What To Expect From Your Covid Infection
by David Archibald
22 July 2024
There are some big known unknowns in the world and there are questions that have yet to be asked. Perhaps the biggest of these is what proportion of people with a covid infection go on to develop asymptomatic long covid? It is considered that 5% to 10% of covid infections result in symptomatic long covid, but it seems that there is a far larger cohort of the asymptomatic covid-infected.
The designers of covid went to the trouble of sewing bits of the HIV genome into the covid virus. They combined the attributes of HIV with the infectiousness of measles. Some people are being infected with covid several times a year. If that seems unnatural, it is. What happened in HIV is that the infected would feel as if they had a case of the flu, it would clear up and life would go back to normal. And then years would pass and they would start developing strange diseases.
It would be easy enough to detect a persistent covid infection if we had a blood test for viral load. Blood tests for HIV viral load were commercially introduced in 1999. We are well into the fifth year of covid and yet no viral load tests have appeared. All we have in its place is the CD4 level, which is a lagging indicator. The US National Institutes of Health recently spent US$1.6 billion on long covid research and produced nothing to show for it. They were able to waste a king’s ransom on consultants and observation. It is as if they didn’t actually want to cure long covid.
A recent paper provides an indication that a high proportion of the covid infected will now have persistent covid. From the time before vaccination started, a cohort of infected had their lymphocyte response tested at 10 weeks and again at 10 months after infection. Amongst the results, most of those tested had an appreciably lower CD4 level at 10 months than at 10 weeks:
Which is exactly the same as what is seen in HIV. So if those bits of HIV sewn into the covid genome are going to make a covid infection much like a HIV infection, what can we expect from here?
It is a lot like the first 20 years of HIV, in that in the absence of a viral load test all we have to guide us is the CD4 level. The CD4 count is the number of cells in a millilitre of blood. The normal range for CD4 count is 500 to 1,800 cells per ml. And normally the number of CD4 cells in your blood is about twice the number of CD8 cells. Because HIV infects and kills CD4 cells, it was found that the number of CD4 cells would fall below the number of CD8 cells. This is called an inverted CD4/CD8 ratio and indicates a HIV infection. The same is seen in covid.
The CD4 count doesn’t measure your viral load. But it is a good indication of how much covid has damaged your immune system. It also indicates the level of danger from covid-related complications. The following figure shows how the CD count is likely to respond to a covid infection. This is in an ideal future in which antiretroviral therapy, yet to be developed for covid, provides an alternative to death.
The CD4 decline in the middle of the graph in HIV is about 50 cells per year in HIV, a rate similar to that has been seen in covid.
In the absence of an inverted CD4/CD8 level, a CD4 count above 500 is considered normal. In HIV, and the same would hold true for covid, a CD4 count below 350 is defined as late diagnosis or advanced disease. A count below 200 indicates very advanced disease.
With respect to children, they have stronger immune systems than adults. That is why when covid started it was thought that children weren’t affected. Then months later some would come down with the symptoms of long covid. Babies can be born with a CD4 count of more than 3,000 cells per ml. So to measure disease progression in children and babies, the CD4 percentage of total immune cells is used. In HIV, the normal CD4 percentage for someone who is HIV-negative is about 40%. A result of 29% equates to a cell count of 500 per ml.
The lower your CD4 count, the greater the risk of opportunistic infections. However there is an increased risk of tuberculosis at any CD4 count. Kaposi’s sarcoma can also occur at any level, though this increases below 500 cells per ml. Below 300 is the territory of microsporidia and cryptosporidium, along with skin problems. A count below 200 brings us fungal pneumonia, chest infections, and toxoplasmosis, which is a parasitic infection than can cause brain lesions. Then a count below 100 brings mycobacterium avium complex (similar to tuberculosis) and cryptococcus –- a fungal infection that can cause meningitis in the brain. Once below 50, that brings cytomegalovirus, which is a viral infection that can cause permanent vision loss and blindness amongst other things.
With all that in mind, let’s look at the recent outbreaks of notifiable diseases in NSW. This graph shows the last 24 years of whooping cough incidence:
The peaks of the outbreaks line up suggesting that their size is directly in response to population growth. Note the almost complete absence of incidence during the lockdown period and for at least a year after. It appears that breaking the transmission chain is effective. Whooping cough is not a HIV-related disease. This graph shows the incidence of cryptosporidium over the same time period:
The amplitude of the recent cryptosporidium outbreak is four times larger than the largest prior excursion in 2009. Cryptosporidium is a HIV-related disease with an increased incidence when CD4 levels are below 300 cell/ml. It could be that the greater increase of cryptosporidium relative to whooping cough in the recent outbreak of respiratory diseases was due to persistent covid. In the absence of a covid viral load test, one way to find out would be to test for CD4/DC8 levels in both groups.
It is very likely that an antiviral therapy can be developed for covid, just as it was for HIV. The sooner one is developed, the better. HIV treatment has evolved to highly active antiretroviral therapy (HAART), which is a combination of three or more antiretroviral molecules from at least two different classes of drugs. There are six classes of antiretroviral drugs:
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- Nucleoside reverse transcriptase inhibitors (NRTIs)
- Protease inhibitors (PIs)
- Entry inhibitors
- Fusion inhibitors
- Integrase inhibitors.
Each class uses a different mode of action to block the virus. HAART reduces the risk of HIV mutating around the treatment. HAART should result in a 30 to 100-fold reduction in the viral load within six weeks, followed by a further fall to below the limit of detection within four to six months. The CD4 count rises slowly over several months in response to the fall in viral load.
There is anecdotal evidence of ART drugs from HIV treatment reversing CD4 count declines in long covid. As the drugs involved are now out of patent, the daily cost of treatment should be less than $1. HIV drugs from India, generic copies of Truvada, can be imported for about $0.75 per day of treatment. Nevertheless, a lot of lab work needs to be done. We also need a viral load test for covid. And someone should check the CD4 and CD8 counts of the people who came down with cryptosporidium in the last outbreak.
Lastly, everyone who has ever had covid is advised to get their lymphocyte panel done to find out what has happened to their CD4 and CD8 levels. That will also establish a baseline to measure a trend should there be a need to test again. There is a federal election coming up and you may feel the need to get candidates to undertake what needs to be done in covid.
David Archibald is the author of The Anticancer Garden in Australia.