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Harry Rakowski: Long-haul COVID-19 is another pressing reason to get vaccinated

Commentary

Our initial fear of COVID-19 infection was of becoming seriously ill, ending up in hospital and possibly even dying. Through each of the three waves of infection, the pressure of infected patients filling hospitals and scarce ICU beds led to a marked reduction in non-emergency care even for serious need.

As infection rates drop dramatically more than 70 percent of Canadians over age 12 receiving at least one jab and nearly 20 percent being fully vaccinated to date what do we still have to worry about?

The Delta variant, recognized in India, appears to be more resistant to a single vaccination dose. That means it is essential that high risk people — those over 60 or with obesity, diabetes and immune-compromised conditions — receive priority for second shots. They also need to be encouraged to do so through ease of bookings and increased efforts to overcome any residual vaccine hesitancy.

Getting a second shot for as many people as possible remains essential to keeping case rates and hospitalizations low. In order to achieve relative herd immunity we hope that over 80 percent of people eligible for vaccination will be fully covered by the end of summer. Canada has a very large vaccine supply coming in the next two months making timely second shots readily available.

The burden of getting COVID-19 goes beyond the initial effects of infection. We now know that there can be very significant long term effects that can persist for months or longer. The syndrome is know as “long COVID“ or “long-haul COVID.”

COVID-19 infection can involve multiple organ systems including the lungs, heart, brain and kidneys. This is a result both of direct infection and a potential over-reaction of the body’s natural immune response. While most people who are infected resolve symptoms within 2 weeks, there is a growing body of scientific literature that characterizes the nature and duration of persisting symptoms.

The diagram below from emergency-live.com highlights the organ systems that COVID-19 infection targets with potential long-lasting impact. Possible mechanisms include prolonged inflammatory response, nerve damage, retained viral load and blood clotting problems. There is also a major psychological effect to being severely ill with potential long term mental health consequences.

The lungs are a prime target of infection. While COVID pneumonia generally clears early, a small number of patients may have lingering scarring that may be permanent and can reduce lung function with persisting shortness of breath. Others may have blood clots leading to strokes, kidney damage or small blood vessel blockage and lingering disability as a result.

A large United States Department of Veterans Affairs study showed a 60 percent increase in all cause mortality within six months of infection especially if hospitalization was necessary.

In a Swedish study of infected health care professionals, 80 percent of hospitalized patients experienced moderate to severe symptoms for many months after initial infection and 10 percent of all those infected, but not hospitalized, experienced one or more moderate to severe symptoms affecting quality of life for more than six months.

A common specific symptom of infection is loss of smell and taste. While not life-threatening, it is very challenging to many and may greatly affect quality of life. The virus does not appear to directly damage the nerve cells that allow us to smell and taste but rather their supporting cells. While these sensory losses may persist for two months after infection in about 25 percent of affected people and in 15 percent beyond eight months, function will ultimately recover in most people.

The virus also affects brain function, perhaps by causing an inflammatory reaction. This can result in persisting brain fog with difficulty concentrating and memory impairment, as well as anxiety and depression.

Chronic fatigue is a known major complication of some viral infections especially mononucleosis and is a significant long-COVID symptom as well. Many patients describe a persisting inability to work or function at a high level.

Vaccine hesitancy has been increased by the belief that healthy people who get infected will only feel like they got the flu. However, it is important to remember that even those with mild symptoms may develop long-haul COVID symptoms, which can be debilitating.

It is estimated that about 20 million people worldwide will develop long-haul COVID symptoms. We don’t yet know who is most at risk other than by the severity of infection. Unfortunately there is no effective treatment to date.

Physicians and patients need to respect that unusual and persisting symptoms after infection are real even when conventional testing fails to reveal blood or imaging abnormalities.

If you are young and healthy and, as a result, vaccine hesitant, preventing long-haul COVID is another good reason to get fully vaccinated as soon as possible.

South African producers look to recover from alcohol ban with great wine at a good price

Commentary

Chenin Blanc is not an especially popular white wine grape, like Pinot Grigio or Chardonnay. Nor does it carry a cultish aura of cool like Riesling.

But those who discover it, when it is made into good wine, become fans and tend to stick with it. Like, for instance Kate Norris and Thomas Monroe, Oregon winemakers at the Division Winemaking Company in Portland.

In 2013 they started Drink Chenin Day (or #DrinkCheninDay), a social media event wherein winos in-the-know post pictures and descriptions of the Chenin Blanc they’re drinking. This year it’s on June 18, so now you know why your social media feed is full of pictures of glasses and bottles of white wine.

The spiritual home of Chenin Blanc is the Loire Valley in France, where it was brought from Burgundy in the Middle Ages. It’s made in sweet or dry styles, as well as sparkling wines.

From the Loire, look for Chenin based wines from Saumur, or the small and exclusive appellation of Savennière, which has only 30 producers. There are pockets of Chenin Blanc grown all over the world, including in Niagara and the Okanagan, but the biggest producer, in both quantity and array, is South Africa. More than two-thirds of the world’s Chenin Blanc grapes are grown there, and they make up 20 percent of the country’s overall production, the greatest share in the world.

Chenin was brought to South Africa by Huguenots, French protestants who, in this case, sought refuge from persecution in what was the Dutch Cape Colony. The French found an ideal growing climate in the Western Cape.

High yields from Chenin vines helped make it the preferred grape for the new popular Dutch drink brandewijn, or brandy. So from the late 17th century through to the end of Apartheid, Chenin became the most planted grape and was called Steen locally in Afrikaans.

Grapes grown to be distilled into spirit alcohol are not generally grown for their finesse. As interest in table wines grew in South Africa, for both domestic and export markets, growers began to pull up their Chenin in favour of more popular wine grapes like Chardonnay and Cabernet Sauvignon.

Still, many held out, either because the high yields made Chenin attractive to those who were paid by the ton by big wineries or because some winemakers saw untapped value in Chenin vines especially, if they were old.

Chenin Blanc is made at all price levels in South Africa from $10 to $100 a bottle.

One man to see potential in South African Chenin Blanc was Ken Forrester. Forrester was a successful restaurateur in Johannesburg before he decided to buy a farm in the wine country of Stellenbosch, not far from Cape Town. It was, of course, planted with Chenin Blanc.

When the newly arrived Forrester told his farmer neighbour he was going to keep the Chenin to make fine wine, the neighbour told him he hoped he had bought a return ticket, as he doubted he’d last more than one vintage. Needless to say he’s still there, and as South Africa began to get ready to open up after the release from jail of Nelson Mandela in the early 1990s Forrester and the winemakers of South Africa got serious about making Chenin Blanc.

Chenin does particularly well in South Africa, even in the warmest wine growing areas, because it has a pronounced acidity, that tends to keep the wines made with it fresh and alive. The dominant fruit notes on South African Chenin Blanc tend to be peach and citrus. It’s the combination of crisp acidity and fully ripened fruit that makes fans of the wines.

Another secret of South Africa’s success with Chenin Blanc lies with older vines. The producers who kept their 30- or 40-year-old vines in the 1980s and 90s, are now making wines with vines that are much older. As vines age, they become less productive but produce smaller grapes with more concentrated flavours.

Chenin Blanc is made at all price levels in South Africa from $10 to $100 a bottle. Where it performs very well is in the sweet spot level of between $15 and $20. In this price range, South African wines often offer great value from a consumer point of view because of a combination of factors including fierce international competition in the export market, low production costs due to cheap labour and growing conditions that don’t require a lot of intervention, and currency exchange.

The COVID-19 pandemic was particularly hard on the wine producers of South Africa. A government ban on alcohol in 2020 extended not just to sales within the country but was extended to include a ban on exports. Still, the producers I have talked to on Zoom this year are optimistic that they can regain their footing by offering the world great wine at a good price. Here is a small and very far from complete list of reputable South African producers of Chenin Blanc widely available in Canada:

A.A. Badenhorst Family Wines

Boekenhoutskloof (Porcupine Ridge)

Bruce Jack

Ken Forrester

Raats Family Wines

Radford Dale

Rascallion Wines