This Week in Long Covid

Keep on Trucking

Issue 2.4: Keep on Trucking

The next time you get a shipment of toilet paper from Amazon, or a knickknack from Etsy, or even a letter from your Aunt Sue in Tuscaloosa, thank a trucker. According to one estimate, roughly 4 million Americans work full-time as long-haul truckers, with another 3 million holding part-time jobs on the nation’s roads. Meanwhile, the U.S. Department of Transportation lists some 770,000 for-hire fleets.

What do all those numbers have to do with COVID-19? A lot more than you might think.

According to Healthy Trucking of America (HTA), an advocacy group for the profession, truckers—the preferred term is professional drivers—are among the least healthy workers in the United States. Roughly 54% are obese, many have liver conditions like hepatitis C infection and fatty liver disease, half suffer from sleep apnea, and smoking and excessive drinking are common.

In other words, says Jon Slaughter, the CEO of the HTA, truck drivers in America are prime candidates for bad cases of COVID-19.

Even mild or asymptomatic cases of the infection can take an enormous financial toll on the nation’s economy. As Slaughter explains, truckers who test positive for the SARS-CoV-2 virus:

“will be sidelined by quarantine for up to 2 weeks.  Consequently, you’re looking at a severe loss of income for some drivers, such as owner operators, who exceed 10% of the driving population.” 

The economic cost is massive, too:

“When you add in the amount of freight that is not moved and deliveries not made, the numbers get into the billions.”

We spoke recently with Slaughter about the impact of the pandemic, and Long Covid in particular, on the trucking industry.

LC: How has the trucking industry acknowledged COVID-19 risks associated with the profession, and has there been some attempt to address, by extension, Long Covid?

JS: The American Trucking Association and dozens of state trucking associations are calling on the CDC's Advisory Committee on Immunization Practices to reclassify truck drivers into priority group '1b' of the committee's vaccination order recommendations. [See letter.]

LC: Have the medical personnel who take care of truckers been given any specific training on Covid, acute or Long, and if so, what, and if not, why not? What are your plans for training?

JS: We don’t know of any special training that was provided to medical examiners specifically about COVID when it relates to drivers.  I can tell you the Federal Motor Carrier Safety Administration suspended the need for drivers to have a required medical exam due to COVID.  That will be lifted later this year, and the burden went back to the fleets and their policies when it came to driver safety following COVID policies that are unique to fleets and not overseen by any government standard—other than the standard mask-wearing requirement. It’s just filled with extensions and waivers to not require physicals and to wear a mask at the end of the day. 

LC: Given higher rates of chronic disease among truckers, and given the nature of trucking, which moves the drivers in and out of more and less infective zones, what are your recommendations for truckers who are out on the roads as they read this? How can they reduce the risks for COVID-19?

JS: Click here for what the CDC says—nothing more than what common sense allows, however fleets have a responsibility to keep up with their drivers and ensure when symptomatic for COVID they are quarantined.  Many fleets including large fleets like UPS and FedEx have excellent programs, but there are NO state or federal reporting requirements. Consequently, small- to mid-size fleets  that cannot afford elaborate software are left unprepared.

LC: What are your recommendations for pro drivers who have had a bout of COVID-19 and who feel they still have symptoms that may indicate Long Covid? What should they do, who should they see?

JS: The first response of course is go see your doctor and respect the health of everyone you interact with.  Sadly, many drivers who don’t know they are symptomatic are contributing to the spread of COVID.  So it’s important to get frequent COVID tests. 

LC: Finally, some Long Covid symptoms, like fatigue and brain fog, would be dangerous for someone negotiating a multi-ton vehicle on the road. When should a driver put away the keys and stop driving, and focus on their health? What should they do about lost income in those circumstances?

JS: What is particularly alarming is that the CDC also warns that adults of any age with obesity are at increased risk of severe illness from the virus that causes COVID-19, while adults of any age with liver disease might be at an increased risk for severe illness from the virus that causes COVID-19.  According to our survey, one in three professional truck drivers has symptoms of prediabetes and doesn’t know it. Unfortunately, the incidence of diabetes or obesity are conditions which lead to onset of fatty liver disease, including non-alcoholic fatty liver disease and the more problematic non-alcoholic steatohepatitis. These diseases often prompt the development of other issues such as advanced fibrosis, increased risk of cardiovascular events and—at the extreme—liver cancer, liver transplantation and death.

Our Take:

To be sure, the interview above has a lot of “what ifs.” The biggest unknowns being: We don’t know how many truckers have had COVID-19, and how many of them are long haulers. But the potential problem is concerning enough, both from an economic and public safety problem, that the Biden Administration needs to pay close attention. @PeteButtigieg @SecretaryPete: are you listening?

Quotation of the Week:

"No one is an expert in Long Covid at this point. It's an emerging clinical syndrome.”

Lara Danziger-Isakov, MD, pediatric infectious disease specialist, Cincinnati Children's Hospital, Ohio, as quoted in this article about Long Covid in children.

News of the Week:

The number is almost impossible to grasp when you consider it represents people, but there is no denying its accuracy: as of this week, half a million Americans have died from COVID-19. The national catastrophe of 9/11 killed nearly 3,000 people; COVID-19 has been killing that number every day for a while now. This is not a case of drip - drip - drip, this is an all-points bulletin to somehow turn the gusher off. Slowly, progress is being made, particularly with the onset of vaccinations.

It can’t be overstated how important it is to get your vaccination when you can; by doing so, you will help reduce the future death toll!

This astonishing death toll comes from the 28.2 million of us who have caught COVID-19. And of the many survivors, a large number of people have come down with Long Covid. How many? A low guess is 10% of survivors, which would mean about 2.77 million Long Covid sufferers in the US. We think a better guess is 30%, which means there are about 8.3 million long haulers out there. And indeed, there very likely could be considerably more.

But for now, let us spare a moment to reflect on the lives lost to this punishing, and puzzling, disease.

Datapoint of the Week:

30% show signs of PTSD.

Early on in the COVID-19 pandemic Italy was a hotspot. Researchers there wanted to do a follow-up study of survivors, and looked at their psychological health 1 to 3 months after being discharged from the hospital. They found that 30% showed signs of post-traumatic stress disorder, or PTSD. They also found that the group with PTSD had “more persistent medical symptoms”—in other words, they had Long Covid.

The physical challenges of Long Covid tend to get the most pixels and ink, but let’s remember that long-term psychological effects exist as well, and can be very damaging.

30% report persistent symptoms.

The same percentage also cropped up in a study from Seattle. This study looked at patients who filled out a questionnaire 3 to 9 months after having had a confirmed case of COVID-19. Fatigue was the most common persistent symptom.

Tweet of the Week:

Erin Baba, a freelance science journalist, on news that Gwyneth Paltrow is promoting a long-term detox for Long Covid on Goop:

Oh great, Gwyneth is using her long-haul COVID to sell snake oil pseudoscience and grift money out of other coronavirus survivors. This is extremely icky.

Homework:

This week’s homework is easy: Email us at longcovid@mcmahonmed.com with a question. We might use it to get an expert to comment. All enquiries considered! And don’t forget to hit that Subscribe button, it is free.

Also: If you have Long Covid and live in the United Kingdom, take heart. The government announced an 18.5 million pound ($26 million USD) infusion of new money to study the condition, and now has more than 70 clinics nationally to care for patients. If from the UK, you should keep track of these studies, and learn about the Long Covid clinic nearest to you.

As George Hencken, a filmmaker in the UK, told the Guardian:

“It’s a year since I’ve felt like myself. It’s a year since my life as I knew it came to an end. And I don’t know if I’m going to get it back again.”