Long term health concerns with COVID-19 infection.

covid can also cause....

Death from COVID is not the only concern for those who get the infection.  Long-lasting effects from the virus can affect the body. Damage to the lungs for those who recover from severe COVID lung infection may lead to an increased predisposition to future lung infections.  Confusion and fatigue are symptoms people may continue to experience after recovering from the acute effects of the virus.  While many who contract COVID do improve, the long term effects of this virus are still unknown.  As a clinician and as a patient, I continue to advocate for you and recommend preventing COVID exposure.


A  virus caused me symptoms for months and may have contributed to other conditions that still bother me.   Within two years of starting my career as a PA, a colleague diagnosed me with infectious mononucleosis.  I had elevated liver enzymes, fevers, sore throat, night sweats, dehydration, and body aches.  When I saw my PA, she and her supervising doctor tested me for streptococcal throat infection, hepatitis A, B, C, tuberculosis, and HIV.  I tested negative for those infections.  A blood smear showed atypical lymphocytes.  An EBV titer blood test suggested it was the cause of my illness.  Epstein Barr is a virus that causes mild symptoms in most people.  However, some people develop more severe symptoms.  In my illness, the acute symptoms lasted three weeks.  I went on to battle postexertional exhaustion; I describe it as feeling like a rag doll.  Instead of feeling energized after a simple 15-minute walk in the park, I would experience overwhelming tiredness that lasted for days.  I knew I had to regain my strength, and it was frustrating when exercise made me feel worse.  I had no choice but to cope with chronic fatigue, which lasted more than six months.  I remember, at the time, my employer allowed me to return to work part-time for several months.  I was grateful I worked in a clinic and for a health care organization.  Had I worked for a less sympathetic employer, I could have lost my job.  It was physically not possible for me to return to full-time employment.  Chronic Fatigue Syndrome is a real condition.  My symptoms were debilitating.  To this day, some health care providers fail to recognize chronic fatigue syndrome and often tell patients that their symptoms are all in their heads.  The unbelieving clinicians cite a lack of blood tests and other organic tests as reasons to support their disbelief.  Yet, those same clinicians believe in the diagnosis of migraines even though there is a lack of blood tests and other tests to confirm migraines.  Both conditions have criteria for meeting the diagnosis and are found in populations around the globe.  Clinicians have had to be encouraged by their colleagues to believe in CFS.  Estimates suggest there are 2.5 million Americans who suffer from CFS.  People who have persistent chronic fatigue seek treatment from more than one health care provider before being diagnosed.  A  2008 survey found up to 44% of people with the diagnosis reported having to visit five or more clinicians before the determination made.  Patients also add they had to seek a different health care provider to find someone who believes them and, thus, treats their symptoms. Even if a person sees a clinician who recognizes CFS, the treatment recommendations may not be up to date.  To make matters more troubling, people with CFS battle symptoms for years before they get treatmentAnother problem with making this diagnosis is the fact that several comorbid conditions share traits with the disease.    Conditions such as fibromyalgia, IBS, and hypothyroidism have overlapping symptoms, making it difficult for even experienced clinicians to make a diagnosis.  Research for CFS continues as this condition is expensive due to costs of care and loss of productivity.

It is essential to remember some viral infections are associated with long term risks.   After an EBV diagnosis, a person has an increased risk of developing lymphoma.  Varicella virus infections can return later in life, causing shingles that may present with a variety of symptoms and possibly severe consequences.

The number of new COVID infections reached all-time highs last week in the states of Arizona, Florida, North Carolina, Oregon, and South Carolina.  As the country reopens, the virus spreads, and new infections abound.  Sign up for member-only benefits, including:

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Stay informed and stay well.

Updated on 6/6/2020 at 2:07 pm EST

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Pandemic Fatigue


In the United States, many of the recent news reports are focusing on trying to find a new normal.  Merely using the word normal implies that things can go back to the way it used to be before COVID-19.  Unfortunately, we know that is not going to happen.   

One definition of fatigue is a person lacks the energy to perform tasks.  It is also known as exhaustion, feeling run down, lethargy, listless, malaise, or weakness.   Fatigue may be due to mental stress.  It may be due to physical demands.  Sometimes it is a combination of both psychological and physical.  Pandemic fatigue is feeling these symptoms as a result of adjusting our daily routine due to the COVID-19 pandemic.  We in the United States are suffering lives lost, unemployment, business disruption, and financial burden.  How the pandemic affects individual Americans varies considerably –  the contrasts can be as different as night and day.

Lives lost due to COVID 19 – over 90,000 Americans.  Australia – lives lost 98.  Iowa State has more COVID related deaths than the country of Australia.   Lucas county of Ohio has more COVID related deaths than the country of Greece.  The city of Chicago has more COVID associated deaths than the country of Poland.  In the United States, we have a stark difference between places that have lost a significant number of lives vs places that have significantly less.  Albany in Georgia, Baton Rouge, Bridgeport in Connecticut, Boston, Buffalo, Cedar Rapids in Iowa, Chicago, Detroit, Farmington in New Mexico, Flagstaff in Arizona, Greely in Colorado, Greensburg in Indiana, New York City, New Orleans, Philadelphia, Salem in Ohio, Sumter in South Carolina, Trenton in New Jersey, and Washington DC are among the hardest-hit cities with higher total death rates per capita.  Some metropolitan areas with low infection rates per capita include Portland, Sacramento, San Antonio, and Tampa Bay.   Another contrast is the percentage of African Americans who died in comparison to other races.  Theories as to why the African American population has suffered more include higher rates of pre-existing conditions, less access to health care, housing disparities, and a higher percentage of essential workers cited as probable causes.  Globally, the United States has one of the higher death rates per capita.  Countries with higher infection rates per capita should logically have higher numbers of COVID related deaths.   However, Singapore has a high number of infections per capita but is not among the top 15 countries in COVID related deaths.  It could be explained by how they define COVID related deaths.   Other undetermined factors could be reasons why they are not seeing as many deaths per capita.

Staggering unemployment is the new normal.   According to the Bureau of Labor Statistics, the unemployment rate for April 2020 spiked to 14.7% as 20.5 million workers lost their jobs.  Those facts do not include May unemployment figures.

Unemployment Rates for the World’s Largest Economies 

The unemployment rates for the world’s largest economies were generally low at the end of 2019.

  • Japan: 2.4%
  • India: 3.5%
  • Germany: 3.6%
  • United Kingdom: 3.9%
  • United States: 4.1%
  • China: 4.8%
  • Canada: 5.9%
  • France: 8.6%
  • Italy: 10.4%
  • Brazil: 11.6%4 

Source: https://www.investopedia.com/articles/personal-finance/062315/unemployment-rates-country.asp

In contrast the unemployment of the same countries in April 2020:

  • Japan: 3.0%
  • India: no data
  • Germany: 3.9%
  • United Kingdom: 4.8%
  • United States: 14.7%
  • China: 4.3%
  • Canada: 7.5%
  • France: 10.4%
  • Italy: 12.7%
  • Brazil: 14.7% 

Source: https://www.imf.org/external/datamapper/LUR@WEO/OEMDC/ADVEC/WEOWORLD/JPN

The United States Unemployment rate is now equal to Brazil.  Other countries who have faced COVID lockdowns such as Germany and the UK have not had as much of a change as the US.  China is the only country to decrease the unemployment rate.  People who still have employment are either essential workers or jobs that accommodated them to work from home.  1 in 5 Americans who had employment, lost it due to coronavirus. Some positions terminated while some companies forced to put their employees on hold, and when the weeks turned into a month, the anger was palpable.  People protested, wanting to return to their jobs or owners fighting for the survival of their business.   We as Americans have invested years of blood, sweat, and tears into our livelihoods, and we realized that we had to return to work.   The problem remains, how to make that happen without allowing the virus to spread out of control.

Finances – While the United States has been the most exceptional economy for more than a decade, we could lose that status. Increased national debt and the loss of employment will have an impact on the GDP.  The actual financial burden with the pandemic and its effect on the US has only begun.  At the beginning of the year, our economy was strong.  Business experts are talking about a recession that could rival the great depression.  One billionaire believes the United States will suffer an economic depression if the lockdowns last for a year.  The United States was already trying to balance saving lives and saving the economy back at the end of March.

Meanwhile, two professors at Northwestern University predicted the costs of not closing down non-essential businesses and allowing the virus to spread unchecked would have been more expensive than closing non-essential businesses. They were not alone in their predictions.  In the US and abroad, experts weighed in on what the best course of action would be. Investors are now predicting a 3.9% fall in U.S. GDP in 2020.

All this stress creates mental fatigue from the pandemic.  The kind that disrupts sleep and changes your appetite.  Psychological stress affects your ability to concentrate and contributes to other symptoms like headaches, muscle aches, and abdominal pains.  It is new stress, and our country unprepared.  Our food banks are in high demand, the unemployment offices that process payments unable to keep up, and the federal government was providing a stimulus intended to offset the financial strains are giving away money to corporations and institutions that do not need it.  While some large chain restaurants and sports franchises have already said they will return the money, one educational institution has already declared they will keep the money and use it for students.  If you don’t acknowledge the mental strain, you are in denial.  Denial itself is a psychological mechanism to try and protect oneself from facts.  When facts are too painful to admit, denial is a coping mechanism to allow you to continue to function, to move on.

Front line health care professionals are working extra hours – the physical demands of caring for more patients in hot zones day after day contributes to fatigue.  The post-traumatic disorder is already presenting in some of them from witnessing more deaths than usual.  It also gives a risk of suicide as we learned of one emergency room physician who got COVID, recovered, returned to work, and ultimately took her own life.  Nonessential workers are also affected.   They are at home, getting restless and weary as they watch the news, interact on social media, and worry about the safety of their loved ones.   In some hot zones, they are returning to work.  They now have to worry about how they can do their job safely and must plan a new work environment to reduce the chances of spreading infection.


What follows are some of the lives lost or changed due to COVID-19.  The loss of these heroes affects their loved ones, their neighbors, the communities they served, and our world:

Police officers – https://www.lawenforcementtoday.com/senior-detention-officer-officer-of-23-years-man-of-faith-dead/

Paramedics – https://www.ems1.com/coronavirus-covid-19/articles/covid-19-ems-deaths-jk5zWFziwYVYUaM4/

Store workers – https://www.eater.com/2020/4/7/21212135/grocery-workers-are-dying-from-coronavirus-trader-joes-walmart


Meatpackers – https://www.usnews.com/news/healthiest-communities/articles/2020-05-01/cdc-nearly-5-000-meat-plant-workers-infected-by-coronavirus

Doctors – https://www.nbcnewyork.com/news/local/new-jersey-er-doctor-dies-one-week-after-exhibiting-covid-19-symptoms/2354084/

Nurses – https://www.usatoday.com/story/news/nation/2020/04/21/us-nurses-who-died-coronavirus-honored-white-house-protest/2996839001/

Physician Assistants – https://www.military.com/daily-news/2020/03/31/guardsman-who-died-covid-19-remembered-1st-responder-passion-serve.html

Nurse Practitioners – fortunately, no deaths reported https://www.11alive.com/article/news/health/coronavirus/georgia-nurse-survives-covid19-battle/85-37c7b703-fe2f-41d3-b62f-f4a6ee2a838d

Nurse Anesthetists – thankfully, no deaths reported – https://www.nola.com/news/coronavirus/article_25b835c0-7b65-11ea-ab5c-67ceca2dba77.html

Respiratory Therapists – https://www.local10.com/news/local/2020/04/24/partner-of-fallen-healthcare-worker-says-they-need-more-protection-from-coronavirus/

Journalists – https://www.cnn.com/2020/03/29/us/maria-mercader-death-trnd/index.html

The journalists and colleagues we’ve lost to the coronavirus


Politicians – https://www.forbes.com/sites/jackbrewster/2020/04/07/these-34-us-lawmakers-have-tested-positive-for-covid-19/#378ee12d46d9


TSA employees – https://www.khou.com/article/news/health/coronavirus/fifth-tsa-employee-dies-of-coronavirus-as-more-than-500-have-tested-positive/285-8910f312-fd8e-418a-acc6-6ca303474a05

Overall Medical workers:  https://www.businessinsider.com/healthcare-workers-who-died-with-the-coronavirus-2020-4?op=1#douglas-linn-hickok-57-a-physician-assistant-and-new-jersey-national-guardsman-became-the-first-us-military-service-member-to-die-from-the-coronavirus-7

Overall memorials: https://www.cnn.com/interactive/2020/health/coronavirus-victims-memories/

When does the pandemic improve?  It could dramatically improve with successful treatments.   Finding effective antiviral medicines would allow for less severe outcomes.  A successful vaccine would prevent illness.   Herd immunity.  Even the possibility of finding a post-exposure prophylactic medication that is mostly safe and lessen the severity of disease would dramatically change things.  Until then, defense remains our best strategy.  Good luck in avoiding exposure to coronavirus in America.  Recent data shows you have had it with the shelter in place recommendations.  The latest guidelines implemented by the CDC to safely return us to work suppressed by the White House task force.  Some Americans are unwilling to wear masks when out in public but eager to protest and visibly display assault weapons to make their voices heard.  The concept of comprehensive testing before Americans returned to work seems to have lost traction.   America is suffering, and it will continue to do so in the unforeseen future as we will are unwilling to help stop the spread.  What we do here in the US has implications for others all around the globe. Our actions as a country will not only affect our economy but will have a ripple effect on other countries that rely upon the US for their country to function.  Many innovators and scientists are finding solutions to these complex problems.  Keep them in your prayers, for they are the ones who will save lives and decrease the suffering.  Our government had the opportunity to prevent the devastation of this pandemic, but that window of opportunity closed a long time ago.  At this time, our politicians can only react as prevention was not enough of a priority.

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Published 5/17/2020 at 8:30 am EST

Updated Local Reports of the COVID-19 impact from around the country 5/3/2020

Reports from around the country

Alabama Lawsuit with voting rules during the pandemic.

Alaska Governor gives an update on 5/1/2020, including the CARES Act funding plan submitted to the state legislature.

Arizona Governor tweets business guidance for reopening on May 4.

Arkansas Inside dining of restaurants begins May 11 with restrictions.

California Most new cases and deaths documented in Southern California where protestors demand lifting restrictions.

Colorado Governor states testing supplies ordered from South Korea not disclosed to the federal government over concerns of seizure.

Connecticut. Connecticut has more COVID documented deaths than the country of Switzerland.

Delaware 26-year-old becomes the youngest COVID related death in the state.

Florida South Florida hospital uses stem cells to improve the health of three seriously ill COVID patients.

Georgia Nearly 20% of the documented COVID infected have required hospitalization.

Hawaii Travelers to the islands will see changes, including no buffet-style luaus.

Idaho Nursing homes hit hard, staff without N-95 masks to protect one another.

Illinois confirmed cases and deaths continue to rise.

Indiana Nearly 900 cases of COVID found in a meat plant.

Iowa Current and former Governors disagree on states’ COVID response.

Kansas Second largest increase in cases.

Kentucky Nursing homes around the state had infection control problems before COVID-19.

Louisianna Two guards die of COVID-19 at immigration detention centers.

Maine When compared to rates in other states, Maine has lower infections and lower deaths.

Massachusetts 81 workers test positive at one store, shutting it down.

Maryland State asks the National Guard to protect testing kits so the federal government does not seize them.

Michigan Governor extends state of emergency through May 28 despite armed protestors demanding to reopen the state.

Minnesota Increased testing, increasing infections, and local hot spots.

Mississippi Governor announced Friday he is going to hold off on reopening the state.

Missouri State workers ask the Governor to do more to protect employees from the coronavirus.

Montana Governor wants 60,000 tests per month.

Nebraska Dakota county has one of the highest rates of confirmed infections per capita in the country.

Nevada State to extend unemployment benefits for additional 3 months.

New Hampshire State outlines reopening of businesses and defines capacity and other guidelines.

New Jersey The state has 1,623 COVID patients in critical or intensive care units. State joins six others to form purchasing consortium to buy PPE, coronavirus tests, ventilators and other medical equipment made locally and help prevent price gouging.

New Mexico Gallup hospitals overwhelmed and city on lockdown.

New York Court dismisses New York nurses case against Montefiore for COVID-19 protection

North Carolina General Assembly passed two COVID-19 response packages, approving over $1.5 billion of funding relief.

North Dakota Wind turbine plant closes temporarily in Grand Forks.

Ohio Governor changes requirement for everyone to wear face masks, extends emergency order to May 29.

Oklahoma Mayor of one city removes requirement of business requirement of employees to wear masks because of threats.

Oregon For the second time since March 29th, there were no deaths reported on Sunday.

Pennsylvania Doctor performs over 1600 free tests for residents who could not get them.

Puerto Rico Governor urges residents who are displaced from a recent earthquake to wear masks when the present to shelters.

Rhode Island 17 deaths on Saturday and over 300 new cases as the emergency order is set to end on May 8.

Samoa Governor extends state of emergency until June 1.

South Carolina Confirmed cases continue to climb, beaches and parks reopen.

South Dakota. No new COVID related deaths two days in a row.

Tennessee Governor’s Health Commissioner states that the probable or suspected deaths of COVID-19 are not being released to the public, only confirmed cases.

Texas and also this link COVID-19 problems in the prison system.

US Virgin Islands Premeir states wearing of masks will soon become law.

Utah The one day everything changed.

Vermont Department of Labor tells unemployed they must return to suitable work if called back by their employer or they will lose benefits.

Virginia 44 deaths reported on Sunday.

Washington Governor warns of increased infections as majority of King county residents are susceptible to the virus.

West Virginia Protests over federal government transferring prisoners from Washington DC into the state.

Wisconsin State tops its record of confirmed cases in 24 hours on May 1.

Wyoming COVID-19 virus, unemployment and Wyoming’s gender pay gap, which consistently ranks as one of the worst in the country, highlights unique struggles for women in the state.

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Updated 5/3/2020 at 6:00 pm EST