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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Mosquitoes can spread the flesh-eating Buruli ulcer. Here’s how you can protect yourself
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Each year, more and more Victorians become sick with a flesh-eating bacteria known as Buruli ulcer. Last year, 363 people presented with the infection, the highest number since 2004.
But it has been unclear exactly how it spreads, until now. New research shows mosquitoes are infected from biting possums that carry the bacteria. Mozzies spread it to humans through their bite.
What is Buruli ulcer?
Buruli ulcer, also known as Bairnsdale ulcer, is a skin infection caused by the bacterium Mycobacterium ulcerans.
It starts off like a small mosquito bite and over many months, slowly develops into an ulcer, with extensive destruction of the underlying tissue.
While often painless initially, the infection can become very serious. If left untreated, the ulcer can continue to enlarge. This is where it gets its “flesh-eating” name.
Thankfully, it’s treatable. A six to eight week course of specific antibiotics is an effective treatment, sometimes supported with surgery to remove the infected tissue.
Where can you catch it?
The World Health Organization considers Buruli ulcer a neglected tropical skin disease. Cases have been reported across 33 countries, primarily in west and central Africa.
However, since the early 2000s, Buruli ulcer has also been increasingly recorded in coastal Victoria, including suburbs around Melbourne and Geelong.
Scientists have long known Australian native possums were partly responsible for its spread, and suspected mosquitoes also played a role in the increase in cases. New research confirms this.
Our efforts to ‘beat Buruli’
Confirming the role of insects in outbreaks of an infectious disease is achieved by building up corroborating, independent evidence.
In this new research, published in Nature Microbiology, the team (including co-authors Tim Stinear, Stacey Lynch and Peter Mee) conducted extensive surveys across a 350 km² area of Victoria.
We collected mosquitoes and analysed the specimens to determine whether they were carrying the pathogen, and links to infected possums and people. It was like contact tracing for mosquitoes.
Aedes notoscriptus was the mosquito identified as carrying the bacteria that caused Buruli ulcer.
Cameron Webb (NSW Health Pathology)Molecular testing of the mosquito specimens showed that of the two most abundant mosquito species, only Aedes notoscriptus (a widespread species commonly known as the Australian backyard mosquito) was positive for Mycobacterium ulcerans.
We then used genomic tests to show the bacteria found on these mosquitoes matched the bacteria in possum poo and humans with Buruli ulcer.
We further analysed mosquito specimens that contained blood to show Aedes notoscriptus was feeding on both possums and humans.
To then link everything together, geospatial analysis revealed the areas where human Buruli ulcer cases occur overlap with areas where both mosquitoes and possums that harbour Mycobacterium ulcerans are active.
Stop its spread by stopping mozzies breeding
The mosquito in this study primarily responsible for the bacteria’s spread is Aedes notoscriptus, a mosquito that lays its eggs around water in containers in backyard habitats.
Controlling “backyard” mosquitoes is a critical part of reducing the risk of many global mosquito-borne disease, especially dengue and now Buruli ulcer.
You can reduce places where water collects after rainfall, such as potted plant saucers, blocked gutters and drains, unscreened rainwater tanks, and a wide range of plastic buckets and other containers. These should all be either emptied at least weekly or, better yet, thrown away or placed under cover.
Mosquitoes can lay eggs in a wide range of water-filled items in the backyard.
Cameron Webb (NSW Health Pathology)There is a role for insecticides too. While residual insecticides applied to surfaces around the house and garden will reduce mosquito populations, they can also impact other, beneficial, insects. Judicious use of such sprays is recommended. But there are ecological safe insecticides that can be applied to water-filled containers (such as ornamental ponds, fountains, stormwater pits and so on).
Recent research also indicates new mosquito-control approaches that use mosquitoes themselves to spread insecticides may soon be available.
How to protect yourself from bites
The first line of defence will remain personal protection measures against mosquito bites.
Covering up with loose fitted long sleeved shirts, long pants, and covered shoes will provide physical protection from mosquitoes.
Applying topical insect repellent to all exposed areas of skin has been proven to provide safe and effective protection from mosquito bites. Repellents should include diethytolumide (DEET), picaridin or oil of lemon eucalyptus.
While the rise in Buruli ulcer is a significant health concern, so too are many other mosquito-borne diseases. The steps to avoid mosquito bites and exposure to Mycobacteriam ulcerans will also protect against viruses such as Ross River, Barmah Forest, Japanese encephalitis, and Murray Valley encephalitis.
Cameron Webb, Clinical Associate Professor and Principal Hospital Scientist, University of Sydney; Peter Mee, Adjunct Associate Lecturer, School of Applied Systems Biology, La Trobe University; Stacey Lynch, Team Leader- Mammalian infection disease research, CSIRO, and Tim Stinear, Professor of Microbiology, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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It’s Not You, It’s Your Hormones – by Nicki Williams, DipION, mBANT, CNHC
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So, first a quick note: this book is very similar to the popular bestseller “The Galveston Diet”, not just in content, but all the way down to its formatting. Some Amazon reviewers have even gone so far as to suggest that “It’s Not You, It’s Your Hormones” (2017) brazenly plagiarized “The Galveston Diet” (2023). However, after carefully examining the publication dates, we feel quite confident that this book is not a copy of the one that came out six years after it. As such, we’ve opted for reviewing the original book.
Nicki Williams’ basic principle is that we can manage our hormonal fluctuations, by managing our diet. Specifically, in three main ways:
- Intermittent fasting
- Anti-inflammatory diet
- Eating more protein and healthy fats
Why should these things matter to our hormones? The answer is to remember that our hormones aren’t just the sex hormones. We have hormones for hunger and satedness, hormones for stress and relaxation, hormones for blood sugar regulation, hormones for sleep and wakefulness, and more. These many hormones make up our endocrine system, and affecting one part of it will affect the others.
Will these things magically undo the effects of the menopause? Well, some things yes, other things no. No diet can do the job of HRT. But by tweaking endocrine system inputs, we can tweak endocrine system outputs, and that’s what this book is for.
The style is very accessible and clear, and Williams walks us through the changes we may want to make, to avoid the changes we don’t want.
In the category of criticism, there is some extra support that’s paywalled, in the sense that she wants the reader to buy her personally-branded online plan, and it can feel a bit like she’s holding back in order to upsell to that.
Bottom line: this book is aimed at peri-menopausal and post-menopausal women. It could also definitely help a lot of people with PCOS too, and, when it comes down to it, pretty much anyone with an endocrine system. It’s a well-evidenced, well-established, healthy way of eating regardless of age, sex, or (most) physical conditions.
Click here to check out It’s Not You, It’s Your Hormones, and take control of yours!
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The Longevity Diet – by Dr. Valter Longo
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Another book with “The New Science” in its subtitle, so, is this one a new science?
Yes and no; some findings are new, many are not, what really sets this book apart from many of its genre though is that rather than focusing on fighting aging, it focuses on retaining youth. While this may seem like one and the same thing, there is a substantive difference beyond the ideological, which is: while anti-aging research focuses on what causes people to suffer age-related decline and fights each of those things, Dr. Longo’s research focuses on what is predominant in youthful bodies, cells, DNA, and looks to have more of that. Looking in a slightly different place means finding slightly different things, and knowledge is power indeed.
Dr. Longo bases his research and focus on his “5 pillars of longevity”. We’ll not keep them a mystery; they are:
- Juventology research
- Epidemiology
- Clinical studies
- Centenarian studies
- Study of complex systems
The first there (juventology research) may sound like needless jargon, but it is the counterpoint of the field of gerontology, and is otherwise something that didn’t have an established name.
You may wonder why “clinical studies” gets a separate item when the others already include studies; this is because many studies when it comes to aging and related topics are population-based studies, cohort studies, observational studies, or (as is often the case) multiple of the above at once.
Of course, all this discussion of academia is not itself practical information for the reader (unless we happen to work in the field), but it is interesting and does give confidence in the conclusions upon which the practical parts of the book are based.
And what are they? As the title suggests, it’s about diet, and specifically, it’s about Dr. Longo’s “fast-mimicking diet”, which boasts the benefits of intermittent fasting without intermittent fasting. This hinges, of course, on avoiding metabolic overload, which can be achieved with a fairly simple diet governed by the principles outlined in this book, based on the research referenced.
In the category of subjective criticism, there is quite a bit of fluff, much of it self-indulgently autobiographical and very complimentary, but its presence does not take anything away from the excellent content contained in the book.
Bottom line: if you’d like a fresh perspective on regaining/retaining youthfulness, then this is a great book to read.
Click here to check out The Longevity Diet, and stay younger!
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The Imperfect Nutritionist – by Jennifer Medhurst
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The idea of the “imperfect nutritionist” is to note that we’re all different with slightly different needs and sometimes very different preferences (or circumstances!) and having a truly perfect diet is probably a fool’s errand. Should we just give up, then? Not at all:
What we can do, Medhust argues, is find what’s best for us, realistically.
It’s better to have an 80% perfect diet 80% of the time, than to have a totally perfect diet for four and a half meals before running out of steam (and ingredients).
As for the “seven principles” mentioned in the title… we’re not going to keep those a mystery; they are:
- Focusing on wholefood
- Being diverse
- Knowing your fats
- Including fermented, prebiotic and probiotic foods
- Reducing refined carbohydrates
- Being aware of liquids
- Eating mindfully
The first part of the book is a treatise on how to implement those principles in your diet generally; the second part of the book is a recipe collection—70 recipes, with “these ingredients will almost certainly be available at your local supermarket” as a baseline. No instances of “the secret to being a good chef is knowing how to source fresh ingredients; ask your local greengrocer where to find spring-harvested perambulatory truffle-cones” here!
Basically, it focusses on adding healthy foods per your personal preferences and circumstances, and building these up into a repertoire of meals that will keep you and your family happy and healthy.
Pick Up Your Copy Of The Imperfect Nutritionist From Amazon Today!
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Avocado vs Olives – Which is Healthier?
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Our Verdict
When comparing avocado to olives, we picked the avocado.
Why?
Both are certainly great! And when it comes to their respective oils, olive oil wins out as it retains many micronutrients that avocado oil loses. But, in their whole form, avocado beats olive:
In terms of macros, avocado has more protein, carbs, fiber, and (healthy) fats. Simply, it’s more nationally-dense than the already nutritionally-dense food that is olives.
When it comes to vitamins, olives are great but avocados really shine; avocado has more of vitamins B1, B2, B3, B5, B6, B7 B9, C, E, K, and choline, while olives boast only more vitamin A.
In the category of minerals, things are closer to even; avocado has more magnesium, manganese, phosphorus, potassium, and zinc, while olives have a lot more calcium, copper, iron, and selenium. Still, a marginal victory for avocado here.
In short, this is another case of one very healthy food looking bad by standing next to an even better one, so by all means enjoy both—if you’re going to pick one though, avocado is the more nutritionally dense.
Want to learn more?
You might like to read:
Avocado Oil vs Olive Oil – Which is Healthier? ← when made into oils, olive oil wins, but avocado oil is still a good option too
Take care!
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What happens when I stop taking a drug like Ozempic or Mounjaro?
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Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.
Drugs like Ozempic are very effective at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger.
But does weight come back when you stop using it?
The short answer is yes. Stopping tirzepatide and semaglutide will result in weight regain in most people.
So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far.
It’s a long-term treatment, not a short course
If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone.
For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns.
Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.)
Obesity drugs only work while you’re taking them. KK Stock/Shutterstock Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less.
Why do people stop?
Research trials show anywhere from 6% to 13.5% of participants stop taking these drugs, primarily because of side effects.
But these studies don’t account for those forced to stop because of cost or widespread supply issues. We don’t know how many people have needed to stop this medication over the past few years for these reasons.
Understanding what stopping does to the body is therefore important.
So what happens when you stop?
When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to move out of your system. As it does, a number of things happen:
- you start feeling hungry again, because both your brain and your gut no longer have the medication working to make you feel full
When you stop taking it, you feel hungry again. Stock-Asso/Shutterstock - blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a low glycemic index to stabilise your blood sugars
- over the longer term, most people experience a return to their previous blood pressure and cholesterol levels, as the weight comes back
- weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle.
While you were on the medication, you will have lost proportionally less skeletal muscle than fat, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat.
Is stopping and starting the medications a problem?
People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of yo-yo dieting.
When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to deal with spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can stress your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual.
Interestingly, the risk to the body from weight fluctuations is greater for people who are not obese. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight.
How can you avoid gaining weight when you stop?
Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include:
- getting quality sleep
- exercising in a way that builds and maintains muscle. While on the medication, you will likely have lost muscle as well as fat, although this is not inevitable, especially if you exercise regularly while taking it
Prioritise building and maintaining muscle. EvMedvedeva/Shutterstock - addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is fat-phobic and discriminates against people in larger bodies
- eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes.
Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important.
Read the other articles in The Conversation’s Ozempic series here.
Natasha Yates, General Practitioner, PhD Candidate, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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