COVID Update

Do you care about COVID?
Probably not.
Probably pretty fatigued by the whole conversation, and just over hearing about it.
I can guarantee you that being fatigued about COVID talk is 100% better than long COVID fatigue.

Not from lived experience, that statement, luckily.

I care about COVID.
I care quite a lot, having read a reasonable amount of the actual research as it is disseminated, over almost the last 5 years. Yeah, reading research is a pretty geeky thing that’s certainly not for everyone, but I like anatomy and physiology and, yeah, I like reading research- there’s a lot of it that doesn’t seem to be reported, for the reason it’s kinda hard to get the average man in the street to care about changes in cellular proteins, not least of all because of everyone being fed up to the gills with COVID coverage, and what does wind up in the media, is often pretty sensationalised.

Should you care about COVID?
Boy, if you’d read and comprehended the things I have, you probably would.

Without getting into too much depth, I’m pretty interested in how COVID affects the function of the nervous system, and what part this plays in the cases that develop into long COVID especially. The way the virus enters cells, and the effect that has when it slips into cells in your sensory nervous system, is a problem. It’s a biiiiiig problem. The way it switches some of the signalling leads to some pretty odd changes that make it pretty hard for your nerves to work properly.

Guess what’s a problem if your nerves don’t work properly?
Everything.
Virally induced chronic fatigue syndrome is a massive, massive hurdle to overcome, and the COVID version is particularly nasty because of how much it changes how your sensory nerves work. Sensory nerves are funky things, some of them actually have a job that’s almost more important than ‘sensing,’ and that is to excrete tissue growth factors that ALL of your tissues need, to keep healthy. People don’t think of nerves as something that excretes anything, but they do! Those tissues, in return, excrete nerve growth factors, which (surprise, surprise) the nerves need to keep healthy. Mess with that relationship, and you mess with not just growth, but healing and repair in general, which your body is doing constantly even after it’s fully grown.

If your nerves aren’t sensing properly, and they’re not repairing properly, and they’re not helping all your other tissues do their repairs…. what do you think goes well in your life?
How are you going to fix that? Rest? Hard to do much else when your body and your nervous system is on the fritz.
Even if you love lying in bed, not being able to do a whole lot apart from that gets pretty un-fun, pretty quick.

Having a reasonable understanding of the physiology involved, and understanding that at present, there’s nothing that conventional medicine can do about long COVID, is the reason I have been masking for as long as I have in clinic.
Are there things you can do that will help if you have long COVID? Yep. There’s also things you can do to reduce the likelihood of ending up with it, chief amongst them just not getting damn COVID, of course! But that’s not the subject for today, that’s another whole equally complicated conversation…

The happenings over this Christmas and New Years holidays have yet to be uploaded to poops.nz, as can probably be expected with it being a holiday period, but having followed the ESR wastewater surveillance for quite some time now, the viral load in Christchurch during the portion of December 2024 reported so far, was almost an order of magnitude lower than it was in December 2023, (0.7-2M genome copies per person per day for Dec 2024, vs. 7.4-11.8M for Dec 2023) which might be partially explained by growing immunity, meaning milder cases and less of a viral load during infection. There wasn’t such a drastic difference at a national level, where the numbers were about a third of last year.
There are also big differences in cases reported- 5 times fewer in 2024 for Christchurch, and 4 times fewer nationally, looking mid-Nov to mid-Dec. This might be partially explained by the COVID Tracer app being disbanded in Sept 2023, and the number of people dutifully self-reporting directly to the Ministry of Health or DHB in the few months after that will have dwindled in the year and a bit since. It’s also unfortunate to say, but the most vulnerable people, amongst the very elderly, probably contributed far more to the case numbers last year than this, as well, with half the total number of deaths nationally for mid-Nov to mid-Dec.

Half the number of deaths sounds good, as does a quarter as many cases and a third of the viral load in wastewater. That also means -statistically anyway- it’s a more deadly disease, basically twice as likely to kill currently, observing the ratios in relation to each other.

What’s all that mean?
Well, I’m fairly confident it means that between the things I’m doing to manage my risk, along with the reduced case numbers, and importantly the trust I put in my patients to do the right thing when they have COVID, means that I am comfortable no longer masking in clinic.
This isn’t a decision I’ve arrived at lightly, and certainly it isn’t arrived at overnight, and it could well change again, as new information comes to light, but for the moment, no more mask!