BY ANISH KOKA
If there was any doubt that the academic research enterprise is completely broken, we have the absolute devastation of a study in one of the many specialty journals of the Journal of the American Medical Association, JAMA Health.
Until now, I had no idea the magazine even existed, but now I know the words printed in this magazine are as close to the words printed in supermarket tabloids. You should too!
The paper that was brought to my attention is one that purports to study the detrimental health effects of Long COVID. A significant number of intellectuals who are still social distancing and wearing n95 devices live with the fear of the syndrome, which persists long after recovery from COVID. There are many papers disputing a number of putative mechanisms for how acute COVID infection can lead to long-term health concerns. This particular piece of research, amplified by the usual credible suspects on social media, found “an increase in adverse outcomes at 1 year for the PCC (post-COVID conditions) group surviving the acute phase of the disease.”
In this case, PCC (Post-Covid Conditions) is the basis of Long COVID, and leading commentators use this paper to point out that heart attacks, strokes and other major adverse outcomes have doubled in people 1 year post-Covid. during…
That’s a crazy statement, and anyone who repeats it has no business commenting on any scientific paper. Let me explain why.
To find out about the potential long-term damage of COVID, researchers need to be able to compare outcomes between those who have been infected with COVID and those who have been infected for a long time with those who have never been infected with COVID. At this point, finding a large enough group of people who have never had Covid is impossible, because everyone in the world will have been infected with COVID many, many times. Long-lasting COVID-19 is also difficult to determine because study after study finds no clear objective markers of the disease.
The syndrome is defined by a nebulous set of subjective symptoms experienced by survivors of COVID. In such cases, the ideal control group is people who believe they have had COVID-19 but have never tested positive for COVID. This was achieved in this study in the context of the epidemic, which compared self-reported COVID19 infection with sars-cov2 serological results (also published in JAMA Network) and found that persistent physical long-term symptoms were more associated with faith; having a COVID-19 infection rather than a positive Sars-COV2 laboratory test. (The notable exception was loss of smell.)
The most recent JAMA-Health study defines long-term COVID as patients who have had at least 3 diagnoses coded in the electronic medical record, claims the database in patients who have had a previous COVID diagnosis or previously tested positive for COVID. : Individuals in the PCC cohort received 3 or more diagnoses of COVID-19 or symptoms of COVID-19 at more than 1 visit between 5 and 12 weeks after their defined index date. Essentially, everyone who has been infected with COVID by default constitutes a potential PCC sample. Of the 205,307 patients with prior COVID available for analysis, 36,000 were excluded because they did not have three or more symptoms of COVID-19 at multiple visits 5–12 weeks after COVID diagnosis. That left about 169,000 patients who continued to have at least three COVID symptoms that met the criteria and were defined as PCC or “longCOVID.”
The authors and those expanding on this research seem to believe that 70% of people with COVID will go on to have chronic symptoms related to COVID. This is an absurd statement that has no basis in reality for anyone living in the real world. If that were true, everyone would be confined to their basements, as opposed to packing Superbowl stadiums.
From the massive list of diagnoses that qualify a patient to have a chronic Covid condition, the authors help provide a breakdown of the symptoms that make patients qualify.
Almost half of the patients still had an ICD10 diagnosis of hypoxemia, and one-third had a cough diagnosis coded 5–12 weeks after COVID. The researchers compared this cohort of patients with historical controls, consisting of patients matched for age, sex, socioeconomic status, and major comorbidities.
This allowed the researchers to find the expected rate of adverse events for the population that did not have COVID-19 and compare it to the adverse events seen in the long-COVID group over 12 months.
The relative risk of each serious adverse event is significantly increased in the post-COVID group.
But what does this mean? Does COVID double the risk of COPD, coronary heart disease, and ischemic stroke?
NO
This means that patients who have a diagnosis of dyspnea or hypoxemia coded in the electronic medical record are more likely to have a COPD diagnosis entered in the electronic medical record within 12 months after COVID-19. Vulnerable patients in the population without formal medical diagnoses are at risk of hospitalization or illness when a new respiratory virus appears. Those same patients are more likely to have persistent symptoms, regardless of whether the virus is a new strain of RSV, influenza, or the novel coronavirus. Patients admitted to the hospital with Covid pneumonia were also significantly more likely to be diagnosed with each outcome the study authors looked for.
The COVID research explosion reveals the dirty secret that much of academic medicine has turned into plumbing big data sets to generate snappy conclusions to serve some ideological ends. This is difficult to handle when the subject is a complex medical topic in a prestigious journal. The default is to believe conclusions that have been published by reputable people in well-known journals. But when the public, who have had COVID-19 many times, are told that 70% of those who survive COVID-19 have long-term symptoms and are now at twice the risk of every major heart/pulmonary/vascular disease, clearly recognized the statement as a lie. is.
One can only hope that the public wakes up to the generally appalling level of research being produced by a vast array of scientists on topics beyond COVID.
Anish Koka is a cardiologist in Philadelphia. Follow him on Twitter @anish_koka