Podcast Series Episode 1 : A look back at Covid-19
welcome to Diseases Simplified the podcast that breaks down medical science into clear accessible conversations hosted by a US board certified medical doctor this show is designed to help you understand your body your symptoms and the science behind common diseases without the medical jargon whether you’re a curious listener a student or someone navigating your own health journey you’re in the right place for reliable simplified and evidence-based information let’s make medicine make sense together welcome to the deep dive we’re here to help you cut through the noise and uh really get to those aha moments
that’s the plan
so today we’re diving into something that feels well like both yesterday and ages ago covid 19
it really does warp your sense of time doesn’t it
absolutely remember how fast everything changed offices empty schools online just overnight the world turned upside down
it was astonishing so our mission today is to unpack all of that for you we want to give you a really solid well-informed grasp of the pandemic
right we’ll look at the virus itself its huge impact the uh global response and the ripple still affecting us now health economy everything
exactly we’ve gathered tons of research articles data the whole nine yards our goal is to pull out the key insights maybe some surprising facts to help you understand those years better
okay let’s do it so starting right at the beginning what is CO 19 well fundamentally it’s a contagious disease it’s caused by a specific corona virus uh called SARS KV2 sars KV2 got it and this thing spread like wildfire right january 2020
yeah it exploded globally triggered the pandemic declaration pretty fast it was first picked up you know in pneumonia cases in Wuhan China
but the really interesting thing is its structure it has features especially that famous spike protein
ah yes the spike
that are found in similar corona viruses in nature specifically uh in Chinese horseshoe bats
so wasn’t entirely new in its type of structure sort of related viruses existed now when SARS COV2 gets into us it primarily goes through the respiratory system
the lungs right
yes the lower tract like the windpipe and lungs but also the upper tract sinuses nose throat
okay
and it gets into our cells using a specific doorway you could say it’s called the AC2 receptor
ac2
right and these receptors are super common on certain lung cells the virus’s spike protein basically acts like a key
unlocking the cell
exactly it connects to AC2 and lets the virus in
okay so once it’s in what happens the symptoms seemed well incredibly varied
hugely varied that was one of the biggest challenges you had everything from really mild almost nothing to sadly fatal illness
the common ones we heard about were fever fatigue that cough
persistent cough yeah breathing problems and then the really distinctive ones loss of smell and loss of taste of juicia
those are so weird
aren’t they but there were others too headaches stuffy nose runny nose muscle aches sore throat diarrhea even eye irritation
and COVID toes i remember that
yeah that skin manifestation and what was tricky is symptoms could change over time in one person made diagnosis tough early on and the incubation period how long after getting infected did people get sick typically about 5 days the median was four to five days most people who got symptoms showed them within say 2 to seven days
okay and pretty much everyone within 12 days but here’s the kicker
you could be infectious for 1 to 4 days during that incubation period before you even felt sick
ah so you’re spreading it without knowing
precisely that silent spread was a massive massive factor in how quickly it took off globally
makes sense
and speaking of silent spread a really significant chunk of people who got infected maybe at least a third some studies said up to 44% never developed any noticeable symptoms
wow nearly half in some studies
yeah asymptomatic but they could still transmit it
that’s huge it is now for those who did get symptoms the breakdown was roughly this about 81% had mild to moderate illness maybe mild pneumonia at worst
okay the majority right then about 14% developed severe symptoms things like um dyneia shortness of breath or hypoxia meaning low oxygen levels or you know significant lung involvement seen on scans
these folks often needed hospital care 14% okay
and then the last 5% developed critical symptoms really life-threatening stuff respiratory failure septic shock multiorgan dysfunction intensive care territory
and older people were hit harder
consistently yes the risk of severe disease definitely increased significantly with age
beyond just the initial sickness though the complications sounded terrifying pneumonia obviously but also ARDS
right acute respiratory distress syndrome that’s when the lungs basically get overwhelmed with inflammation and fluid and can’t function properly it often leads to needing a ventilator and can cause multiorgan failure it was a major cause of death
but it wasn’t just the lungs was it
not at all that was another surprising and scary aspect we saw major cardiovascular issues heart failure irregular heartbeats inflammation of the heart muscle itself liver injury too elevated liver enzymes were seen in like 20 30% of cases kidneys could take a hit as well up to 30% of hospitalized patients showed signs of kidney injury even if they had no prior kidney problems
and the brain I remember hearing about neurological effects
yes definitely reports of seizures strokes encphilitis which is brain inflammation uh gamber syndrome that rare paralysis even acute encphylopathy studies found damage to tiny blood vessels in the brain
goodness it really attacked the whole body
in severe cases yes and that brings us to the cytoine storm
right that term was everywhere what does it actually mean
so it’s basically the body’s own immune system going into overdrive in severe COVID you sometimes see this massive rapid release of pro-inflammatory molecules called cytoines
immune signals kind of
exactly but way too many all at once it creates this systemic hyperinflammation throughout the body
that’s bad because because that inflammation itself causes huge damage it can lead directly to ARDS to multiorgan failure
and it’s strongly linked to another major problem blood clots
ah thrombosis yes
a really high rate of blood clots was seen especially in ICU patients strokes heart attacks clots in the lungs or legs this cytoine storm and the clotting were considered leading causes of severe illness and death the body’s defense turned destructive
that’s terrifying and even if people survived the initial illness the problems didn’t always end there did they long co
exactly long COVID this huge umbrella term for effects that linger for months even years after the infection itself is gone
what kind of effects
all sorts chronic fatigue is a big one persistent cough shortness of breath ongoing inflammation or injury in organs like the lungs and heart
still affecting the organs months later
yes and neurological issues too brain fog memory problems headaches
psychological effects like anxiety depression mood swings we’ve actually seen observable damage to organs in long-term studies which are still ongoing
it’s really serious
it is and it’s why the WHO the World Health Organization was so adamant that just letting the virus rip through the population to get her immunity was uh morally unconscionable and unfeasible the potential for long-term harm was just too high
yeah that makes sense and certain groups faced unique risks too right like children
yes while kids generally had milder acute illness a small number developed something called pediatric multi-systemm inflammatory syndrome or MISC similar to Kawasaki disease causing inflammation in different body parts
and pregnant women pregnant women were found to be at increased risk of severe COVID illness more likely to need hospitalization ICU care ventilation and also higher risk of complications like miscarriage pre-term birth or the baby having restricted growth unvaccinated pregnant women especially later in pregnancy were particularly vulnerable and babies born to mothers with COVID were more likely to have breathing issues initially
so a really vulnerable group
definitely highlighted the need for careful management and prevention during pregnancy
okay so faced with this complex dangerous virus the world had to react how did we fight back let’s talk diagnostics first how do we know who had it well initially is often based on symptoms a provisional diagnosis
but confirmation relied on lab tests
pcr test
exactly rtpcr real-time polymerase chain reaction that became the workhorse it detects the virus’s genetic material from like a nose or throat swap
right chess CT scans were also useful sometimes especially if doctors strongly suspected COVID pneumonia but the PCR was maybe negative or pending
and antibbody tests
corological tests yeah they don’t detect the active virus but antibodies to the virus in your blood so they tell you if you’ve had a past infection important for tracking spread and immunity
got it then came prevention huge focus there obviously vaccines were the game changer
absolutely the speed of vaccine development was unprecedented the first one got regulatory approval in the UK in December 2020
less than a year after the pandemic started incredible it was but it built on decades of prior research into other corona viruses like the ones that cause SARS and MS that groundwork was crucial
and these vaccines they really made a difference didn’t they
hugely widely credited with slashing rates of spread severe illness hospitalization and death
though immunity wasn’t permanent boosters became necessary
right immunity waines over time especially as new variants emerged but the data was and remains pretty stark death rates for unvaccinated people were substantially higher than for vaccinated people they were also deemed safe for pregnant and breastfeeding individuals
okay besides vaccines what else masks lots to talk about masks
masks were key they work in two main ways source control stopping infected people from spreading droplets and aerosols right
and personal protection reducing the wearer’s chance of inhaling the virus
did the type of mask matter
yes properly fitted N95 respirators offered the best protection surgical masks were next best cloth masks provided some benefit but generally less especially if not well fitted or multi-layered but studies consistently show that community masking did reduce overall transmission
and then social distancing that really defined the early pandemic for so many people
it really did things like quarantines travel restrictions closing schools workplaces stadiums all aimed at minimizing close contact
stay home save lives
pretty much people stayed home limited travel avoided crowds and related to that was ventilation
ah yes air flow
became increasingly recognized as critical avoiding crowded indoor spaces was step one indoors things like increasing the rate of air exchange using more fresh outdoor air reducing recirculation
all helped
he filters and stuff exactly air filtration the WHO specifically recommended better ventilation and filtration in public buildings to clear out those infectious aerosols really underscored that this was primarily airborne
which leads to hygiene early on there was intense focus on cleaning surfaces wasn’t there wiping down groceries
there was and while the virus can survive on surfaces for a time hours to days the evidence piled up that this wasn’t the main way it spread fulmite transmission it’s called so touching things wasn’t the big risk
not the primary risk compared to breathing and aerosols that led to some criticism of intense deep cleaning as maybe hygiene theater
giving a false sense of security
potentially yeah diverting attention from the airborne risk of course regular handashing is always good practice for preventing many illnesses including COVID
sure and selfisolation and quarantine
standard public health tools recommended for anyone diagnosed or suspected of having COVID and quarantine usually 14 days initially for people who might have been exposed like close contacts or those returning from high-risisk areas
travel controls too border shutting down
yeah international travel controls were widely implemented the evidence for their effectiveness is sort of low certainty but they likely helped slow the spread especially early on
but screening at borders wasn’t foolproof
no symptom checks miss asymptomatic or preymptomatic people even testing could miss cases if done too early or without follow-up combining measures like testing plus a quarantine period maybe 10 days minimum was seen as more effective
okay let’s shift to treatment if someone did get sick what could be done initially it was mostly just supportive care right
pretty much managing symptoms like fever ensuring hydration providing oxygen if needed just supporting the body while it fought the virus
but then specific drugs started to emerge
yes as of around April 2022 a few key antivirals got approved though access varied neuratrol veritonavir which you probably know is pax leaves these were mainly for mild to moderate cases in people at high risk of getting severe disease they showed they could reduce the chance of needing hospitalization
and the US had that test to treat thing
yeah aimed at getting people free paxlovid quickly after testing positive to start treatment early when it’s most effective
what about drugs for more severe cases a major breakthrough was dexamethasone it’s a common corticoststeroid an anti-inflammatory drug
okay
it was found to significantly reduce mortality death rates in patients who were critically ill especially those on ventilators or needing supplemental oxygen
by calming inflammation
exactly counteracting some of that damaging hyperinflammation and related to that drugs specifically targeting the cytoine storm were also investigated
right drugs like toilazmab which blocks a specific inflammatory signal called IL6 or lensolumab these aim to directly dampen that immune overreaction some got included in treatment guidelines
but not everything worked out i remember hearing about hydroxychloricquin
right several drugs that showed early promise in labs or small studies like hydroxychloricquin lepino veriratonavir fluoxamin they ultimately didn’t pan out in larger rigorous trials found to be ineffective or in some cases potentially harmful science in action really it’s
trial and error what about using antibodies from people who recovered convolescent plasma that was explored heavily early on the idea makes sense transfer antibodies from someone who recovered to someone who’s sick
passive immunity
exactly but um the large scale evidence wasn’t great a big review in May 2023 found that for patients with moderate to severe CO 19 convolescent plasma didn’t actually reduce mortality or help symptoms improve so another promising idea that didn’t quite deliver in practice
so putting it all together virus response treatments
what did recovery look like how did outcomes vary
big variation again people with mild cases usually felt better within about two weeks okay but severe or critical cases recovery could take much longer maybe 3 to 6 weeks or even more and sadly for those who died the time from getting symptoms to death was typically between 2 and 8 weeks
and the lungs took the biggest hit long term
often yes the lungs were definitely the most affected organs as pretty striking studies showed up to 98% of hospitalized patients still had some abnormalities on their lung CT scans even after they felt clinically better 98%
yeah and long lasting effects like pulmonary fibrosis scarring in the lungs or just generally reduced lung function were more common in older people those who’d been severely ill spend a long time in the ICU or were smokers
how long did it take for lungs to recover
it could take months anywhere from 3 months to a year sometimes longer for lung function to get back to where it was before COVID if it ever fully did
and what about getting infected again reinfection initially it seemed pretty uncommon but once the omocrron variant arrived around 2022 reinfections became much more frequent
were they generally milder
the thinking was generally yes especially if it was the same variant you’d had before or if you were vaccinated your immune system had some memory some ability to fight it off better the second time
okay let’s talk risk factors who is most likely to get seriously ill age seems like the big one age was definitely the strongest predictor of severity mortality rates climbed dramatically among older adults how much more dangerous was it than say the flu
for middle-aged adults estimates suggested the infection fatality rate the chance of dying if you got infected was maybe a hundred times higher than the annual risk of dying in a car crash and way way more dangerous than typical seasonal flu
that really puts it in perspective and having other health problems coorbidities
huge factor the vast majority of people who died from COVID also had underlying conditions like what
data from Italy for example showed over 96% of deaths had at least one other condition averaging about 3.4 diseases per person
wow
most common were things like high blood pressure type 2 diabetes heart disease also serious respiratory conditions like moderate or severe asthma or COPD obviously increased risk significantly
lifestyle factors too smoking yes smokers were more likely to need intensive care or die air pollution exposure both short-term and long-term was also linked to worse outcomes and obesity particularly with fatty liver disease was another significant risk factor
what about people with weakened immune systems individual like organ transplant recipients were definitely at higher risk for severe illness their bodies just couldn’t mount as strong a defense and genetics did that play a role it seems so some people naturally don’t produce certain key antiviral proteins called type I interferons very well or they make antibodies against their own interferons those individuals tended to get much sicker
interesting
and specific genetic variants were identified that acted as risk factors in some populations also uh sex differences seem pretty consistent
males versus females yeah data from places like France and that Diamond Princess cruise ship showed males generally had higher rates of hospitalization higher rates of ICU admission among those hospitalized and higher fatality rates across all age groups compared to females the reasons aren’t fully clear but the pattern was there
okay and measuring mortality we heard CFR and IFR what’s the difference again
right two key ways to look at it right
cfr is the case fatality rate that’s deaths divided by confirmed cases so people who tested positive globally as of March 2023 that ratio is about 1.02% okay
but IFR the infection fatality rate is probably a better measure of the virus’s true deadliness it divides total deaths by the estimated total number of people infected including all the mild and asymptomatic cases that never got officially diagnosed
so it accounts for the hidden infections
exactly it gives you a more complete picture of the overall risk of dying if you contract the virus regardless of testing
got it now shifting gears dramatically the the economic impact it wasn’t just a health crisis was it it was a massive economic shock wave
massive is an understatement it hit practically everything capital markets labor markets global trade how much people were buying what factories were producing
supply chains breaking down
totally broken supply chains businesses suddenly having no cash flow it led to huge revenue losses and unfortunately millions of job losses worldwide how bad was the overall hit predicted to be
the IMF the International Monetary Fund initially projected a 4.4% contraction in the global economy just for 2020 they thought it could be worse than the Great Depression
wow
and the estimated total economic losses for 2020 2021 were somewhere around $9 trillion which is more than the entire economies of Japan and Germany combined it wasn’t just lost money it exposed how fragile some of our global systems were
right like manufacturing and trade already dealing with tensions
exactly they got hit with new pressures from lockdowns everywhere factory output dropped getting hold of necessary parts and materials became incredibly difficult the World Trade Organization predicted global trade could fall by anywhere from like 13% to almost 32% in 2020
a huge range but all bad
all bad it forced a lot of companies to rethink how and where they make things
and some sectors were just gutted weren’t they service industry
absolutely hammered shops closed restaurants closed people stayed home even where online sales picked up it didn’t make up for the loss of in-person business for many interestingly even when China lifted its restrictions the retail sector there didn’t just snap back immediately the hit was deep
tourism and hospitality must have been catastrophic
catastrophic is the right word travel bans mobility restrictions billions and billions in lost revenue countries heavily reliant on tourism saw huge chunks of their economy vanish vietnam expected maybe $7.7 billion in losses thailand over $3 billion
and hotels
hotel occupancy rates just plummeted globally china saw rates fall nearly 90% early on this meant immense hardship for hourly workers and huge financial strain on even the biggest hotel chains
sports and entertainment too everything just stopped
yep major events canled or postponed the Euros the Tokyo Olympics and Parolympics the British Open Golf billions in losses there and even when sports came back
it wasn’t the same initially was it limited crowds masks it changed the whole experience the entertainment world movies theater live music estimated maybe $5 billion in losses in 2020
hollywood shut down pretty much yeah
film releases delayed production halted something like 120,000 below the line jobs especially stage hands and crew were lost almost overnight movie attendance dropped over 80% box office revenue crashed and even by 2021 2022 it hadn’t really recovered to prepandemic levels
so facing this economic meltdown what did governments do
massive interventions especially in wealthier nations huge spending on health care direct support payments to people loans and grants for businesses central banks got involved too
big time slashing interest rates pumping liquidity into the financial system providing emergency financing trying to stop a complete financial collapse and keep credit flowing did experts see this economic crisis coming so fast
the speed really stunned many people how quickly the health crisis turned into an economic calamity initially a lot of focus was on the immediate financial fires maybe less on the long-term debt being accumulated
and the impact wasn’t equal globally was it
not at all many developing economies were hit incredibly hard struggling with both the health crisis and the economic fallout projections showed many wouldn’t recover the income losses per person even by 2022 reversing years of progress in reducing poverty and increasing insecurity
so what was the thinking among global leaders how do you tackle something like this
there was a widespread recognition that this needed immediate aggressive global action calls for international cooperation on economic policies trying to restore confidence and head off what looked like a potential great recession it really drove home how interconnected everything is
right one country’s problem quickly becomes everyone’s problem
exactly a truly globalized crisis needs a globalized response
so fast forward to now it’s been what nearly 5 years since the pandemic declaration how are things looking how do people feel
it’s interesting surveys suggest most Americans now feel the pandemic is sort of in the rear view mirror they aren’t personally worrying about catching COVID dayto-day as much
that feels right anecdotally
yeah but and this is a big butt even with that feeling threearters of Americans also say the pandemic took a real personal toll on their lives still feeling the effects
right and maybe even more tellingly 72% believe it actually further divided us as a country that’s a high number
it is it suggests that even if the immediate health fear has faded for many the social scars the divisions they linger something for you the listener to really think about
and schools that disruption must have had lasting impacts
absolutely k12 schools went through an incredibly difficult time as reports put it for students for parents for teachers and kids are still you know working their way through the impacts learning loss social development delays
it’ll take time to fully understand that
it will on a somewhat more positive note though the pandemic did result in this um enormous amount of public education about how illnesses spread and how to prevent them
masks distancing handwashing ventilation
exactly it seems to have genuinely shaped how many people now think about and handle illnesses more generally maybe some of those habits that awareness will stick so we’ve covered a lot of ground here from the virus’s biology to the uh global economic chaos the medical fight back and the lasting societal marks it’s been quite the journey
it really has a story of science moving at incredible speed of the economies under unprecedented strain and you know of human resilience and adaptation but also a deep vulnerabilities understanding all these different threads the medical the economic the social is so important for making sense of where we are now and maybe where we’re headed hopefully you feel better equipped now with a much deeper understanding than just the headlines
yeah you’ve got the context now the details behind the big picture so to leave you with a final thought the pandemic forced this incredibly rapid global reckoning it showed us where we were vulnerable definitely but it also revealed this immense capacity we have for collective action for innovation when we’re really pushed so the question is
what enduring lessons about preparedness about resilience not just for pandemics but across all our interconnected systems economics social ability what lessons should we be actively carrying forward to face whatever unexpected global challenge comes next thanks for listening to Diseases Simplified this episode was created with the aid of AI technology including voice generation to improve clarity and accessibility all medical content is based on current literature carefully curated and independently reviewed by a US board-certified physician please remember the information in this podcast is for educational purposes only and should not be taken as medical advice always consult your own healthcare provider for diagnosis and treatment tailored to your needs stay curious stay informed and we’ll see you next time
Episode 1 to our new Podcast Series – A look back at Covid-19
We’re excited to launch our podcast, to do deep dives on interesting medical subjects. We hope you enjoy it!
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Hey everyone, remember that wild ride we all went on a few years back? You know, the one where the world literally hit the pause button? We’re talking about COVID-19, the tiny virus that caused a massive stir and changed everything overnight.
It all started subtly enough, whispers from a city called Wuhan in China in late 2019 about a mysterious new illness. But before we knew it, this little bug, officially named SARS-CoV-2, had packed its bags and was on a world tour, landing everywhere. The World Health Organization quickly sounded the alarm, first calling it a global health emergency, then a full-blown pandemic.
Suddenly, our lives flipped upside down. Remember the Great Lockdown? Schools went silent, offices became ghost towns, and our favorite hangouts were suddenly off-limits. We were stuck at home, glued to daily updates, wondering if our grocery store shelves would ever be full again. It was a weird time of empty aisles, skyrocketing unemployment lines, and grandparents waving from behind windows.
This sneaky virus primarily spread through the air, carried by tiny droplets when people breathed, talked, coughed, or sneezed, especially when we were close together indoors. And the kicker? You could be spreading it without even knowing you had it! Symptoms varied wildly, from a sniffle that felt like a bad cold to a full-blown fight for breath, and for too many, it tragically led to severe illness or death.
But here’s where the heroes in labs stepped up! Scientists across the globe, in an unprecedented relay race, worked at “light speed” to understand this virus. They developed vaccines that were nothing short of a scientific marvel, rolling them out to protect us and lessen the blow. While the virus kept shapeshifting into new variants like Alpha and Omicron, scientists adapted, creating new boosters to keep pace.
Beyond health, the pandemic truly rocked our world. The global economy took a massive hit, impacting everything from tourism and entertainment to manufacturing and farming. It brought out mental health struggles, exposed societal inequalities, and forced us to rethink our ‘normal.’ But eventually, things mellowed out. The virus became more manageable, like a ‘bad flu or wicked cold.’
Finally, in May 2023, the global health emergency was officially declared over. Most of us gradually eased back into a semblance of our pre-pandemic lives. It was a chaotic, unforgettable chapter that showed us how interconnected our world is, and hopefully, it taught us a thing or two about being ready for whatever the future might throw our way!