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Harry Rakowski: Is long COVID still a concern?

Commentary

There has been ongoing concern not just about becoming infected with COVID-19, but also about developing ongoing symptoms known as long COVID. While there is no precise definition of this term, it generally refers to symptoms persisting more than two months after recovering from infection.Long COVID or Post-COVID Conditions https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html#:~:text=Some%20people%20who%20have%20been,(PCC)%20or%20long%20COVID. 

Indeed, early in the pandemic, studies in hospitalized patients reported ongoing symptoms more than a month after discharge in 25-80 percent of patients. Has the risk and burden of long COVID changed with the decreasing severity of disease caused by the Omicron variant? 

Early on, the Wuhan and even Delta strains were associated with more severe disease and the development of COVID pneumonia and lung scarring. As well, a very frequent complaint was the loss of smell and taste which often persisted for many months after the infection cleared. MRI studies showed persisting inflammatory changes in the regions of the brain that sense smell and taste as the likely cause. 

The Omicron strain, which has dominated infections since the start of this year, has been shown to be more contagious but less dangerous than previous strains. It affects the upper airways much more than the lungs and causes much less frequent disturbance of smell and taste but likely more gastrointestinal symptoms. This difference in Omicron targeting different organ systems has also led to differences in the frequency and nature of perceived ongoing symptoms.

A recent study by Antonelli and others published in the Lancet compared the risk of long COVID symptoms after one month of infection in a large U.K. population.Risk of long COVID associated with delta versus omicron variants of SARS-CoV-2 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00941-2/fulltext They compared 56,000 people infected with Omicron between December 2021 and March 2022 to 41,000 people infected with the more dangerous Delta strain between June and November 2021. People self-reported their symptoms using a COVID symptom study app. Long COVID occurred in 4.5 percent of Omicron and in more than double, namely 10.8 percent, of Delta infected persons. Symptoms for both strains included fatigue, headaches, brain fog, anxiety, depression, palpitations, and gastrointestinal symptoms. People under 60 had a lower incidence of symptoms for both strains. 

As previously demonstrated, other risk factors besides age were needed for hospitalization, and especially ICU, admission. The nature of long COVID also seems to have changed based on the organ systems affected by the virus. Also, since pneumonia is much less prevalent, persisting symptoms due to residual lung scarring are much less frequent. Some of the persisting anxiety and depression seen after infection was likely related to PTSD associated with the trauma of hospitalization, especially ICU care, and fear of impending death. 

Previous vaccination greatly reduces the risk of hospitalizationCOVID-19: Effectiveness and benefits of vaccination https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19/vaccines/effectiveness-benefits-vaccination.html and thus, again, it is not surprising that persons vaccinated have a lower risk of prolonged symptoms. 

The presence of ongoing fatigue can be frustrating and is also seen with other viral illnesses, such as mononucleosis. The mechanism is not well understood but may be related to an inflammatory effect on the brain. While this resolves in most people, a small number develop chronic fatigue syndrome—that is, symptoms persisting beyond six months. The greatest predictor of lasting symptoms is the severity of the infection.COVID-19: Long-term effects https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351 

Some viruses such as herpes, chickenpox, and West Nile are more frequently associated with encephalitis, a serious brain inflammation. The post-COVID-19 brain fog is likely a mild version of brain inflammation.“Brain fog after COVID-19 is biologically similar to cognitive impairment caused by cancer chemotherapy, something doctors often refer to as ‘chemo brain.’ In both cases, excessive inflammation damages the same brain cells and processes, according to research led by Stanford University School of Medicine.” https://med.stanford.edu/news/all-news/2022/06/brain-fog-covid-chemo-brain.html#:~:text=Brain%20fog%20after%20COVID%2D19%20is%20biologically%20similar%20to%20cognitive,Stanford%20University%20School%20of%20Medicine. Analysis of spinal fluid may show the presence of inflammatory markers, although most MRI studies show only minor brain changes. 

Many people now have much less fear of becoming infected, especially if they only suffer a relatively low-grade cold, as I did. There is greater fear of developing persisting long COVID symptoms. Fortunately, even most of these symptoms are relatively mild and resolve within a few months. 

There is no treatment for long COVID. The symptoms related to persisting inflammation or trauma to organ systems need time to resolve. The best solution is to not become infected, however in the current environment most people have or will become infected at one time, and some even more than once. Vaccination remains somewhat protective against infection, and future vaccines targeted to prevent infection by newer strains should further reduce risk in the future. 

The risk of long COVID has greatly decreased as the Omicron strain is less dangerous and, most importantly, few people now require hospitalization. While even people with mild disease can develop persisting symptoms, particularly mild fatigue, we need to take comfort in the reduced risk and severity of long COVID. 

J.L. Granatstein: Hammy Gray, Canadian hero

Commentary

“He had blond hair—straight and fine—with a fresh boyish complexion. Medium height, and inclined to be plump, with a somewhat rolling gait,” said Hammy Gray’s squadron commander on HMS Formidable. “He was tremendously warm-hearted, always cheerful and even-tempered—rather easy going…modest….He liked to tell us stories of hometown life in Nelson B.C. in his mild British Columbian accent,” the officer continued, “and was unmercifully ribbed about that hick town in the west.”

Somehow that doesn’t sound like the usual description of a hero, but Lieutenant Robert Hampton Gray, Royal Canadian Naval Volunteer Reserve, would receive the Distinguished Service Cross and the Victoria Cross posthumously for his actions during the final stages of the war in the Pacific in the summer of 1945.

Robert Hampton Gray was born in Trail, B.C. in 1917—his father was a Boer War veteran and jeweller—and grew up in Nelson. After high school, he attended the University of Alberta for one year, then transferred to the University of British Columbia. He had intended to go to McGill to get a medical degree but instead joined the Navy in the summer of 1940. He did his basic training at HMCS Stadacona in Halifax, then applied for officer and pilot training. Many applied for the first, fewer for the second, but Gray was chosen for both and proceeded to England where he was commissioned as a sub-lieutenant.

Gray then returned to Canada for flying training under the British Commonwealth Air Training Plan in Kingston, Ontario, returned to Britain, and then was posted to Nairobi, Kenya. There he spent most of two years as a shore-based naval pilot flying Hawker Hurricanes but with some time flying off the aircraft carrier Illustrious. His brother, flying with the Royal Canadian Air Force, was killed on operations during Gray’s African posting.

Now a lieutenant, Gray received a billet on HMS Formidable, another Royal Navy carrier, and in August 1944 played a prominent part in two attacks on the German battleship Tirpitz that was sheltering in a Norwegian fjord. The battleship was not sunk during these raids (it was in November 1944), but Gray’s courage and skill in flying his fast, well-armed fighter-bomber, the F4U Corsair, “right down the barrels” of the guns of the German destroyers protecting the Tirpitz was noted, and he was twice Mentioned in dispatches. In April 1945, Formidable joined the British Pacific Fleet as the Allies closed in on Japan, attacking shipping and shore installations.

Japan was in dire straits by the summer of 1945, its cities fire-bombed, its merchant fleet all but destroyed. There was no sign of surrender, however, and the United States and its British Commonwealth allies, including Canada, were planning a seaborne invasion that all feared would meet the same fanatical resistance the Americans had faced for almost three months at Okinawa. Japanese kamikaze pilots were still attacking Allied vessels and their airfields were prime targets. In these circumstances, the pressure on the leadership in Tokyo had to be maintained, and on July 18, 24, and 28 Gray led his flight of six Corsairs in attacks on airfields and shore installations around Japan’s Inland Sea. Once again, his remarkable bravery was noted and Admiral Sir Philip Vian, commanding the British Pacific Fleet, recommended him for an immediate award of the Distinguished Service Cross, a high decoration.

Hiroshima was struck by the atomic bomb on August 6 and, while no one in the Fleet knew in detail of its effects, it was clear that this weapon of enormous power was going to shake the Japanese leadership and that the end of the war was drawing near. Aircrew on Formidable, as Gray’s squadron leader recalled, were told “to take it easy” on August 9 and avoid unnecessary risks as they again set off to strafe airfields. Neither Gray nor his mates knew that Nagasaki had been levelled that day by the second atomic bomb. 

The chosen route took Gray’s flight over Onagawa Bay on Honshu where five Imperial Japanese Navy ships were at anchor. As the citation of Gray’s Victoria Cross, announced in November 1945, “the fliers…dived in to attack. Furious fire was opened on the aircraft from army batteries on the ground and from warships in the Bay. Lieut. Gray selected for his target an enemy destroyer. He swept in oblivious of the concentrated fire and made straight for his target. His aircraft was hit and hit again, but he kept on. As he came close to the destroyer his plane caught fire but he pressed to within fifty feet of the Japanese ship and let go his bombs. He scored at least one direct hit, possibly more. The destroyer sank almost immediately. Lieutenant Gray did not return,” the citation ended. “He had given his life at the very end of his fearless bombing run.”Robert Gray Citation https://forvalour.ca/gray/citation/

The historian of the Royal Navy’s operations in the Pacific, John Winton, wrote that “Gray’s VC was in a sense the saddest and certainly one of the least-known of the war. The war was so nearly over; the cause for which he gave his life was already won.”The Victoria Cross at Sea: The Sailors, Marines and Airmen Awarded Britain’s Highest Honour https://www.scribd.com/book/444693220/The-Victoria-Cross-at-Sea-The-Sailors-Marines-and-Airmen-Awarded-Britain-s-Highest-Honour Japan capitulated on August 15. Gray was very likely the last Canadian serviceman killed in action in the Second World War, and his Victoria Cross was the only one awarded to a member of the RCN in the 1939-45 war.Second World War Victoria Cross Recipients https://www.veterans.gc.ca/eng/remembrance/classroom/fact-sheets/vcwinner 

Gray is commemorated by one of the fourteen statues and busts on The Valiants Memorial near Confederation Square in Ottawa.“The Valiants Memorial, located in downtown Ottawa, is a collection of nine busts and five statues depicting individuals who have played a role in major conflicts throughout our history. It also includes a bronze wall inscription that reads, “No day will ever erase you from the memory of time”, which is from The Aeneid by Virgil.

The monument pays tribute to the people who have served this country in times of war and the contribution they have made in building our nation. These 14 men and women were chosen for their heroism, and because they represent critical moments in Canada’s military history.” https://www.canada.ca/en/canadian-heritage/services/art-monuments/monuments/valiants.html

Most Canadian pass it by and few know anything of Gray’s courage. They should know more. He deserves to be remembered as the Canadian hero he was.