Monthly Archives: October 2025

“Those who don’t remember the past are condemned to repeat it.” – George Santayana

This graph related to Kaposi’s sarcoma (KS) by @1goodtern has been making the rounds. I thought I would go into a little bit more of why it both doesn’t surprise me and why it gravely concerns me.

Classic KS normally appears in males of Mediterranean or Eastern European descent at 50-70 years of age. This graph is of 19 – 44-year-olds. One major exception to this is endemic KS in sub-Saharan Africa, where it is common in children and young adults. The only other population that this is commonly seen in besides AIDS patients is in organ transplant recipients due to immunosuppressive therapy

This has been my big concern with COVID. I keep thinking how the progression of HIV to AIDS is about a decade, yet here we are seeing some of the same sequela in just a few years after the onset of COVID.

Here’s the entire thread of graphs like this.

Thread by @1goodtern on Thread Reader App – Thread Reader App

Models suggested that by 2023, 70% of the US population had been infected. I wouldn’t be surprised by 80+% now. There is also some evidence suggesting that people don’t clear the virus. That could account for why we see less severe cases, particularly since mutations have mostly been antigenic drift. That would account for why there are fewer cases over time…people are still harboring a similar virus and maintain some level of antibody response. However, when an antigenic shift happens, we will have a much more serious surge.

The big concern I have is viral persistence. Fragments and proteins have been detected in blood and tissue samples two years after infection. That seems to suggest active, but perhaps latent infection causing chronic immune activation, autoimmune reactions, and the possibility of reactivation of other latent infections as a result, TB for one.

This is why I continue to wear respiratory protection except in my office where I have two HEPAs running. More importantly, it’s why I keep pushing others to do the same. I fear we are on the same trajectory as AIDS. I keep thinking that if HIV were airborne, would we require people to use respiratory protection? COVID is a far worse disease in the long term.

I have come to a much better understanding of the frustrations of Semmelweis (faced resistance and skepticism from the medical community) and the constant battle Sisyphus fought over the past five years.

My current role is as director of infection prevention for a hospital system. I do this kind of work as a traveler, so I see the best and worst practices in many places.

Today I was working on our healthcare associated infection (HAI) plan for the execs. Hospitals routinely monitor rates of HAI and work to reduce them. I wanted to include a section about how COVID is going to make HAI rates climb. This is what I wrote.

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One important measure to keep in mind is the impact COVID is going to have on HAI rates due to the immune dysregulation and vascular damage it causes. I had expected HAI rates to climb as a result and pulled UK data on MRSA bacteremia in late 2024. I did not use 2020 data for pre-COVID and pandemic trends because of the high number of confounding variables that year. The trend lines painted a picture far worse than expected.

Eventually data was published that showed similar trends with other organisms.

It’s not just adults. These problems are showing up in pediatric populations, such as this study from JAMA around Group A strep infections.

This is also reflected in pediatric influenza deaths by season. One doesn’t even need trend lines to see a big difference in the patterns before COVID and now.

As part of assessing cognitive ability of HCWs, I used Google Search Trends to extrapolate some answers to brain function pre-COVID versus current, showing similar trends. This suggests that procedural errors that could result in HAI will become more frequent. In this case, I used a simple cutoff of March of 2021 to account for the lagging effects of problems like this after acute infections.

In the current era, maintaining infection rates may become challenging. This is compounded by the recent gutting of the CDC, which would normally provide data at a national level, although it lags far more than the data that is provided by the UK. It may be worth thinking of HAI goals in the framework of increasing at slower rates than the national average.

The chronic disease sequelae from COVID are going to place a high burden on healthcare in the coming years, particularly in combination with the aging baby boomer population. Further, these sequelae will hit healthcare workers as well, which will reduce the size of the HCW labor force. That will likely lead to more HCWs leaving the field from burnout, causing a positive feedback loop.

The excess burden of this combined with multiple infections will hasten this outcome. The reinfection burden was recognized back in 2022.

We are facing a very harsh reality that much of the population is either ignorant about or is living in denial about. Neither changes the outcome. All we can do is try to mitigate the worst of this, but I have my doubts that we have the willpower (or current leadership) to do so.

Who needs horror movies when we have reality?