dr Stuart Ekdahl is a New Zealand-trained physician, Fellow of the Royal New Zealand College of Urgent Care and co-founder of the White Cross clinic network
OPINION: I am a specialist in emergency medicine. I have worked with other clinicians for more than 25 years to care for people when they are in health crises and are most vulnerable.
I’ve seen it all in my role – strokes, heart attacks, broken limbs, psychosis and kids with pneumonia.
I have never been more concerned about health and healthcare issues than I am right now. Last week I was on a Zoom call speaking to a critical care specialist who suddenly started stuttering and slurring his words. I found out later that this intermittent speech difficulty has been happening to him for over a year.
A few days later I met up with a colleague who had been struggling with standing for three months and could only walk very short distances. What both colleagues had in common was a “mild” Covid-19 infection. Both were fit and healthy and fully vaccinated prior to their infection.
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I know these people and I believe what they tell me and what I hear and see. But two people I happen to know might just be coincidences. However, it seems that what my colleagues are experiencing is being picked up by researchers tracking Covid-19 survivors. This study of 4231 people in the Netherlands, followed for 17 months after Covid-19, showed that around 12% of people (around 10% of those vaccinated) had symptoms that disrupted their daily life for 3-6 months after their infection significantly affected.
Long Covid may be 40% less with the vaccine, but around 50% of people who get the Omicron variant may not have any symptoms. If those numbers are similar in New Zealand, where 1.7 million of us have tested positive for Covid, then we can estimate that 170,000 people are struggling with health conditions they didn’t have before they were infected. It’s no wonder my local coffee shop can’t seem to find staff and, perhaps more importantly, no wonder my emergency clinic sometimes struggles to fill rosters.
If we let it, the mounting long Covid and mass disability means every person, service and industry in our country could feel the effects of an even worse shortage.
I am concerned for these people and want to ensure that as few people as possible experience Long Covid. Why the quotation marks? Because we still do not have a clear definition or diagnostic pathway for this syndrome which, as my experience with my two colleagues above shows, can present very differently in different people. What we do know for sure is that long covid only occurs after infection with SARS-CoV-2 (Severe Acute Respiratory Syndrome 2), the virus that causes Covid-19, and is the only way to safely avoid long covid , is the SARS-CoV-2 virus.
The aim should be not to get Covid at all and if you have had it to try not to get it again. Every infection is like rolling the dice. This study with comment, out of 257,427 people over six months shows each Covid-19 infection increases the likelihood of long-Covid disability. Some people don’t get better due to a series of debilitating symptoms lasting 6-12 weeks to a year or more. In the UK, around one in five people with long Covid say they are “very badly” impaired in their daily lives.
A Covid infection is like a forest fire where each new fire seems to have more energy than the last and each new fire burns underground causing root damage.
How do we avoid contagion with Covid-19? Understanding how it’s transmitted is a good first step. The SARS-CoV-2 virus is transmitted primarily from the lungs of an infected person to anyone who shares indoor airspace with them. The virus spreads in aerosols created by people breathing. The aerosols can float like smoke, they can collect in areas where air movement is minimal, and they can survive for several hours. Any room in which infectious people have been present for hours and the air is not cleaned by ventilation or disinfection can contain infectious aerosols.
While vaccines are very effective at keeping us out of the hospital, they were developed two and a half years ago before anyone even heard of Long Covid. For now, vaccines can reduce Covid, but they can’t stop it for long. Unfortunately, our current vaccines do not prevent transmission of SARS-CoV-2. We cannot rely on vaccines to defeat the “variant soup” of rapidly changing BA2 and BA5 Omicron subvariants currently in circulation. We’re doing nothing to stop the exponential growth of new variants. New mucosal vaccines give us hope that infections and transmission can be reduced, but it is very likely that many millions more people will be infected before these vaccines are available in months or years.
Model makers tell us there will likely be another wave in New Zealand before Christmas. This new wave is likely to be fueled by variants currently circulating in Europe and America that we haven’t seen yet. Very few people will be immune to these new variants.
This may sound hopeless, but the truth is that we have the tools at our disposal to drastically reduce the number of infections we get individually and that our population gets. Vaccination and booster is the first resort, and it remains incredibly effective against death and serious illness.
The government has made rapid antigen tests free and easy to access. We can use these to test when we feel sick and to decide when it’s safe to come out of isolation. The government is also providing free face masks, including N95, for the vulnerable in collecting RATs, and the really good news is that masks will protect you from every SARS2/Covid-19 variant there is. Wearing a well-fitting N95 mask can protect you 10 times (compared to no mask). If everyone around you is wearing the same one, you are protected 100 times.
And when you add excellent ventilation and/or air purification (using HEPA filters or Ultraviolet-C technology) you can have protection similar to that out there in the Wellington wind. Excellent ventilation means at least 12 air changes in the room per hour, but studies have shown that transmission of Covid-19 (and other viruses) is greatly reduced at six air changes per hour. In many environments where large groups of people gather, excellent protection can be achieved by installing UV lamps above head height. The best thing about ventilation and air purification is that they work in the background and most people are completely unaware of them – it’s effortless.
In any case, it is necessary to keep 1 meter distance and avoid direct breathing to achieve this protection. For example, if we are in a restaurant at a distance of 1 m, avoid direct breathing and with 12 air changes per hour we can be protected a little less than 10 times.
It’s unclear why anyone would want to have Covid for a long time or want to be the cause of someone else getting it. The protective tools I spoke about are all recommended by healthcare professionals on the website www.vaccinesplus.nz. If you don’t want to endure Covid for long, you need to understand what it takes to avoid Covid infection and get used to using the tools available. Businesses looking to create safe workspaces for their employees and customers should check out the covidpledge website I created.
Once you know what to do, how to do it, and how you want to do it, many of the methods of preventing infection and transmission become child’s play. Let’s make it happen and long avoid Covid.