Plus, a special deep dive into long-COVID, including its high cost for transplant patients, its complicated diagnosis, the lack of cures, and more. Email not displaying correctly?
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** How a new COVID-19 outbreak in Beijing could affect you
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Residents and office workers wearing face masks line up on a road for mass coronavirus testing near the residential and commercial office complex at the central business district, Monday, April 25, 2022, in Beijing. (AP Photo/Andy Wong)

The question of the week is whether Beijing will become the next Shanghai ([link removed]) and close its doors to business while it confronts a new COVID-19 outbreak. A new shutdown of a major Chinese city will affect the price Americans pay for gasoline, put new inflation pressures on American businesses and send global stock markets into a tizzy.

Keep in mind,Fortune reports ([link removed]) , “China accounts for 18% of all the goods the U.S. imports, according to Bank of America. And for computers and electronics, that number rises to 35%.”

The panic, which sent shoppers running to Beijing grocery stores, is based on fewer than two dozen COVID-19 cases reported in Beijing Sunday. In Shanghai ([link removed]) , 39 COVID-19 patients died, according to government reports. Few who died in China so far were thought to have been vaccinated.

If Beijing is locked down as Shanghai has been for more than two weeks, the supply chain backlogs will send U.S. industries, wholesalers and retailers into a panic. Fortune ([link removed]) points out why:

One in five container ships ([link removed]) is now stuck at ports worldwide, with 30% of the backlog coming from China. And Lars Jensen, the CEO of the shipping container industry consulting firm Vespucci Maritime, told Fortune that the full impact of China’s policies will only begin to reveal itself over the coming weeks.

“Until now most vessels have still been calling Shanghai almost as per normal—this means cargo to Shanghai does not end up in the wrong place,” Jensen said. “But this is likely to change in the coming weeks if the lockdown is not removed. Then you will see more omissions of Shanghai as a port and canceled sailings, and the [supply chain] impact will increase.”

Even if strict lockdowns in Shanghai are lifted, U.S. ports will likely be slammed with a wave of pent-up cargo ([link removed]) from newly reopened factories in China. That will lead to higher freight rates, Jensen says, and worsen congestion at ports worldwide.

Some shipping experts said the Shanghai shutdown alone would create delivery backlogs into June. A Beijing lockdown would multiply that.

Dylan Alperin with Keelvar ([link removed]) , which helps businesses with logistics, is quoted in the Fortune article:

“The freight cost for a single container from China to the U.S. went from $5,900 last year to $15,764 today,” Alperin said. The impact of those price increases alone could significantly drive inflation up globally, he added.

One Chinese district with a population bigger than Chicago ordered every resident to get a PCR test before this weekend. The BBC reports ([link removed]) :

Some of the measures Chinese authorities have enforced include placing electronic door alarms ([link removed]) to prevent those infected from leaving and forcibly evacuating people from their homes to carry out disinfection procedures.

Some in locked-down areas of Shanghai say they have been struggling to access food supplies, and forced to wait for government drop-offs of vegetables, meat and eggs.

Green barricades have also been erected ([link removed]) overnight in parts of Shanghai without prior warning, effectively preventing residents from leaving their homes.

Global oil prices fell ([link removed]) on the news that Beijing might be next to shut down. It could mean that gasoline prices have the potential to fall if China’s economy requires less fuel for a couple of weeks or longer.


** The high cost of long-COVID
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Jacki Graham, a 64-year-old COVID survivor, sits for a photo in her home in Los Angeles, Thursday, Jan. 20, 2022. Her bout with COVID-19 at the beginning of the pandemic wasn’t bad enough to put her in the hospital. But months later, she experienced breathlessness and a racing heart. She couldn’t taste or smell. Her blood pressure shot up. (AP Photo/Jae C. Hong)

We do not have reliable figures about how many people suffer from long-COVID symptoms in America, but some estimates put the figure at about 15 million. A new Government Accountability Office report ([link removed]) estimates that up to 23 million Americans are affected by long-COVID. The GAO says a million Americans may be too sick with long-COVID to work. Health experts say that as we drive COVID-19 hospitalizations and deaths down, long-COVID may well be our next health disaster.

Journalists, long-COVID deserves your attention.

There are fewer people hospitalized with COVID-19 since the earliest days of the pandemic (but the figure is rising ([link removed]) in some states). Hundreds of Americans are hospitalized with lingering long-COVID conditions ([link removed](22)00127-8/fulltext) . NBC News ([link removed]) found one person who has been hospitalized for 230 days and counting. She, like hundreds of others across the country, gets help breathing with extracorporeal membrane oxygenation ([link removed](ECMO,to%20tissues%20in%20the%20body.) , called ECMO.

But a significant number of long-COVID patients will need more than mechanical help. They need new lungs. NBC finds ([link removed]) :

As of February, more than 10 percent of new patients on the lung transplant waiting list wound up there because of Covid, according to data from theUnited Network for Organ Sharing ([link removed]) .

And just over 10 percent of 2,510 lung transplants performed from March 2021 to February have been Covid-related, according to the UNOS data, collected on behalf of NBC News.

Historically, lung transplants have been limited to chronic lung diseases, such as cystic fibrosis, rather than viral infections.

“The need for lung transplantation from patients who have had Covid is really striking,” Dr. David Klassen, chief medical officer for UNOS, said, particularly “for a disease that hasn't been here very long.”

The increase in COVID-19 patients on the lung transplant list has implications for others awaiting transplants. Patients who needs ECMO treatment get higher spots on the transplant list. So, as COVID-19 cases pile up, they push others deeper in line for a transplant. NBC finds:

According to the UNOS data, the number of lung transplants performed each month has remained relatively steady since March of last year. The number of transplants related to Covid, however, has been ticking up.

This suggests that Covid-related transplant candidates are leapfrogging others in need of new lungs.


** The complicated diagnosis of long-COVID
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If I told you I had “the flu,” you could understand my probable symptoms. Same with a cold or even heart disease. Not so for long-COVID.

Key questions remain about whether being vaccinated reduces the risk for long-COVID. Some reliable studies say yes, while other compelling evidence finds vaccines do not prevent long-COVID. For reasons we do not understand, women and obese people are less likely to recover from long-COVID, accordingto a new study from the UK ([link removed]) . That study also found that two-thirds of people who were hospitalized with COVID-19 still have some symptoms.

Long-COVID is so complex that it could involve any combination of a number of symptoms.
[link removed]
(GAO)

The GAO, which distilled hundreds of studies and research findings ([link removed]) , described the suspected causes of long-COVID this way:

Researchers do not yet fully understand the risk factors, causes, and effects of long COVID. Risk factors include preexisting conditions, such as type 2 diabetes. Severity of COVID-19 may also be a predictor, although people with mild or asymptomatic infections can also develop the syndrome. Whether vaccination for COVID-19 reduces an infected person’s risk of developing long COVID is unclear.

Some studies have suggested that vaccination reduces risk by up to 50 percent, while others have found no reduction in risk. Researchers have identified several possible causes of long COVID and have suggested that causes may vary from person to person (see fig. 2).

For some, COVID-19 may cause the body to produce an antibody that mimics SARS-CoV-2 and triggers an autoimmune response in which the immune system attacks its own antibodies. For others, SARS-CoV-2 virus may persist in the body and cause symptoms.

Another possible cause is organ damage from COVID-19. Research also suggests that microclots may form in blood vessels, blocking blood flow and causing tissue damage. And COVID-19 may disrupt the immune system and reactivate other previously contracted viruses, such as Epstein-Barr.


** The confounding lack of long-COVID cures
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The New York Times recently explored ([link removed]) why it has been so difficult to find a one-size-fits-all treatment for long-COVID sufferers. The story focused on the experience of one patient who has been caught in a two-year quest to breathe freely. The story describes the experience, which:

… speaks to the dysfunction of the organ-centered U.S. health-care system when it comes to long covid and the challenge of trying to treat an ill-defined illness for which there is no clear cause and no test, and for which the number of documented symptoms now stretches to more than 200. Many of the country’s top medical centers have set up multidisciplinary clinics to see long-haul patients, but advocates say there aren’t nearly enough to handle the millions of Americans expected to be dealing with lingering issues from covid-19 in coming years, leaving most of them struggling to navigate a maze of doctors and diagnoses on their own.

The complexity of finding reliable treatments begins with understanding the cause of the problem and MedicalxPress gives you a glimpse of how hard that can be.

A UCLA-led team of researchers studying the effect of the monoclonal antibody Leronlimab on long COVID-19 may have found a surprising clue to the baffling syndrome, one that contradicts their initial hypothesis. An abnormally suppressed immune system may be to blame, not a persistently hyperactive one as they had suspected.

The Washington Post points out ([link removed]) that long-COVID research was slow to get started but that researchers are now finding some commonalities with other health problems that carry long-term symptoms:

Now with long covid, which has many symptoms that overlap with those of chronic fatigue syndrome, research is finally beginning to take off. The National Institutes of Health last year launched a $1.15 billion initiative to better understand long covid, which will include 40,000 adults and children.

Oneleading area of research ([link removed].) is exploring possible dysfunction in the body’s autonomic nervous system, which controls unconscious functions such as breathing, heart rate and digestion.

Another theory is that the virus continues to hide out in reservoirs in the body, creating inflammation that triggers all kinds of symptoms.

A third possibility is that the body’s immune system is overreacting or misfiring in these situations and attacking itself.

The Mayo Clinic offered five non-medical responses ([link removed]) to long-COVID symptoms. Chiropractors are also finding some success ([link removed]) in treating some long-COVID sufferers.


** What is being done for long-COVID patients?
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GAO describes some of the work underway now ([link removed]) :

The federal government is taking steps to fund additional long COVID research. For example, the National Institutes of Health launched the $1.15 billion Researching COVID to Enhance Recovery (RECOVER) Initiative, which combines data across more than 200 research sites.

The initiative is using electronic health records to group common characteristics of tens of thousands of volunteers to better identify risk factors and causes of long COVID. Similarly, the CDC has contracted for a study in which patients voluntarily share their health data through a cloud-based personal health platform.

The federal government has also taken steps to support long COVID patients. For example, the Departments of Justice and Health and Human Services (HHS) issued guidance stating that the condition can be a disability under the Americans with Disabilities Act of 1990. Some long COVID patients may qualify for Social Security Disability Insurance (SSDI) if they meet certain requirements.

The CDC has developed long COVID guidance for health care providers and the public. Another HHS agency, the Administration for Community Living, published a guide to community-based resources to help connect affected people to services like transportation and personal care attendants.

Read The White House’s April 5 plan ([link removed]) to turn attention to long-COVID care, treatment and research.


** Helping the public understand the long-COVID story
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Nancy Rose, who contracted COVID-19 in 2021 and continues to exhibit symptoms including brain fog and memory difficulties, pauses while organizing her desk space, Tuesday, Jan. 25, 2022, in Port Jefferson, N.Y. Rose, 67, said many of her symptoms waned after she got vaccinated, though she still has bouts of fatigue and memory loss. (AP Photo/John Minchillo)

A Kaiser Health News essay included ([link removed]) :

“There could be more to help people understand that it’s not always a quick bounce back right away after the initial infection,” said Dr. Ben Abramoff, director of the Post-COVID Assessment and Recovery Clinic ([link removed]) at Penn Medicine in Philadelphia. “This is still a very significant viral infection, and sometimes it’s just a more gradual recovery process than people’s previous viral illnesses.”

There are examples ofcelebrities ([link removed]) who have told their stories of long-COVID symptoms. One story that is less told is how even teens ([link removed]) have these lingering symptoms. The symptoms may keep you from work and may make it difficult to concentrate ([link removed]) when you are working. Quartz points out ([link removed]) that employers need to be aware of what workers are going through and be open to making adjustments they would for other disabilities:

Sometime in the last two years they caught covid, recovered, and went back to work. Back at work, they soon realize something isn’t right—Concentrating is harder; once-familiar tasks take more effort. Perhaps they suspect the effects of the virus are lingering. But they brush the idea away with the thought: “It’s just me.”

Many of these people are suffering from long covid ([link removed]) , said Ted Drake, global accessibility leader at tech firm Intuit. And workplaces need to be aware of it—from an emotional and practical standpoint.

What’s frustrating about long covid is that the symptoms ([link removed]) are so varied, Drake told Quartz, after studying its effects ([link removed]) among employees at Intuit, the platform behind TurboTax, QuickBooks, and Mailchimp. “One of the things that’s been the toughest is people who are having trouble concentrating and focusing, remembering,” Drake said. Employees often tell him they go to do a task they’ve done a million times before, “but all of a sudden, they can’t remember how to do that task,” Drake said.


** The difficulty of describing what qualifies as long-COVID
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There is no official definition of long-COVID. The Kaiser essay draws on the expertise of Dr. Ben Abramoff, director of the Post-COVID Assessment and Recovery Clinic ([link removed]) at Penn Medicine in Philadelphia:

Abramoff has seen about 1,100 patients since Penn’s post-covid clinic opened in June 2020. There is no official threshold at which someone officially becomes a long-covid patient, he said.

A National Institutes of Health-funded study on long covid ([link removed]) , called Recover ([link removed]) , designates any case with symptoms lasting more than 30 days as long covid.

Dr. Stuart Katz, a New York University cardiologist who is the study’s principal investigator, said he estimates 25% to 30% of the nearly 60,000 covid patients in the study will fit the long-covid criteria.

The 30-day mark is an arbitrary cutoff, Katz said. “There’s this whole spectrum of changing symptoms over time.”

A study published in Nature ([link removed]) last year tracked more than 4,000 covid patients from initial infection until symptoms subsided.
* Roughly 13% reported symptoms lasting more than 28 days.
* That dropped to 4.5% after eight weeks and 2.3% after 12 weeks, indicating most people with symptoms lasting more than a month will recover within another month or two.

That leaves potentially millions of Americans suffering from a variety of covid symptoms — some debilitating — and a lingering burden on the health care system and workforce.


** The 66 clinics specifically treating long-COVID
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Beckers Hospital Review assembled a list of 66 clinics ([link removed]) that are treating long-COVID with the caveat that there might be more.

We’ll be back tomorrow with a new edition of Covering COVID-19. Are you subscribed? Sign up here ([link removed]) to get it delivered right to your inbox.
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