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Strokes, heart attacks, sudden deaths: Does America understand the long-term risks of catching COVID?

October 6, 2022, 3:07 PM UTC
Arizona Cardinals defensive end J.J. Watt recently disclosed that he had an episode of atrial fibrillation. While the condition can be caused by a number of reasons, Watt was diagnosed with COVID in the weeks leading up to his health crisis.
Jordon Kelly—Icon Sportswire/Getty Images

A 35-year-old acquaintance drops dead from a hemorrhagic stroke. A friend in her 40s, and another in his 70s, experience recurrent spells of extreme dizziness, their hearts pounding in their chests when they stand. A 21-year-old student with no prior medical history is admitted to the ICU with heart failure, while a 48-year-old avid tennis player, previously healthy, suddenly suffers a heart attack. A relative is diagnosed with pericarditis, an inflammation of the protective sac surrounding the heart.

I can’t confirm the exact etiology of all these cases. But every one of the people I mentioned had a history of COVID either days or months beforehand–and all of them experienced only mild cases of infection at the time.

Is it possible, despite everything we know, that we still underestimate COVID’s reach and danger? It is not normal for me to know so many people with severe conditions. Not normal at all.

Lengthy social media threads have begun compiling lists of people much like those mentioned above, and while there are many possible causes for their health misfortunes, the sheer volume of cases speaks to something more worrisome than just a Twitter phenomenon.

A large international study involving 136 research institutions in 32 countries has documented an increased incidence of ischemic strokes in young patients compared to pre-pandemic levels. More than a third were under the age of 55, and many lacked typical risk factors such as smoking, diabetes, and high blood pressure.

Is COVID the reason?

In a study that included patients from the initial wave of the pandemic, scientists from the University of Florida found that survivors of severe COVID-19 had two-and-a-half times the risk of dying in the year following illness compared to people who were never infected. Of note, nearly 80% of downstream deaths were not due to typical COVID complications like acute respiratory distress or cardiac causes.

“The results suggest that a severe impact of COVID-19 exists beyond the cost and suffering of the initial hospitalization,” says Arch Mainous, one of the study’s authors.

How vaccinated patients have fared

In a huge analysis of more than 30,000 vaccinated patients who had experienced COVID breakthrough infections (pre-Omicron), scientists found that six months later, even the vaccinated incurred a higher risk of death and debilitating long COVID symptoms involving multiple organs (the lungs, heart, kidney, brain, and others) when compared to controls without evidence of SARS-CoV-2 infection.

Even the fittest are not immune. Researchers have noted a troubling pattern of sudden cardiac death in athletes in the wake of the pandemic, owing possibly to COVID-related heart complications–myocarditis and pericarditis. The Arizona Cardinals football lineman J.J. Watt recently disclosed that he had an episode of atrial fibrillation and while there are many possible causes of AFib, it’s notable that Watt was diagnosed with COVID-19 just about six weeks prior. Atrial fibrillation has long been associated with COVID. 

COVID reinfections

In a non-peer-reviewed study, Ziyad Al-Aly from the Washington University School of Medicine and his team analyzed the health records of 38,000 people with COVID reinfections. Compared to individuals with a single infection, researchers found that these reinfected individuals had higher risks of mortality, hospitalization, and adverse health outcomes in multiple organs.

These risks were present regardless of vaccination status. Every infection added increased risk for both acute and long-term complications.

We’re still learning how pervasive this all is. An analysis of more than 150,000 COVID-19 survivors published in Nature Medicine found that people with coronavirus are at increased risk of developing neurologic sequelae–including strokes, cognition and memory problems, seizures, movement disorders, and many other issues–in the first year after infection. The risks of developing these long-term complications were apparent even in people who did not require hospitalization during their initial infection.

“The results show the profound long-term consequences of COVID-19,” Al-Aly told me. “Some of these will scar people for a lifetime.”

According to the researcher’s estimate, COVID is responsible for more than 40 million new neurologic cases. A key caveat: The study period mostly predated vaccines. However, Al-Aly says, “We know that vaccines minimally reduce and do not eliminate long COVID risk.” Indeed, a large study found that vaccines were only about 15% effective at preventing long COVID.

No age group is reliably safe

Significantly, the risk of some of these complications is stronger in younger adults. At the other end of the spectrum, a huge study found that COVID-19 increased the risk of developing Alzheimer’s in those 65 and older by 50% to 80%–and that was in people with no previous diagnosis.

Researchers believe that COVID-19 infection induces a prothrombotic and proinflammatory state, which may increase the risk of blood clots. In a cohort study of 48 million adults in England and Wales just published, COVID-19 was linked with dramatic increases in both arterial clots (these cause strokes and heart attacks) and venous thromboembolism (these are blood clots in the lungs and legs, among other places). 

Clearly, we are still in the clutches of the virus, and some of the outcomes are frightening. A study that included data from over a million pediatric patients found that adolescents ages 18 and younger had a 72% increased risk of developing Type 1 diabetes in the six months following their COVID infection. That risk isn’t limited to children; it’s being seen in adults, too.

A nightmare scenario? A mild COVID case that leads to life-long diabetes. But rather than continue to beat the drum for caution, most cities, governments, and even the CDC are loosening restrictions when it comes to COVID precautions.

America needs to wake up–now. A recent Kaiser Family Foundation survey shows that two thirds of U.S. adults have no intention of getting the updated booster shots anytime soon, yet rampant breakthrough infections and more immune-evading variants are on the horizon.

“The degree of immune escape and evasion is amazing right now, crazy,” Yunlong Richard Cao, an immunologist at Peking University in Beijing told Nature a few days ago. In a preprint, which has not been peer-reviewed, Cao et al. found that new subvariants like BQ.1.1, CA.1, and especially XBB, are the most antibody-evasive strains to date. “These results suggest that current herd immunity and BA.5 vaccine boosters may not provide sufficiently broad protection against infection,” they wrote.

In our country, 300 to 400 COVID deaths are already occurring every day. Cases are rising in some European countries such as France, Germany, Italy and Belgium. “We are clearly at the start of a winter [COVID-19] wave,” said Karl Lauterbach, Germany’s federal minister of health, in a press briefing. Germany has just implemented new rules requiring mask-wearing on trains, local buses, as well as in hospitals, nursing homes, and doctors’ offices.

The road ahead is going to be rough until we can develop a variant-proof vaccine, approve nasal vaccines to help block infection at the port of entry and reduce transmission, and develop better treatments. As the virus becomes more immune-evasive, our arsenal is shrinking, not expanding, despite what the CDC and political leaders may claim. The monoclonal antibody strategy, for instance, proved ineffective as the virus outsmarted us and kept evolving, rapidly rendering many monoclonal therapies obsolete shortly after they were approved.

We have plenty still to understand about long COVID, particularly in the vaccinated population, but Al-Aly estimates that 8% to 12% of vaccinated people with breakthrough infections may develop long COVID. Around the world, an estimated 145 million people are suffering from the condition, cases of which rose more than 300% in 2021.

We need to do a much better job preventing mass infections and reinfections, fast-tracking research, funding new treatments for victims, and developing a coordinated response, both nationally and internationally. Producing universal coronavirus and nasal vaccines and drugs to minimize long COVID risk is a top priority. As Al-Aly puts it, “We need ambitious policies to get ahead of this virus and the pandemic.”

As a country, we’re clearly tired of masking, boosting, and COVIDing in general. But as exhausting as this march has already been, we’re nowhere near the finish line. We must stop pretending otherwise.

Correction: Due to a miscommunication, an earlier version of this essay said 8 to 12% of breakthrough infections may die of long COVID–this is incorrect. The researcher in question estimates that 8 to 12% of vaccinated people with breakthrough infections may develop long COVID.

Carolyn Barber, M.D. has been an emergency department physician for 25 years. Author of the book Runaway Medicine: What You Don’t Know May Kill You, she has written extensively about COVID-19 for national publications, including Fortune. Barber is co-founder of the California-based homeless work program Wheels of Change

The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.

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