Reply To: Corona virus: Government takes the St Augustine approach.

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Thank you for the references. I was referring to acute morbidity, i.e. proportion of people who test positive who have illnesses including hospitalization and ventilation. The figures for hospital admissions are published daily by the Guardian but not many people focus on them. There is also acute morbidity that does not necessarily requiring hospital admissions but some nevertheless debilitating. Incidentally the later category as far as I know have been rather neglected in the drama, but their study would have been very important in determining factors related to disease progression and identifying possible strategies for introducing interventions that may prevent or ameliorate progression.

The subject of ‘long covid’ is a separate one which I need to look at more publications to understand more. From first principles of pathology we have an acute illness caused by say a virus and some viruses persist and continue to cause damage in a chronic infection. Examples are Hepatitis B and C which in some people will cause cirrhosis of the liver or even hepatocellular carcinoma. But SARS cov2 as far as I know does not persist beyond the acute phase and is cleared from the system. So what is called long covid is really the result of the sequelae of the acute infection plus interventions that may have been used to treat patients in the ITU setting. In a way the name, a popular one, is a misnomer and I hope this name is not eventually adopted by the ICD organization.
Some of these sequelae such as lung fibrosis and other chronic lung changes are results of the intense inflammatory response to the virus associated with ARDS. Others may be secondary to the hypercoagulability state that results in various organ damage, the heart and brain. Yet others may result in multiorgan damage due to the cytokine activation syndrome, such as renal failure, myocarditis and other conditions.

Unlike chronic fatigue syndrome, where not much pathology has been demonstrated and where there may or may not be a direct association with an infectious agent, this condition is directly related to the aftermath of the acute infection with SARS-cov2 and it is ‘not in the mind’.