The Whole View, Episode 425: Covid-19 FAQ Part 4

In Episode 401, Stacy and Sarah explored the way out of this pandemic and how to get back to normal life as we know it.They touched a little bit on reinfection cases, which they will be taking at a more in-depth look at today.

They also broke down the science behind wearing face masks. 

In Episode 412, Stacy and Sarah talked about how isolation can impact immune function. They also myth-busted some of the concerns that have circulated around it.

They discussed how isolation might affect the gut microbiome, public health messaging, and the huge importance of vitamin D when reducing the risk of Covid-19.

 In today’s episode, Sarah reminds us that they will be focusing on:

• Reinfection versus Reactivation
• Long haulers (sometimes “Long Covid”)
• Longterm complications/damage

Stacy shares that this has been an ongoing thing for her. (7:50)

Stacy has shared in past podcasts that she had a feeling there were two unknowns that we would find out later on about the Coronavirus:

First, there’s an effect on the brain, which has since been shown. And second, that there is a hormonal impact on the body.

Stacy has noticed she gets reactivated symptoms during her menstrual cycles, specifically inflammation.

Stacy feels that it is really important to talk about because there’s so much focus on how many people have died.

As someone who’s gone through it and now living with the long-term side effects of it, she feels it’s important to acknowledge that millions of people in the world survived but are still feeling the effects months later.

She considers herself one of the lucky ones since she had a mild case and cannot be more thankful for that.

Stacy would like the audience to understand that Covid-19 is not like the flu. You don’t get it, and then you’re done, and you have immunity for a short time until the next strain comes out.

And she thinks that Sarah going through the science of it will be very beneficial to people.

Sarah points out that we’re now at a point where more research and studies are trying to look at the spectrum of the long term impacts.

It’s really important to understand the long-term impact of this so that we can monitor at-risk people for potential health-specific complications in the future.

Sarah also references potential economic impacts we could see due to prolonged symptoms and brain fog keeping millions of people from returning to work.

There are down-stream effects that we need to really understand and be able to wrap our heads around.

Sarah also explains that there’s a lot of work that still needs to be done to reduce the spread.

She also explains that we are still at a really high level of new cases every day.

With high community spread, it makes any kind of gathering (school, church, weddings, funerals) all very challenging.

As we’re trying to figure out how to continue with precautions to reduce spread, Sarah expresses the need to understand this whole other side of the virus that’s not related to the two to three weeks of active infection.

Sarah first wants to look into whether the recent reports that look like reinfection are truly that. (14:26)

Stacy shares that this is something especially concerning to her.

Sarah explains antibody-dependent enhancement of infection (ADE or ADI).

It is a common phenomenon in many other viruses, such as influenza A virus, Coxsackievirus B, respiratory syncytial virus (RSV), Ebola virus, human immunodeficiency virus (HIV) dengue virus.

Dengue Fever is the best understood in terms of the ADE mechanism.

There are four known strains of the virus; when you contract one strain, you get Dengue Fever, and your body mounts a response.

You are then protected for a relatively short time frame of time, not just against the strain you caught but also the other three.

As the antibodies fall in number, there’s a window where if you get exposed to one of the other three strains, you can develop a much more severe case.

If you don’t get exposed to one of those three, you’re still immune to the first strain you caught even after all the antibodies are gone.

If you catch one of the other three strains after the window is closed, you will develop regular Dengue Fever again, but not get the life-threatening reaction.

Sarah explains that that magic sweet spot with a low level of antibodies actually magnifies the infection.

One thing Sarah notes is that the Dengue Fever virus actually replicates inside immune cells.

So when there are high levels of antibodies shortly after an infection, these “eater cells” are able to neutralize the infection.

When there are low levels of antibodies, they’re not sufficient enough to neutralize the virus.

This sweet spot typically starts from a few months out from infection and can last to about a year.

What This Means For Covid-19

What’s happened in these few dozen cases of possible Covid-19 reinfection is that people tested positive and were sent home. They recovered and later tested negative. Then, months later, they once more test positive for Covid-19.

Some are similarly sick as the first time, some are sicker the second time, and others are asymptomatic.

This begs the question if it’s real reinfection.

Sarah claims that of the researchers studying these cases, nobody is convinced that it’s true reinfection.

None of these cases are from immunocompromised people and aren’t thought to be very concerning.

Reinfection is a legitimate concern for those with autoimmune disorders, such as HIV.

A more likely explanation for what is going on with these cases is that it’s actually viral reactivation.

This means that these people are long-haulers who had a latent period, combined with testing limitations and failures.

It’s possible that those negative tests weren’t true negatives.

Sarah explains this as the immune system almost beat it, but didn’t neutralize it fully, and pulled back fighting too soon.

There’s a really wide range in how long people have measurable virus in their systems, and they may not be infectious the entire time.

Sarah explains that there’s a lot that we still don’t know about the Covid-19 virus and its ability to hide out in our bodies long-term.

Data has shown viral shedding in some people lasting as long as eighty-three days out from the first day of symptoms.

Sarah sums up that the most likely explanation for the resurgence of symptoms is due to the virus’s ability to hide inside our bodies. (36:03)

She goes a bit more in-depth on how exactly a virus can hide from our immune systems.

One of the implications of this is that we could have more lasting immunity from a vaccine than natural infection.

It may hide out in exosomes within cells, which are little tiny bubbles inside the cell membrane.

What this all data points to is herd immunity through natural infection is unlikely.

And that we may be able to achieve a more lasting immunity through vaccination.

Stacy references the Scientific Method from a previous episode and explains how we’re still mid-process. (40:41)

Sarah wants to acknowledge listeners that this doesn’t feel like good news.

The main message that this scientific research has for Sarah is that the efforts going in to protect herself and others are still really important to do, even though we may be getting tired of it.

The science behind wearing masks to slow the spread just gets stronger and stronger.

It’s potentially a large percentage of people who fall into the long-hauler or long-Covid category.

Over 30% of long-haulers still have symptoms at 3 weeks, and approximately 10% still have symptoms at 2 months.

Sarah also notes that data might be lacking because not all long-haulers are seeking medical attention if their symptoms are tolerable.

The most common symptoms for long-haulers are fatigue, ongoing shortness of breath, joint aches, muscle aches, brain fog, and difficulty focusing.

Some people report feeling better for a few weeks, while others report not feeling better at all.

Sarah explains how autoimmune diseases work and how it relates to Chronic Fatigue Disorder, which shows similar symptoms to long-Covid.

Some researchers think what’s happening in long-haulers isn’t exactly continued infection. But more of the infection melding into Chronic Fatigue.

Another thing that could affect long-haulers is organ and tissue damage, which takes a long time to heal.

Researchers have now started to note Multisystem Inflammatory Syndrome cases in some Covid patients. 

This was thought to be more common in children but is showing up increasingly in adults. 

MIS typically happens in people who had Covid and recovered from it. It’s a very severe, life-threatening (but treatable) inflammatory syndrome.

Clinical features in children have varied but include shock, cardiac dysfunction, abdominal pain, and elevated inflammatory markers.

Adults show severe dysfunction of one or more extrapulmonary organ systems (e.g., hypotension or shock, cardiac dysfunction, arterial or venous thrombosis or thromboembolism, or acute liver injury); 4) laboratory evidence of severe inflammation (e.g., elevated CRP, ferritin, D-dimer, or interleukin-6); 

Sarah sums up that in its severe form, patients can develop MIS. But in mild-form, patients show symptoms of long-Covid.

What This Means For Covid-19 Patients

The way this is currently treated mostly by symptom relief, rest, and stress reduction.

Stacy shares that until we know more and the science can catch up with medial solutions, we know what we need to do to at least feel better. And how to continue to reduce the spread.

Stacy reminds us that drinking alcohol can exacerbate long-haul symptoms on the front end.

Sarah explains that alcohol is actually the opposite that’s needed to support immune function.

Because we focus so much on the physical side of Covid-19, Stacy reminds us that there’s a lot of mental health at play from anxiety.

This anxiety comes from all the things we don’t know. 

Even if you’ve already had it, like Stacy, we don’t know if we can get it again, if it will be worse the second time, or if we’ll be asymptomatic and infect others.

You’re not alone. You’re not the only one feeling frustrated and exhausted and over it and ready for change. We’re on the same team.

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