Issue 21.7: Veterans’ Health
For this week’s newsletter, we spoke with Dr. Evelyn L. Lewis, president of the Veterans Health and Wellness Foundation, a group devoted to improving the lives of the nation’s roughly 20 million veterans.
LC: How has COVID-19 affected the nation’s veterans? Have they been hit particularly hard by the pandemic?
Dr. Lewis: At the beginning of the pandemic, about a year ago now, we began to hear that the people who were most vulnerable to catching this virus were those with co-morbid conditions. So, it was no surprise to me that the issue of health disparities would soon arise in the conversation. Central to that conversation would be the issue of ethnic minorities, whom we know are notably at higher risk for almost any of the diseases that we talk about. And, I will venture to say, veterans also fit that category, regardless of their race or ethnicity. They’re at higher risk for things like diabetes and pulmonary hypertension and even certain kinds of cancers—in part due to their experiences and exposures and the types of jobs they’ve had during their service to their country.
LC: Can you elaborate on the exposures and how that might make veterans more susceptible to COVID-19 and even Long Covid?
Dr. Lewis: Well, everyone is familiar with the use of Agent Orange during the Vietnam era. Very few people realize that each of our conflicts has its own version of Agent Orange. If you think about the first Gulf War, there was Gulf War Illness [https://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp], and a lot of that was a result of their exposures in those environments. The issue now with Afghanistan and Iraq involve—and many of you have heard the term—burn pits, which were used to burn various waste products. While the VA has made the association with a number of illnesses regarding Vietnam and Agent Orange, they have not yet made that same association with the exposures to burn pits. But a lot of the illnesses that veterans are reporting may be linked to those exposures.
LC: So, right now the case is largely circumstantial?
Dr. Lewis: That’s correct. We know that many veterans belong to racial and ethnic minorities that are already at higher risk for contracting bad cases of COVID. And we also know that many of them have experienced exposures during their service that might make them even more vulnerable to a bad course of the infection. The problem is that, so far, researchers haven’t teased out who among the groups of patients that suffered bad cases of COVID-19—or even who died of the disease—are veterans. What we can say, however, is that we now appear to have had more veterans die of COVID-19 than all the U.S. soldiers who died in the Iraq and Afghanistan conflicts combined [7,036 as of Feb. 2, 2021 https://www.statista.com/statistics/303472/us-military-fatalities-in-iraq-and-afghanistan/], or who committed suicide in the past year.
LC: As you mentioned, some of the health problems that affect veterans, like “brain fog,” chronic fatigue and chronic pain, might be holdovers from either combat trauma or other service-related illness—or they might be signs of Long Covid. Do you think that there might be sort of a masking effect, and might it be difficult to figure out who has Long Covid instead of, or perhaps as well as, these other conditions?
Dr. Lewis: Well, I think what will be interesting is if we were to look at long haulers and ask the question, how many of them are veterans, and then look at how many of those who are veterans have had these other issues that have similar symptoms, like post-traumatic stress disorder [PTSD] and traumatic brain injury, which can have the mental fog we’re talking about. I think we might find something there.
One critical thing to keep in mind is that many veterans have mental health problems stemming from their service—PTSD, depression, anxiety and obsessive compulsive disorder. Before the pandemic, they were able to get help by going to different groups and meeting with their battle buddies, etc. The pandemic has really affected their ability to do that, and many of them are terribly isolated. We have mitigated to some degree that isolation by all of the Zoom calls that we're doing. But veterans will tell you that that really hasn't cut the mustard for them in terms of being able to see and connect with the people who helped them from place to place.
Our Take:
Veterans represent a significant chunk of the American populace. It is very likely that they have suffered more than average when it comes to getting COVID-19 and getting Long Covid. It is worth pointing out that one of the biggest socialized medicine organizations in the world happens to be the VA—the Veterans Health Administration. Most don’t think of it that way, but that’s in fact what it is. How will the VA, this one outpost of socialized medicine in the United States, handle the challenge of Long Covid? For the answer to that question we must stay tuned.
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Quotation(s) of the Week:
As per this opinion piece on Long Covid in the New York Times (paywall alert):
“Lingering symptoms from the coronavirus may turn out to be one of the largest mass disabling events in modern history.”
Also: You can read more about the similarities between Long Covid and other so-called “post-viral syndromes” in Julia Belluz’s recent article for Vox. As microbiologist Amy Proal said:
“I can’t find a single thing that the SARS-CoV-2 virus can do, that other viruses cannot. It’s well understood, and it’s been understood for decades, that every major pathogen capable of infecting people has a syndrome associated with it in which a certain number of patients who get that pathogen will develop chronic symptoms that never go away.”
News of the Week:
An important new study has just been published online by JAMA that looked at the health of a cohort of patients 4 months after having been hospitalized with COVID-19. These patients were followed up via telephone survey (n=478) and an in-person screening (n=171). Telephone screening revealed that about half reported a new symptom they had not had before, including fatigue (31%), cognitive symptoms (21%) and dyspnea (labored breathing, 16%).
In-person lung scans found that 63% had “subtle ground-glass opacities,” which is a description of foggy, unclear areas on lung scans that are indicative of disease. There were other abnormal findings from the study.
In an accompanying editorial, the author notes: “The heterogeneity of symptom profiles suggests that a single approach to follow-up and management of long COVID will not be effective,” thereby stressing the need to be inventive and nimble when it comes to addressing these patients.
The author also concludes: “Access to multidisciplinary clinics designed to address the myriad challenges after critical illness or COVID-19 is extremely limited. Thus, along with funding for research to better understand and treat Long COVID, simultaneous investment in clinical infrastructure will be needed to support patients as they recover from this challenging disease.”
In other words, a one-size-fits all approach to dealing with Long Covid isn’t going to succeed. And setting up specialized clinics designed for Long Covid sufferers is critical. We couldn’t agree more.
Tweet of the Week:
“We tend to think of viral infections as acute, short term, over once the virus clears the blood — and #longcovid as a unique phenomenon. That's wrong. This isn’t unique to Covid, [as] @VirusesImmunity told me.”
Julia Belluz, Vox.com
Homework:
Vaccines may be helping us return to a sense of normalcy, but what will the world look like for people who lost their jobs during the pandemic? And what if you dropped out of the workforce because you were experiencing disability due to Long Covid? How will employers view these gaps in our resumes? Jessa Crispin takes a look at the issue for The Guardian.
Plus: Although hidden behind a paywall, this opinion piece on Long Covid from the New York Times is worth a read if you have access to it.
If you should have a look, start with the early posts in November to get the big picture.
Thanks.
Hi Adam and James,
I wonder if you have had a look at my posts? I offer an hypothesis based on mitochondria dysfunction exacerbated by chronic inflammation. Let me know if you would want to cross post any of yours and my materials. Kind regards, Mardi Crane-Godreau, PhD