A recently published study on new onset diabetes in children within 6 months of COVID infection left me a bit stunned. At the six-month mark, the authors found children who had been infected had a 58% increased risk. It seemed worth explaining why this is so alarming.
There are 72.5 million children in the US. The baseline incidence of pediatric diabetes is 13.8 per 100,000 per year, or 72,500,000 x (13.8/100,000) = 10,005 new cases/year.
COVID seroprevalence studies suggest that 96.3% of children have been infected with COVID at least once, which equals 72,500,000 x 0.963 = 69,817,500 are at increased risk.
How do we calculate excess diabetes as a result of COVID in children? First, we need to calculate the rate due to COVID, which is only going to occur in the children infected with COVID. That rate is 0.58 x 13.8 per 100,000, or 8.004 per 100,000. That provides us with 69,817,500 x (8.004/100,000), or 5,588 new cases of diabetes among children per year, but that is a gross underestimate for many reasons.
First, the original study was only looking at risk within a few months of a COVID infection. That means that this risk figure is more akin to a point estimate than looking at lifetime risk. This is in part due to COVID being a vascular disease that causes microthrombi and focal tissue necrosis. I still suspect that most of the chronic disease burden from COVID infections will take a decade to become manifest.
Second, we also know that repeated infection increases the diabetes risk in adults by 70%, and we can use that number to estimate what happens in kids.
Let’s assume that half of the pediatric population in the US has been infected twice, which would be 34,908,750 facing this increased risk. The rate from repeat COVID infection would add 8.004 x 0.7 x 34,908,750, or an additional 8.004 x 0.7 x 34,908,750 / 100,000, or another 1,956 new cases of diabetes per year among those who were infected twice. The annual burden of diabetes from RECENT COVID infection then becomes 7,544 cases/year. It’s reasonable to assume that each subsequent infection increases that risk even further.
This further supports my argument than most of the disease burden of COVID is really many years off in the future. We have become so focused on the acute phase of the disease and are ignoring these other serious sequelae.
Similar calculations can be made with other diseases, but again, it would only be a small fraction of what is to come. This is but one example of why I have such a mix of emotions about COVID, ranging from anger, futility, and to depression. All of the numbers I just calculated are just the tip of the iceberg of what we are doing to future generations. We do not have the capacity to handle this scale of disease. We are handing future generations a dystopia of our own making between this, H5N1, and climate change. Those who have the power to make decisions to protect the public and fail to do so will not be remembered kindly by history.
A few people asked if I could share the letter I wrote to help someone get approved for disability from the Social Security Administration. I wrote to them and asked if it would be ok for me to share. Since it doesn’t contain any personally identifiable information, they approved.
Since I’m not a clinician, which likely would be important for dealing with the SSA, I wrote my thoughts on their medical history and tied it to their symptoms. It was simply a means to provide their primary care provider with some ammunition to help with their claim. Sadly, I would be surprised if more than about 5% of physicians understood the scale of COVID sequelae. The letter is below the line.
I finally had a chance to review your records and pull together some of the research I have in my files. It sounds like it’s been a really rough time for you. I wish I could simply snap my fingers and make it go away.
With two known COVID infections, we know that your risks of multiple adverse outcomes increases as described by Bowe et al (2022). If you had asymptomatic infection(s) that went undiagnosed, these risks increase as well.
The hazard ratio (HR) in this graph shows the risk of those who have been reinfected compared to those who have not been infected. A 95% CI (the range in parentheses) is what is known as the confidence interval, which can be thought of as the range where 95% of the variation is due to the condition itself and not just due to statistical anomalies.
I’ll focus on a few of your complaints. Your risk of fatigue is 2.33 (2.14-2.54) times higher, mental health issues 2.14 (2.04-2.24) times higher, and neurological problems 1.60 (1.51-1.69) times higher compared to those infected just once.
It’s also clear that the risk of just one problem as a result of a COVID infection is about twice as high for those with two infections compared to those who have not been infected. You can see how each reinfection increases the risk compared to never being infected.
One of the mechanisms behind the neurological damage caused by COVID has been described. It has to do with the endothelial damage in capillaries during an infection. These capillaries cease to function and become what are known as string vessels, which are just the remnants of the capillaries that are no longer bringing blood to the local tissue, depriving brain cells of oxygen. The difference in the numbers of string vessels between controls and infected study animals is quite apparent with microscopy. The yellow arrows point to the string vessels.
This can easily explain some of the problems you are having. With the loss of capillaries, brain tissue can be deprived of oxygen and some cell death may occur.
One editorial in the NEJM specifically describes some of what you have been going through. “The cardinal features of long Covid include fatigue, dysautonomia (or postural orthostatic tachycardia syndrome), postexertional malaise, and cognitive difficulties that are colloquially referred to as ‘brain fog.'” That makes a pretty clear case for a disability claim.
The authors continue, stating “A recent analysis of the U.S. Current Population Survey showed that after the start of the Covid-19 pandemic, an additional one million U.S. residents of working age reported having “‘serious difficulty’ remembering, concentrating, or making decisions” than at any time in the preceding 15 years.” That would make it extremely hard for someone who has to memorize lines for their work.
In a very large (n=112,964) study on cognition and memory, the authors point out how different variants could have different impacts on cognition. Given that you were infected at least twice and based on the earlier study I provided, this would explain why a couple of different factors may have made memory and cognition harder for you.
The authors concluded “In this observational study, we found objectively measurable cognitive deficits that may persist for a year or more after Covid-19. We also found that participants with resolved persistent symptoms had small deficits in cognitive scores, as compared with the no–Covid-19 group, that were similar to those in participants with shorter-duration illness. Early periods of the pandemic, longer illness duration, and hospitalization had the strongest associations with global cognitive deficits. The implications of longer-term persistence of cognitive deficits and their clinical relevance remain unclear and warrant ongoing surveillance.”
“Our findings revealed significant attention deficits in post-COVID patients across both neuropsychological measurements and experimental cognitive tasks, evidencing reduced performance in tasks involving interference resolution and selective and sustained attention.”
“Furthermore, our patient group exhibited significantly higher levels of state and trait anxiety, as well as depression scores, than the control group. Anxiety and depression are among the most common COVID-19 sequelae, reported both in hospitalized and non-hospitalized patients.”
This suggests that both cognitive function and emotions are adversely affected by COVID. Again, I would argue that multiple infections likely increases the chances of having these problems and may increase their severity.
I think this supports the letters that were written by the professionals supporting your case.
My particular area of expertise is in healthcare infection prevention. Given two known prior infections, it really behooves you to avoid getting a third. The insistence of the SSA that you be seen again really goes against your best health interest. You have provided them with plenty of clinical support for your claim and as I have shown, there is plenty of research support for it as well.
If they are not taking simple precautions of increased ventilation, air filtration, and respirator use in their offices, this puts you at further unnecessary risk.
