COVID-19

You get COVID-19, you get sick, maybe go to the hospital, get over it, and it's history. Is it?

The hard truth is that we know almost nothing about this virus. The book of symptoms is growing as rapidly as an urban dictionary. Your lungs at risk, only? Think again. We're beginning to appreciate that this virus affects us at multiple levels, i.e., total body, organ, tissue, and even at the cellular/molecular levels:

• PSYCHIATRIC: This virus manipulates your gut's microbiome, which affects serotonin neurotransmitter function. In fact, depression is now recognized to be a feature of COVID. I know someone who tested positive, and his very first symptom was uncontrollable depression. Imagine crying all night long and not even knowing why. He is now on antidepressants. He also cannot exercise without crashing in bed for 2-3 days.

• NEUROLOGIC: The virus messes with your glia, the immune cells of the central nervous system that police and modulate synapses of neurons. The famous "brain fog" is real and the worst part of it is no one — no one — knows how long it can last, will it come back, or will it keep coming back.

--Also, anosmia, i.e., loss of smell, which can impact taste, too.

• PULMONARY: There are many people who have developed asthma — people who never had it before. Older people, now with COPD-like shortness of breath, who never smoked in their lives.

• DERMATOLOGIC: The virus affects the circulation in small blood vessels, resulting in skin changes, expecially in the toes ("COVID toes"). This discoloration can sweep across the toes of one foot and on to the other foot. It resolves, but can come back.

Many of these are mere nuisances. Who cares if your toes turn brown, right? But the brain fog, memory impairments, and loss of physical agility or stamina are really big deals. I have a niece who is an ER physician who had to retire. If she does anything physically, she's down for days.

There is a saying in medicine,

"When you hear the sound of many hooves, think of horses, not zebras."

It is an adage that you should think of the most likely diagnosis when evaluating a symptom cluster, not the stuff you see on House, Yet, with COVID, there has been a stampede of zebras in medicine. Countless people are being turned away from ERs with the doctors having no clue as to what patients have or how to treat them. Yet, they had COVID. Although that isn't a smoking gun, there seem to be more and more zebras coming 'round.

Another expression in medicine is de novo, an adjective to describe a condition that is new, unexpected, and even unlikely. Like de novo asthma. De novo chronic fatigue. "De novo" used to be a big deal because it was just so unusual. De novo is slowly becoming de usual.

COVID is here to stay and worse, like any good virus, it keeps reinventing itself. We're going to be an über-vaccinated species soon. Add that to taking your shoes off at the airport or paying extra on Netflix to have no commercials.

Herd immunity? Not likely, because of — not only new variants — but because people who had it keep getting it. It may sound alarmist, but it's probably not a stretch to say we are not the dominat species on the planet. True, viruses won't discover fire or invent the wheel — just infect those who have.

The next shoe to drop is when this young COVID generation hits Medicare age. Long COVID will see a rise in healthcare costs never before seen. Even those who have no more COVID symptoms, per se (i.e., fever, shortness of breath, fatigue), will start seeing their own zebras that no one saw coming as they get older.

Is it really this bad?

I don't want to spout just gloom and doom. We will survive it. We won't beat it, but we will live with. Most importantly, howver, we must respect it. It is a work in progress. Zebras are showing ever-changing stripes.

The good news is that — today — total medical knowledge is DOUBLING every 73 days! (A thousand years ago, it took, well...a thousand years. Consider how quickly we had vaccines for the first COVID waves.) Now that we've begun to appreciate how our gut microbiome probably runs our lives, how the brain-body connection is really a thing, and how to tweak the human genome, COVID is what we've evolved our big brains to fight — the things without brains.