Covid-19 Has Been Harmful. Let's Not Compound the Harm to Ourselves

In the movie No Country for Old Men, Carson Wells (played by Woody Harrelson) is asked how dangerous Anton Chigurh (played by Javier Bardem) is. Wells replies, “Compared to what? The bubonic plague?” That was a joke in 2007, but in 2020 was uncomfortably close to worst-case fears of SARS-CoV-2.

Now (fingers crossed) it seems as if the virus death toll will be a fraction of 1% of that historic pandemic. That is largely beyond our control, it still depends more on the virus than on human actions, other than basic social distancing, hand washing, mask wearing and other precautions; plus contributions from specialists. For those of us not involved in virus research or public health it makes sense to turn our attention to the aftermath, where there is more scope for effective action. We should think not about the dead, but the survivors.

Early reports show significant amounts of severe lung, heart and even brain damage among recovered CoVID-19 patients. While there is still tremendous uncertainty, it’s plausible that people with serious lifelong complications will be many times the number of deaths. Severe influenza can cause similar damage, which in most (but not all cases) improves over time. If the nature of the damage is emphysema-like, it will probably be permanent.  Nobody knows this yet.

Other diseases that inflict this kind of damage on the body cause permanent disability. Polio before widespread vaccination, and rheumatic fever still, are examples of diseases that inflict severe lifelong disabilities far more often than they kill quickly.

Chronic obstructive pulmonary disease, COPD, a.k.a. “smoker’s lung,” is the third-leading cause of death in the US, and the second-leading cause of disability. It consumes 5% of healthcare spending. And the bulk of it in the US results from smoking (it can also result from occupational or environmental exposure to lung irritants, but this has been sharply reduced in developed countries). It’s plausible that the number of people exposed to SARS-CoV-2 will be similar to, or greater than, the number of smokers. While we have no idea, it’s not implausible that rates of severe, permanent lung damage will be similar; or perhaps that other damage to survivors will impose similar costs in terms of early death, disability and money. Healthcare workers have already noticed post-traumatic stress disorder like symptoms among some survivors of intensive care units.

During wars, people focus on the tragic numbers of deaths. But afterwards, they find that there is a much bigger population of survivors with physical and mental wounds that range from serious to life-ruining. There were 58,220 official US casualties in the Vietnam war, but there have been twice that many excess suicides (that is suicides beyond population averages based on age and sex) among Vietnam veterans. Around a million veterans suffered from serious post-traumatic stress disorder, some with painful bouts, others with disabling chronic conditions. Over 300,000 soldiers were wounded, including 75,000 severely disabled as a result.

Much of that can be chalked up to the horrors of war. But part of the blame is the poor treatment received by returning soldiers both by military health authorities and the general population. If we knew then what we know now, we would—I hope—have devoted as many resources to treating returning soldiers as we had to trying to win the war. Merely taking complaints of veterans seriously would have gone a long way toward recognizing problems earlier and developing treatments.

Well, for CoVID-19, we know things now. It’s as important to follow up with survivors as it is to treat the sick. In the panic, overwhelmed healthcare workers are necessarily focused on saving lives today, not improving lives in the future. But researchers are under less pressure. Some, of course, are working on treatments and vaccines. But there should be plenty of money for careful study of life after the ICU. And not just the severely ill, there could be serious progressive problems caused by autoimmune (in fighting the infection, the body may do damage to liver, kidneys or other organs) or other responses even among people with mild or no symptoms at the time.

One cheap no-brainer is a Genome Wide Association Study. Take cheek swaps from a few thousand SARS-CoV-2-infected people to record DNA, and track them through time. The cost is about $50 per person, plus administrative overhead. Tracking these people could provide both early warning of follow-on problems as well as genetic data that could help understand the effects of the virus and improve vaccines and treatments.

Early detection and treatment of lingering effects of CoVID-19 could save more lives, more productive years and more money than, perhaps, any other medical research right now. Putting survivors though years of hell from skeptical insurance companies and government disability adjudicators could cause harm on a scale of ignoring suffering of Vietnam veterans.

The virus has caused great harm. Let’s not compound it by doing even greater harm to ourselves.