November 5, 2021
To me, each relatively easily preventable death is shameful.
Since March of 2020, I have been trying to convince medical colleagues and scientists worldwide that the psyche plays a substantial role in COVID progression ― in vain.
What would be expected back then is that in due time, epidemiological studies would show relevant correlations. Flash forward to now. Extensive studies on correlations become feasible. And we see… relevant correlations. More and better studies in the future may reveal more.
This piece is based on an article of high scientific standard, documenting research from March to March over the ‘first year of COVID’ ― pre-vaccination time. [*]
This study examined data from about half a million hospitalized patients from 800 US hospitals, 18 years or older, with COVID-19, based on discharge electronic datasets and using ICD-codes. These don’t capture for instance ‘some feelings of anxiety’ but only strong disorders that are recorded as such. In this study, severe COVID was diagnosed when a patient ended up in the intensive care unit, on mechanical ventilation, or died.
Note that these are observational data, in which causality is especially challenging to discern.
These are the results in frequencies of comorbidities from the article:
As to the impact on mortality per condition, we see as top three in the same study:
- obesity: surplus mortality of 30%
- anxiety and fear-related disorders: 28%
- diabetes with complications: 26%
Noteworthy is that depression and several other frequently associated conditions (such as essential hypertension, lipid metabolism disorders, and asthma) somewhat diminished the mortality rate. This might be caused by the disorder and/or the therapy, or some bias such as why people are being diagnosed as ‘severely ill.’ The human body/mind is a highly complex entity. So are diagnosticians.
Strikingly, anxiety shows a substantial correlation with severe COVID illness and death.
Does this mean that some politicians and (social and other) media who did their best to scare people to death in order to make them comply, or just to sell or be in the spotlights, succeeded too literally? This issue should not be easily rejected.
Of course, people may be anxious because of being in the hospital with COVID getting worse. It may also be reciprocal, as in a whirlpool. Also, anxiety being diagnosed before COVID-19 was not independently associated with death or mechanical ventilation during COVID-hospitalization. On the other side, this does not include much of the direct nocebo effect of being ill with ‘the disease.’
As you can see, science is challenging, always. As an intellectual game, it’s super. To know the truth, it’s the best we’ve got on the condition that the game is played adequately and with fervor.
What we should do now: take mental profiles/questionnaires and stress parameters such as salivary cortisol of people entering the hospital. This is a pretty blunt instrument but better than nothing for sure. A small Iranian study from March 2020 showed positive results in this. [**] Unfortunately, there has not been any replication of this study as far as I know.
There is more in the data for whoever has some insight in psycho-somatics. If you want a deep dive, you might read my book: [see: “Your Mind As Cure”].
There are immense gaps in our knowledge about causality in several conditions listed above. For instance, there’s a reason why essential hypertension is called ‘essential.’ Meanwhile, there are many severe indications that the mind perspective plays a prominent role in many of them. [see: “Mind the Gap”]
The future of the past
We head towards a future in which this will be apparent, as two centuries ago, we were heading towards a future without leeches and venipunctures.
But surely, now, we have science to guide us, you say? Think again. Indeed, we have proper science oriented towards pharmacology, but not (yet) towards psychotherapy or psycho-somatics. We just haven’t, at least not experimentally. As such, we’re in the Middle Ages. We can think our way forward, but there is as yet an unfathomable lack of motivation to do so in healthcare. [see: “Are Physicians Interested in Healthcare?“]
Crudely based on US data, it appears that double the numbers of deaths are those of people with ‘long-haul COVID.’
That’s huge. Many of these may have symptoms for the rest of their lives. Mental problems are substantial in this. And mental causes?
Is this number too big to care?
Worldwide, at present, 155 million people are ‘pushed to extreme levels of hunger,’ substantially COVID-related (intertwined with conflicts and climate change). [OXFAM]
While we are waging war against the viral enemy, this can be seen as collateral damage. There is no war without it. Starting a war always carries the decision to take such damage for granted. This case is not different. It comes on top of those who directly succumb to COVID. Almost certainly, collateral fatalities are a manifold of the direct deaths.
That’s one more reason to not see it as a war but as a jointly Compassionate effort. [see: “The Virus is Not the Enemy“] That makes it all much more human and efficient.
Several trillion € are spent to keep economies afloat after the COVID disaster.
To psychogenic COVID research goes practically nothing.
To feeding the hungry goes way too little.
We have the means for progress.
I mean, some are right under your fingertips, right here. It’s ready for scientific studies and to be used in COVID. It’s ready for experimentally proving and acting upon what can be done in many healthcare domains. It only needs a diminishment of active denial. [see: “The Basic Denial“]
Is this the complete solution? Surely not.
Is this to be ignored as a decent part of the solution? Surely not.
Should it always at least have been 50/50 in COVID? I think so. What I am sure of is the necessity of sound science in this regard.
One way or another, there is insanity in this.
This insanity doesn’t disappear by closing one’s eyes or taking refuge in a box.
Please think out of the box.
[*] Kompaniyets L, Pennington AF, Goodman AB, Rosenblum HG, Belay B, Ko JY, Chevinsky JR, Schieber LZ, Summers AD, Lavery AM, Preston LE, Danielson ML, Cui Z, Namulanda G, Yusuf H, Mac Kenzie WR, Wong KK, Baggs J, Boehmer TK, Gundlapalli AV. Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020-March 2021. Prev Chronic Dis. 2021 Jul 1;18:E66. doi: 10.5888/pcd18.210123. PMID: 34197283; PMCID: PMC8269743. You also find the article directly at: https://www.cdc.gov/pcd/issues/2021/21_0123.htm
[**] Ramezani M, Simani L, Karimialavijeh E, Rezaei O, Hajiesmaeili M, Pakdaman H. The Role of Anxiety and Cortisol in Outcomes of Patients With Covid-19. Basic Clin Neurosci. 2020 Mar-Apr;11(2):179-184. doi: 10.32598/bcn.11.covid19.1168.2. Epub 2020 Apr 13. PMID: 32855777; PMCID: PMC7368100.