that are unvaccinated by choice to not only get the vaccine, but return for a second dose.

In some countries, travelers must be vaccinated against Yellow Fever and receive a card as a vaccine passport if they want to enter the country. No card, no travel. If connecting our vaccine card to a QR code can help protect the public and get us on the way back to some normalcy, isn’t it at least worth trying?

References

[1] Carlsen, A., Huang, P., Levitt, Z., & Wood, D. (2021, October 14). How is the COVID-19 vaccination campaign going in your state? NPR. Retrieved October 14, 2021, from https://www.npr.org/sections/health-shots/2021/01/28/960901166/how-is-the-covid-19-vaccination-campaign-going-in-your-state.

[2] Ritchie, H., Mathieu, E., Rodés-Guirao, L., Appel, C., Giattino, C., Ortiz-Ospina, E., Hasell, J., Macdonald, B., Beltekian, D., & Roser, M. (2020, March 5). Coronavirus (COVID-19) vaccinations - statistics and research. Our World in Data. Retrieved October 14, 2021, from https://ourworldindata.org/covid-vaccinations.

[3] Osama, T., Razai, M. S., & Majeed, A. (2021, April 1). Covid-19 vaccine passports: Access, equity, and Ethics. The BMJ. Retrieved October 14, 2021, from https://www.bmj.com/content/373/bmj.n861#ref-1.

[4] Hart, R. (2021, September 5). By the numbers: Who's refusing Covid vaccinations-and why. Forbes. Retrieved October 14, 2021, from https://www.forbes.com/sites/roberthart/2021/09/05/by-the-numbers-whos-refusing-covid-vaccinations-and-why/?sh=63d03bdc52ea.