'Long Covid': Why are some people not recovering? - BBC News

'Long Covid': Why are some people not recovering? - BBC News


'Long Covid': Why are some people not recovering? - BBC News

Posted: 05 Oct 2020 04:56 PM PDT

Woman with fatigueImage copyright Getty Images

For most people, Covid-19 is a brief and mild disease but some are left struggling with symptoms including lasting fatigue, persistent pain and breathlessness for months.

The condition known as "long Covid" is having a debilitating effect on people's lives, and stories of being left exhausted after even a short walk are now common.

So far, the focus has been on saving lives during the pandemic, but there is now a growing recognition that people are facing long-term consequences of a Covid infection.

Yet even basic questions - such as why people get long Covid or whether everyone will fully recover - are riddled with uncertainty.

What is long Covid?

There is no medical definition or list of symptoms shared by all patients - two people with long Covid can have very different experiences.

However, the most common feature is crippling fatigue.

Others symptoms include: breathlessness, a cough that won't go away, joint pain, muscle aches, hearing and eyesight problems, headaches, loss of smell and taste as well as damage to the heart, lungs, kidneys and gut.

Mental health problems have been reported including depression, anxiety and struggling to think clearly.

It can utterly destroy people's quality of life. "My fatigue was like nothing I've experienced before," said one sufferer Jade Gray-Christie,

Long Covid is not just people taking time to recover from a stay in intensive care. Even people with relatively mild infections can be left with lasting and severe health problems.

"We've got no doubt long Covid exists," Prof David Strain, from the University of Exeter, who is already seeing long-Covid patients at his Chronic Fatigue Syndrome clinic, told the BBC.

How many people are getting it?

A study of 143 people in Rome's biggest hospital, published in the Journal of the American Medical Association, followed hospital patients after they were discharged.

It showed 87% had at least one symptom nearly two months later and more than half still had fatigue.

However, such studies focus only on the minority of people who end up needing hospital treatment.

The Covid Symptom Tracker App - used by around 4 million people in the UK - found 12% of people still had symptoms after 30 days. Its latest, unpublished data, suggests as many as one in 50 (2%) of all people infected have long-Covid symptoms after 90 days.

Do you need severe Covid to get long Covid?

It appears not.

Half of people in a study in Dublin still had fatigue 10 weeks after being infected with coronavirus. A third were physically unable to return to work.

Crucially, doctors found no link between the severity of the infection and fatigue.

However, extreme exhaustion is only one symptom of long Covid.

Prof Chris Brightling, from the University of Leicester and the chief investigator in the PHOSP-Covid project which is tracking people's recovery, believes people who developed pneumonia may have more problems because of damage to the lungs.

Image copyright SPL
Image caption Scans of lungs infected with coronavirus showing areas of pneumonia

How is the virus causing long Covid?

There are lots of ideas, but no definitive answers.

The virus may have been cleared from most of the body, but continues to linger in some small pockets.

"If there's long-term diarrhoea then you find the virus in the gut, if there's loss of smell it is in the nerves - so that could be what's causing the problem," says Prof Tim Spector, from King's College London.

The coronavirus can directly infect a wide variety of cells in the body and trigger an overactive immune response which also causes damage throughout the body.

One thought is the immune system does not return to normal after Covid and this causes ill-health.

The infection may also alter how people's organs function. This is most obvious with the lungs if they become scarred - long-term problems have been seen after infection with Sars or Mers, which are both types of coronavirus.

But Covid may also alter people's metabolism. There have been cases of people struggling to control their blood sugar levels after developing diabetes as a result of Covid, and Sars led to changes in the way the body processed fats for at least 12 years.

There are early signs of changes to brain structure, but these are still being investigated. And Covid-19 also does strange things to the blood, including abnormal clotting, and damaging the network of tubes that carry blood around the body.

  • Inside Health: Sticky Blood and Covid 19

Prof Strain told the BBC: "The theory I'm working on is a premature ageing of the small blood vessels that deliver oxygen and nutrients to the tissues." But he warned that until we figure out what is causing long Covid "it is difficult to figure out treatments."

Is this unusual?

Post-viral fatigue or a post-viral cough are well documented and common - we've probably all had an infection that has taken ages to fully recover from.

Around one in 10 people with glandular fever has fatigue which lasts for months. And there have even been suggestions that flu, particularly after the 1918 pandemic, may be linked to Parkinson's-like symptoms.

"With Covid there seem to be more far-reaching symptoms and the number of people seems to be much greater," says Prof Brightling.

The emphasis though is on the word "seems" as until will have a true picture of how many people have been infected we won't know exactly how common these symptoms are, he says.

He told the BBC: "The uniqueness of the way the virus attacks the host and the different ways it then alters the way cells behave seem to be both giving people more severe infection than other viruses and persistent symptoms."

Will people fully recover?

The number of people with long-Covid appears to be falling with time.

However, the virus emerged only at the end of 2019 before going global earlier this year so there is a lack of long-term data.

"We've asked, deliberately, to follow people for 25 years, I certainly hope only a very small number will have problems going beyond a year, but I could be wrong," said Prof Brightling.

However, there are concerns that even if people appear to recover now, they could face lifelong risks.

People who have had chronic fatigue syndrome are more likely to have it again and the concern is that future infections may cause more flare-ups.

"If long Covid follows the same pattern I'd expect some recovery, but if it takes just another coronavirus infection to react then this could be every winter," said Prof Strain.

It is still possible more problems could emerge in the future.

The World Health Organization has warned that widespread inflammation caused by coronavirus could lead to people having heart problems at a much younger age.

What should I do if I think I have long Covid?

The NHS has a "Your Covid Recovery Plan" which has advice, particularly for those who needed hospital treatment.

It recommends the "three Ps" in order to conserve energy:

  • Pace yourself so you don't push yourself too hard, and make sure you have plenty of rest
  • Plan your days so your most tiring activities are spread out across the week
  • Prioritise - think about what you need to do and what can be put off

It advises speaking to either your hospital team or your GP if you are not recovering as quickly as you might expect.

Some have raised concerns that there is not enough support for people with long-Covid.

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Are You Causing Zoom Fatigue? - Forbes

Posted: 17 Sep 2020 12:00 AM PDT

By Dianna Booher—

You may be hearing the phrase Zoom fatigue often nowadays. In the age of COVID, more and more people find themselves presenting ideas live online—whether in a staff briefing, a client meeting, or a virtual party. 

That fatigue is not so much because we're actually on Zoom, GoToMeeting, WebEx or a dozen other platforms. The fatigue problem flows from hearing so many coworkers and presenters drone on and on in a low-energy, monotone manner.

If you think you may be contributing to the online fatigue factor, here's help. (And of course, you may want to share this with your team to improve the virtual experience for all.)

Common Mistakes Professionals Make in Developing Their Presentations Skills for Online Meetings

Modeling After An Executive

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Brilliant executives do not necessarily have excellent presentation skills—when they're speaking live, much less online. As a keynoter myself, I've been backstage at many organizational events and have seen the faces of their employee audience. 

Do not assume that this executive's low-energy drone represents what's expected in the culture. I'm always amazed that these same executives complain about the "presence" of those below them in the hierarchy. 

But they do. Align with their ideas, certainly! But understand that they expect better from you.

Adapting To Mediocrity

In coaching leaders at one particular client organization for years, I repeatedly heard this refrain: "We're required to present in the 'bull pen.' Everybody does it that way." By this, the coaching client meant that the executive team required them to sit (rather than stand) in front of a large U-shaped room to present project updates and proposals.

After hearing this from several reluctant-to-change presenters, I asked the CEO to verify that the "bull pen" was a requirement. He laughed, and told me this backstory: An executive of the engineering division had done this kind of briefing in years past. But despite this executive's retirement a decade earlier, the engineers still followed his delivery style, insisting that was "just the culture." 

Needless to say, those who dared step away from "the culture" made a name for themselves as excellent communicators. Adapting to mediocrity has never been a winning strategy—live or virtually.

Model after the best presenters from any culture—yours or your competitor's.

 Focusing On Content To The Exclusion Of Delivery

Sure, your insights matter. But an engaging delivery makes those insights stick longer and easier. Few would argue that a defense attorney's style in the courtroom was of no consequence—that only her argument counted in the jury's mind.

Put your heart into what you say. People are looking you directly in the eye in your virtual delivery. Let them see—and hear—your commitment and confidence in what you're saying.

Ignoring Engagement Features

The talking head has had its day. In our current state of fatigue, people want to talk back. They expect a dialogue rather than a monologue. Either facilitate the oral discussion or use the platform's various features to let people have their say: break-out rooms, chat-backs, polling, links to other resources such as blog articles or tools.

While keynoters got away with lecturing for years, that's no longer the case. Talk with people, not at them.

Slumping, Tired, Bored Body Language

A national media outlet recently showed photos of elementary-age children appearing zombie-like as they ate lunch in the school cafeteria—masked and spread out away from their peers. The accompanying feature story talked about the loneliness of these children. And their body language provided evidence.

Recently, as a participant in a large gathering for an online conference, I noticed the same zombie-like appearance from so many on the screen. Those attendees who looked alert and perky definitely stood out from the crowd. They were the members that the two emcees focused their attention on, asking them to share opinions, advice, and expertise. In other words, they received the spotlight on their accomplishments.

Consider whether you may be creating the same impression with slumped shoulders, chin in hand, elbows on your desk, glazed eyes, and a ho-hum expression. Perk up to move up!

Hiding Off-Camera

By all means, turn on your camera—unless you have an exceptional situation (a spouse working out nearby or kids playing in the background). Otherwise, your presence feels like a lurker—even when you speak up during a discussion. 

Bottom-line: You can Zoom to broader visibility with a strong executive presence online. 

Dianna Booher is the bestselling author of 48 books, including Communicate Like a Leader. She helps organizations communicate clearly. Follow her at BooherResearch.com and @DiannaBooher.

Study: Menopause Increases the Risk of Cardiovascular Disease - Pharmacy Times

Posted: 05 Oct 2020 06:38 AM PDT

Women with 2 or more moderate to severe menopause symptoms are at a significantly higher risk for cardiovascular disease and stroke, according to a recent study presented at the 2020 Virtual Annual Meeting of The North American Menopause Society. 

Menopause frequently causes a variety of symptoms that can interfere with a woman's quality of life. For example, a commonly reported symptom is hot flashes, which can cause fatigue and make it difficult to concentrate. However, hot flashes alone were found not to increase the risk of cardiovascular disease or stroke. 

Further, investigators found that any single moderate to severe symptom did not increase the risk of cardiovascular disease or stroke. Additionally, moderate to severe menopause symptoms were not associated with other adverse health outcomes, such as cancer risk, according to the study. 

Symptoms considered an added risk for cardiovascular disease or stroke included hot flashes, night sweats, dizziness, heart racing, tremors, restlessness, fatigue difficulty concentrating, forgetfulness, mood swings, vaginal dryness, breast tenderness, migraines, and waking multiple times throughout the night. 

"We found that even severe hot flashes were not associated with any adverse clinical health outcomes when occurring on their own, but if they or any other moderate to severe menopause symptoms were present in combination, there was an association with an increased risk of cardiovascular disease," said lead study author Matthew Nudy, MD, in the press release. 

Calcium and vitamin D supplements did not mitigate the risk of cardiovascular disease or stroke; however, identifying risk factors may help the implication or risk reduction strategies, according to the study.  

Reference:
Could your menopause symptoms be hard on your heart? [News Release] Cleveland, OH. September 28, 2020. https://www.eurekalert.org/pub_releases/2020-09/tnam-cym092320.php. Accessed September 28, 2020. 

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