Can you die from long COVID? The answer is not so simple
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Nearly five years into the pandemic, COVID is feeling less central to our daily lives.
But the virus, SARS-CoV-2, is still around, and for many people the effects of an infection can be long-lasting. When symptoms persist for more than three months after the initial COVID infection, this is generally referred to as long COVID.
In September, Grammy-winning Brazilian musician Sérgio Mendes died aged 83 after reportedly having long COVID.
Australian data show 196 deaths were due to the long-term effects of COVID from the beginning of the pandemic up to the end of July 2023.
In the United States, the Centers for Disease Control and Prevention reported 3,544 long-COVID-related deaths from the start of the pandemic up to the end of June 2022.
The symptoms of long COVID – such as fatigue, shortness of breath and “brain fog” – can be debilitating. But can you die from long COVID? The answer is not so simple.
How could long COVID lead to death?
There’s still a lot we don’t understand about what causes long COVID. A popular theory is that “zombie” virus fragments may linger in the body and cause inflammation even after the virus has gone, resulting in long-term health problems. Recent research suggests a reservoir of SARS-CoV-2 proteins in the blood might explain why some people experience ongoing symptoms.
We know a serious COVID infection can damage multiple organs. For example, severe COVID can lead to permanent lung dysfunction, persistent heart inflammation, neurological damage and long-term kidney disease.
These issues can in some cases lead to death, either immediately or months or years down the track. But is death beyond the acute phase of infection from one of these causes the direct result of COVID, long COVID, or something else? Whether long COVID can directly cause death continues to be a topic of debate.
Of the 3,544 deaths related to long COVID in the US up to June 2022, the most commonly recorded underlying cause was COVID itself (67.5%). This could mean they died as a result of one of the long-term effects of a COVID infection, such as those mentioned above.
COVID infection was followed by heart disease (8.6%), cancer (2.9%), Alzheimer’s disease (2.7%), lung disease (2.5%), diabetes (2%) and stroke (1.8%). Adults aged 75–84 had the highest rate of death related to long COVID (28.8%).
These findings suggest many of these people died “with” long COVID, rather than from the condition. In other words, long COVID may not be a direct driver of death, but rather a contributor, likely exacerbating existing conditions.
‘Cause of death’ is difficult to define
Long COVID is a relatively recent phenomenon, so mortality data for people with this condition are limited.
However, we can draw some insights from the experiences of people with post-viral conditions that have been studied for longer, such as myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS).
Like long COVID, ME/CFS is a complex condition which can have significant and varied effects on a person’s physical fitness, nutritional status, social engagement, mental health and quality of life.
Some research indicates people with ME/CFS are at increased risk of dying from causes including heart conditions, infections and suicide, that may be triggered or compounded by the debilitating nature of the syndrome.
So what is the emerging data on long COVID telling us about the potential increased risk of death?
Research from 2023 has suggested adults in the US with long COVID were at greater risk of developing heart disease, stroke, lung disease and asthma.
Research has also found long COVID is associated with a higher risk of suicidal ideation (thinking about or planning suicide). This may reflect common symptoms and consequences of long COVID such as sleep problems, fatigue, chronic pain and emotional distress.
But long COVID is more likely to occur in people who have existing health conditions. This makes it challenging to accurately determine how much long COVID contributes to a person’s death.
Research has long revealed reliability issues in cause-of-death reporting, particularly for people with chronic illness.
So what can we conclude?
Ultimately, long COVID is a chronic condition that can significantly affect quality of life, mental wellbeing and overall health.
While long COVID is not usually immediately or directly life-threatening, it’s possible it could exacerbate existing conditions, and play a role in a person’s death in this way.
Importantly, many people with long COVID around the world lack access to appropriate support. We need to develop models of care for the optimal management of people with long COVID with a focus on multidisciplinary care.
Dr Natalie Jovanovski, Vice Chancellor’s Senior Research Fellow in the School of Health and Biomedical Sciences at RMIT University, contributed to this article.
Rose (Shiqi) Luo, Postdoctoral Research Fellow, School of Health and Biomedical Sciences, RMIT University; Catherine Itsiopoulos, Professor and Dean, School of Health and Biomedical Sciences, RMIT University; Kate Anderson, Vice Chancellor’s Senior Research Fellow, RMIT University; Magdalena Plebanski, Professor of Immunology, RMIT University, and Zhen Zheng, Associate Professor, STEM | Health and Biomedical Sciences, RMIT University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Vodka vs Beer – Which is Healthier?
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Our Verdict
When comparing vodka to beer, we picked the vodka.
Why?
As you might have guessed, neither are exactly healthy. But one of them is relatively, and we stress relatively, less bad than the other.
In the category of nutrients, vodka is devoid of nutrients, and beer has small amounts of some vitamins and minerals—but the amounts are so small, that you would need to drink yourself to death before benefiting from them meaningfully. And while beer gets touted as “liquid bread”, it really isn’t. A thousand years ago it will have been a lot less alcoholic and more carby, but even then, it wasn’t a health product aside from that it provided a way of making potentially contaminated water safer to drink.
In the category of carbohydrates, vodka nominally has none, due to the distillation process, and beer has some. Glycemic index websites often advise that the GI of beers, wines, and spirits can’t be measured as their carb content is not sufficient to get a meaningful sample, but diabetes research tells a more useful story:
Any alcoholic drink will generally cause a brief drop in blood sugars, followed by a spike. This happens because the liver prioritises metabolizing alcohol over producing glycogen, so it hits pause on the sugar metabolism and then has a backlog to catch up on. In the case of alcoholic drinks that have alcohol and carbs, this will be more pronounced—so this means that the functional glycemic load of beer is higher.
That’s a point in favor of vodka.
Additionally, in terms of the alcohol content, correctly-distilled vodka’s alcohol is pure ethanol, while beer will contain an amount of methanol that will vary per beer, but an illustrative nominal figure could be about 16mg/L. Methanol is more harmful than ethanol.
So that’s another point in favor of vodka.
Once again, neither drink is healthy; both are distinctly unhealthy. But unit for unit, beer is the least healthy of the two, making vodka the lesser of two evils.
Want to learn more?
You might like to read:
- Can We Drink To Good Health? (answer: we cannot, but this was about alcohol’s proposed heart-healthy benefits)
- Guinness Is Good For You* (it isn’t, but this was the long-time slogan and marketing campaign that fooled many)
- How To Reduce Or Quit Alcohol
- How To Unfatty A Fatty Liver
Take care!
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The Sardinian Cholesterol Paradox
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Broadly speaking, low-density lipoprotein (LDL), or “bad” cholesterol, is generally considered to be… Well… Bad. Specifically because of how it can functionally narrow arteries, causing bits of floating detritus to get stuck in it, narrow it further, and eventually harden into atherosclerotic plaque, at which point it becomes even harder for the body to clear out.
We wrote about the process here: Demystifying Cholesterol
When it comes to cholesterol, the most common lay understanding (especially under a certain age) is “it’s bad”.
A more informed view (and more common after a certain age) is “LDL cholesterol is bad; HDL cholesterol is good”.
A more nuanced view is “LDL cholesterol is established as significantly associated with (and almost certainly a causal factor of) atherosclerotic cardiovascular disease and related mortality in men; in women it is less strongly associated and may or may not be a causal factor”
We wrote more about that, here: Statins: His & Hers? ← despite most research being on men, statins have very different effects (and side effects) for women, often being relatively less useful, and more dangerous. There are exceptions (for some women’s specific profiles they can still be worthwhile), but the trend is certainly troubling.
What, then, of Sardinia?
Sardinia is well-known for being one of the “Supercentenarian Blue Zones”, a place whose inhabitants enjoy (on average, statistically) unusually healthy longevity. These places have been looked to for clues as to how to live the healthiest life.
For example: From Blue To Green: News From The Centenarian Blue Zones
However, researchers recently were investigating life in a region of Sardinia where a lot of people are aged 90+, and followed the health of 168 of them for up to 6 years (because in the case of those who died during that time, obviously the time was less than 6 years).
Note: because this was specifically a Blue Zones study, they only included participants of whom all four grandparents were born within the Blue Zone—so not, for example, looking at the health of someone who just moved there from New York, say.
They collected a lot of interesting data (of course), but what we’re talking about today is that they found that participants with LDL levels above 130 mg/dL had a significantly longer average survival than those with LDL levels below this threshold. Specifically, a 40% lower mortality risk.
This is interesting, because LDL levels ≥130 mg/dL are considered moderate hypercholesterolemia (i.e., the LDL levels are a bit too high).
However, if the same participants had total cholesterol levels over 250mg/dL, they got no extra survival benefits, and very high cholesterol was still linked with shorter survival.
You can read the paper here: The Cholesterol Paradox in Long-Livers from a Sardinia Longevity Hot Spot (Blue Zone)
But before you reach for the butter…
The researchers have several hypotheses about why these results could be so, including:
- The longevity has less to do with LDL itself, and more to do with the diet, with the ratio of grain to olive oil.
- Most of the participants with higher LDL cholesterol were on antihypertensive drugs, which a) will obviously have a cardioprotective effect, and b) means that their heart health is probably enjoying greater scrutiny, and medical scrutiny can also have a protective effect (indeed, that’s the point of it).
- It was also speculated that the locals of that region may have a genetic defense against the harm of moderate hypercholesterolemia, due to historical exposure to malaria meaning that naturally slightly higher cholesterol levels without increased cardiovascular risk may have been naturally selected-for (i.e. those without it were more likely to die of malaria and not pass on their genes).
Thus, it may be that it’s not so applicable more generally. However, it is still reason to at least re-examine how bad LDL cholesterol actually is, and whether for some demographics it could have a protective factor (much like “overweight” BMI is a protective factor for people over 65).
Still, if you’d like to keep on top of your cholesterol levels, check out:
How To Lower Cholesterol Naturally, Without Statins
Enjoy!
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Just Be Well – by Dr. Thomas Sult
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Firstly, what this is not: a “think yourself well” book. It’s not about just deciding to be well.
Rather, it’s about ensuring the foundations of wellness, from which the rest of good health can spring, and notably, an absence of chronic illness. In essence: enjoying chronic good health.
The prescription here is functional medicine, which stands on the shoulders of lifestyle medicine. This latter is thus briefly covered and the basics presented, but most of the book is about identifying the root causes of disease and eliminating them one by one, by taking into account the functions of the body’s processes, both in terms of pathogenesis (and thus, seeking to undermine that) and in terms of correct functioning (i.e., good health).
While the main focus of the book is on health rather than disease, he does cover a number of very common chronic illnesses, and how even in those cases where they cannot yet be outright cured, there’s a lot more that can be done for them than “take two of these and call your insurance company in the morning”, when the goal is less about management of symptoms (though that is also covered) and more about undercutting causes, and ensuring that even if one thing goes wrong, it doesn’t bring the entire rest of the system down with it (something that often happens without functional medicine).
The style is clear, simple, and written for the layperson without unduly dumbing things down.
Bottom line: if you would like glowingly good health regardless of any potential setbacks, this book can help your body do what it needs to for you.
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Palliative care as a true art form
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How do you ease the pain from an ailment amidst lost words? How can you serve the afflicted when lines start to blur? When the foundation of communication begins to crumble, what will be the pillar health-care professionals can lean on to support patients afflicted with dementia during their final days?
The practice of medicine is both highly analytical and evidence based in nature. However, it is considered a “practice” because at the highest level, it resembles a musician navigating an instrument. It resembles art. Between lab values, imaging techniques and treatment options, the nuances for individualized patient care so often become threatened.
Dementia, a non-malignant terminal illness, involves the progressive cognitive and social decline in those afflicted. Though there is no cure, dementia is commonly met in the setting of end-of-life care. During this final stage of life, the importance of comfort via symptomatic management and communication usually is a priority in patient care. But what about the care of a patient suffering from dementia? While communication serves as the vehicle to deliver care at a high level, medical professionals are suddenly met with a roadblock. And there … behind the pieces of shattered communication and a dampened map of ethical guidelines, health-care providers are at a standstill.
It’s 4:37 a.m. You receive a text message from the overnight nurse at a care facility regarding a current seizure. After lorazepam is ordered and administered, Mr. H, a quick-witted 76-year-old, stabilizes. Phenobarbital 15mg SC qhs was also added to prevent future similar events. You exhale a sigh of relief.
Mr. H. has been admitted to the floor 36 hours earlier after having a seizure while playing poker with colleagues. Since he became your patient, he’s shared many stories from professional and family life with you, along with as many jokes as he could fit in between. However, over the course of the next seven days, Mr. H. would develop aspiration pneumonia, progressing to ventilator dependency and, ultimately, multi-organ failure with rapid cognitive decline.
What strategies and tools would you use to maximize the well-being of your patient during his decline? How would you bridge the gap of understanding between the patient’s family and health-care team to provide the standard of care that all patients are owed?
To give Mr. H. the type of care he would have wanted, upon his hospital admission, he should have been questioned about his understanding of illness along with the goals of care of the medical team. The patient should have been informed that it is imperative to adhere to the medical regimen implemented by his team along with the risks of not doing so. In the event disease-related complications arose, advanced directives should have been documented to avoid any unnecessary measures.
It is important to note, that with each change in status of the patient’s health status, the goal of treatment must be reassessed. The patient or surrogate decision-maker’s understanding of these goals is paramount in maintaining the patient’s autonomy. It is often said that effective communication is the bedrock of a healthy relationship. This is true regardless of type of relationship.
This is why I and Megan Vierhout wrote Integrated End of Life Care in Dementia: A Comprehensive Guide, a book targeted at providing a much-needed road map to navigate the many challenges involved in end-of-life care for individuals with dementia. Ultimately, our aim is to provide a compass for both health-care professionals and the families of those affected by the progressive effects of dementia. We provide practical advice on optimizing communication with individuals with dementia while taking their cognitive limitations, preferences and needs into account.
I invite you to explore the unpredictable terrain of end-of-life care for patients with dementia. Together, we can pave a smoother, sturdier path toward the practice of medicine as a true art form.
This article is republished from healthydebate under a Creative Commons license. Read the original article.
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Steps For Keeping Your Feet A Healthy Foundation
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Important Steps For Good Health
This is Dr. Kelly Starrett. He’s a physiotherapist, author, speaker, trainer. He has been described as a “celebrity” and “founding father” of CrossFit. He mostly speaks and writes about mobility in general; today we’re going to be looking at what he has to say specifically about our feet.
A strong foundation
“An army marches on its stomach”, Napoleon famously wrote.
More prosaically: an army marches on its feet, and good foot-care is a top priority for soldiers—indeed, in some militaries, even so much as negligently getting blisters is a military offense.
Most of us are not soldiers, but there’s a lesson to be learned here:
Your feet are the foundation for much of the rest of your health and effectiveness.
KISS for feet
No, not like that.
Rather: “Keep It Simple, Stupid”
Dr. Starrett is not only a big fan of not overcomplicating things, but also, he tells us how overcomplicating things can actively cause problems. When it comes to footwear, for example, he advises:
❝When you wear shoes, wear the flat kind. If you’re walking the red carpet on Oscar night, fine, go ahead and wear a shoe with a heel. Once in a while is okay.
But most of the time, you should wear shoes that are flat and won’t throw your biological movement hardware into disarray.
When you have to wear shoes, whether it’s running shoes, work shoes, or combat boots, buy the flat kind, also known as “zero drop”—meaning that the heel is not raised above the forefoot (at all).
What you want to avoid, or wean yourself away from, are shoes with the heels raised higher off the ground than the forefeet.❞
Of course, going barefoot is great for this, but may not be an option for all of us when out and about. And in the home, going barefoot (or shod in just socks) will only confer health benefits if we’re actually on our feet! So… How much time do you spend on your feet at home?
Allow your feet to move like feet
By evolution, the human body is built for movement—especially walking and running. That came with moving away from hanging around in trees for fruit, to hunting and gathering between different areas of the savannah. Today, our hunting and gathering may be done at the local grocery store, but we still need to keep our mobility, especially when it comes to our feet.
Now comes the flat footwear you don’t want: flip-flops and similar
If we wear flip-flops, or other slippers or shoes that hold onto our feet only at the front, we’re no longer walking like we’re supposed to. Instead of being the elegant product of so much evolution, we’re now walking like those AT-AT walkers in Star Wars, you know, the ones that fell over so easily?
Our feet need to be able to tilt naturally while walking/running, without our footwear coming off.
Golden rule for this: if you can’t run in them, you shouldn’t be walking in them
Exception: if for example you need something on your feet for a minute or two in the shower at the gym/pool, flip-flops are fine. But anything more than that, and you want something better.
Watch your step
There’s a lot here that’s beyond the scope of what we can include in this short newsletter, but:
If we stand or walk or run incorrectly, we’re doing gradual continual damage to our feet and ankles (potentially also our knees and hips, which problems in turn have a knock-on effect for our spine, and you get the idea—this is Bad™)
Some general pointers for keeping things in good order include:
- Your weight should be mostly on the balls of your feet, not your heels
- Your feet should be pretty much parallel, not turned out or in
- When standing, your center of gravity should be balanced between heel and forefoot
Quick tip for accomplishing this last one: Stand comfortably, your feet parallel, shoulder-width apart. Now, go up on your tip-toes. When you’ve done so, note where your spine is, and keep it there (apart from in its up-down axis) when you slowly go back to having your feet flat on the ground, so it’s as though your spine is sliding down a pole that’s fixed in place.
If you do this right, your center of gravity will now be perfectly aligned with where it’s supposed to be. It might feel a bit weird at first, but you’ll get used to it, and can always reset it whenever you want/need, by repeating the exercise.
If you’d like to know more from Dr. Starrett, you can check out his website here 🙂
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Stop The World…
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Some news highlights from this week:
“US vs Them”?
With the US now set to lose its WHO membership, what does that mean for Americans? For most, the consequences will be indirect:
- the nation’s scientists and institutions will be somewhat “left out in the cold” when it comes to international scientific collaboration in the field of health
- the US will no longer enjoy a position of influence and power within the WHO, which organization’s reports and position statements have a lot of sway over the world’s health practices
Are there any benefits (of leaving the WHO) for Americans? Yes, there is one: the US will no longer be paying into the WHO’s budget, which means:
- the US will save the 0.006% of the Federal budget that it was paying into the WHO annually
- for the average American’s monthly budget, that means (if the saving is passed on) you’ll have an extra dime
However, since US scientific institutions will still need access to international data, likely that access will need to be paid separately, at a higher rate than US membership in WHO cost.
In short: it seems likely to go the way that Brexit did: “saving” on membership fees and then paying more for access to less.
Why is the US leaving again? The stated reasons were mainly twofold:
- the cost of US membership (the US’s contribution constituted 15% of the the overall WHO budget)
- holding the US’s disproportionately high COVID death rate (especially compared to countries such as China) to be a case of WHO mismanagement
Read in full: What losing WHO membership means for the U.S.
Related: What Would a Second Trump Presidency Look Like for Health Care? ← this was a speculative post by KFF Health News, last year
Halt, You’re Under A Breast
More seriously, this is about halting the metastasis of cancerous tumors in the breast. It is reasonable to expect the same principle and thus treatment may apply to other cancers too, but this is where the research is at for now (breast cancer research gets a lot of funding).
And, what principle and treatment is this, you ask? It’s about the foxglove-derived drug digoxin, and how it stops cancerous cells from forming clusters, and even actively dissolves clusters that have already formed. No clusters means no new tumors, which means no metastasis. No metastasis, in turn, means the cancer becomes much more treatable because it’s no longer a game of whack-a-mole; instead of spreading to other places, it’s a much more manageable case of “here’s the tumor, now let’s kill it with something”.
Note: yes, that does mean the tumor still needs killing by some other means—digoxin won’t do that, it “just” stops it from spreading while treatment is undertaken.
Read in full: Proof-of-concept study dissolves clusters of breast cancer cells to prevent metastases
Related: The Hormone Therapy That Reduces Breast Cancer Risk & More
Force Of Habit
“It takes 21 days to make a habit”, says popular lore. Popular is not, however, evidence-based:
❝This systematic review of 20 studies involving 2601 participants challenges the prevailing notion of rapid habit formation, revealing that health-related habits typically require 2–5 months to develop, with substantial individual variability ranging from 4 to 335 days. The meta-analysis demonstrated significant improvements in habit scores across various health behaviours, with key determinants including morning practices, personal choice, and behavioural characteristics❞
So, this is not a lottery, “maybe it will take until Tuesday, maybe it will take nearly a year”, so much as “there are important factors that seriously change how long a habit takes to become engrained, and here is what those factors are”.
Read in full: Study reveals healthy habits take longer than 21 days to set in
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