06.11.21
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Medicine generally defines health conditions as acute or chronic. For most individuals, COVID-19 has presented as an acute illness, with few evident lingering or long-term effects. However, some patients have not recovered as completely and — while the COVID-19 virus itself will have cleared their bodies — they continue to experience long-term, chronic illness associated with their infection.
We don’t know much about these conditions, which sometimes are referred to as “long COVID,” with patients often called COVID-19 “long-haulers.” Physicians and scientists are actively working to identify areas of commonality, including a growing number of long-haulers who experience chronic fatigue symptoms. These long-haulers challenge our understanding of the illness — as potentially chronic, rather than acute. However, they also provide a metaphor for COVID-19 response.
Earlier this week, MHA spotlighted recent national data identifying several counties in Missouri as among the top nationally in COVID-19 infections. Although COVID-19 hotspots are troubling in general, the write-up puts a fine point on the issue.
“Local public health officials in the affected counties attribute the outbreak to several factors, including vaccine hesitancy, presence of the Delta variant that recently swept through India, and gatherings related to high school graduation and Mother’s Day. As of June 7, 45% of Missouri adults have completed vaccination against COVID-19; however, the rates of vaccination in the affected counties are far lower.”
Missouri’s daily and weekly vaccination rate has fallen consistently since April. Among adults, the rate is approximately 45%. When looking at the entire eligible population — including all Missourians ages 12 and older — only 42% have initiated vaccination, with just 36% completing the process. We don’t have a supply problem; we have a demand problem.
COVID-19 is a virus. It doesn’t have hopes or fears, motives or a political worldview. Its biology simply is driven to survive and replicate. Our response to its biological imperative matters.
Hospitals’ efforts to fight the disease have been straightforward — work to decrease transmission and offer the best possible care to sick patients. We’ve treated COVID-19 primarily as an acute illness.
Perhaps we are entering the chronic phase of COVID-19 response and recovery. The desire to return to a more normal life, and vaccine hesitancy could provide enough time and space for new variants to result in a long-COVID response — in the disease, not individual illness. The likelihood of this increases as the disease mutates and imperils vaccine efficacy.
How long it takes medicine to identify the biology of long COVID — the chronic condition experienced by individuals — and to understand how to treat it, is unclear. As with all disease, prevention remains the best approach.
I fear that despite our significant accomplishments throughout the last year, complacency will shift our collective response from acute COVID-19 care to chronic COVID-19 disease management.
Missourians are skeptical by nature. I get it.
However, evidence of the efficacy of the current vaccines continues to grow, as does the evidence of long COVID’s harm. I hope we can move fast enough to contain the virus in the near term, and COVID-19’s toll in the long term.
Send me an email to let me know what you think.
Herb B. Kuhn
MHA President and CEO
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