The Health of US Citizens Is Declining—But Why?

United States Flag (Adobe Stock 77995519 by Carsten Reisinger)

The health of the United States is rapidly declining, both medically and economically. Life expectancy has been well below comparable countries for decades, but recently with COVID-19, it has fallen off a cliff.
 
There are many reasons for this, but 1 of the prime causes is the abandonment of Public Health strategies. Much of the abandonment has been driven by disinformation. Associated with the pandemic has been a rise in infectious diseases which has caused a wave in mortality, adversely impacting. Pandemic-associated surges in various infectious diseases are becoming a worldwide phenomenon. The following are just a few of the reports:

Fig 1

Source: Kaiser Family Foundation

 
1. Childhood hepatitis
2. Surging Streptococcal infections
3. RSV infections
4. Influenza infections
5. Candida auris
6. Antibiotic-resistant

Epidemiological Evidence

Fig 2

Source: Public Health Agency of Sweden

Some policymakers have blamed the infection increase on public health strategies, such as the few weeks of lockdowns 3 years ago. However, this phenomenon is also seen in Sweden, a country that implemented limited mandates and shunned masking. But the data does not support this contention. Below are the RSV cases in Sweden. Two unusually large surges can be seen during the COVID-19 pandemic. Sweden also has reported severe cases of pediatric influenza, some of which have had complications of myocarditis and encephalitis.

We have also seen 2 large surges in human respiratory syncytial virus (RSV) infections in the United States. During the RSV surge in the Fall of 2022, a lack of prior exposure to RSV was blamed. Still, we had a significant surge the previous year, which should have produced ample community exposure to the virus. Influenza seasons have also been unexpectedly severe in the United States post-relaxation of pandemic measures. One study recently published in JAMA Network found that during the 2021 to 2022 influenza season, there was a 150% increase in transmission compared to the prepandemic. This is very surprising since influenza cases only approximate 10% of the population yearly.

The overriding question is, are these infections just an association with the COVID-19 pandemic, or is there a causal relationship, and if so, what is the underlying cause?
 
The data from Sweden and the second wave of RSV infections experienced in numerous countries indicate that public health interventions at the beginning of the pandemic are not the cause. Attention is now being focused on post-COVID-19 immune dysfunction.
 

Fig 3

Source: Centers for Disease Control and Prevention

The immunological effects and research findings regarding SARS-CoV-2’s impact on our population may vary. It must be remembered that our immunological history and the dominant strain of the virus are in constant flux. What is known is that as of November 2022, the vast majority of the population, as high as 94%, have been infected with SARS-CoV-2. Currently, we are dealing with natural versus hybrid immunity, and reinfections are all too common.
 
The virus has also not been sitting still. A new variant, XBB.1.9.1, is rising rapidly. In the United States, XBB.1.9.1 is doubling about every 2 weeks and currently comprises 4.6% of the isolates. Similar to the United States, the United Kingdom previously had significant infections from XBB.1.5 and is currently experiencing a rise in COVID-19 caused by XBB.1.9.1.

Laboratory Evidence

Fig 4

Source: Our World in Data

There is mounting research evidence that infection with SARS-CoV-2 causes immunological damage in at least a subset of patients, a subset which may progressively enlarge as reinfections occur. Anthony Leonardi and Rui Proenca were among the first to note post-COVID-19 immunological damage and depicted SARS-CoV-2 as a “lymph-manipulative pathogen.” This depiction was supported by Chansavath Phetsouphanh et al., who found a lack of naive T and B cells post-COVID-19 and that this dysfunction can last as long as 8 months (the most extended period studied) in patients with Long COVID. CD8+ T cells were 1 of the cells absent in Long COVID donors. Several other authors have reported dysfunction in CD8 T Cells:

· In 2021, Xu-Rui Shen et al noted that CD4+ and CD8+ T Cells were almost absent in some patients and that “Collectively, this work confirmed a SARS-CoV-2 infection of T cells, in a spike-ACE2-independent manner…. “

· In 2022, Jacob K. Files et al found “sustained cellular immune dysregulation” post-SARS-CoV-2 infection and that, “Changes in T cell activation/exhaustion in nonhospitalized patients were found to correlate with age positively.” The authors also found that CD8 T cell exhaustion markers in nonhospitalized patients may be lower than in hospitalized patients but increased over time. In addition, their findings suggested older individuals may have an impaired ability to form specific SARS-CoV-2 memory responses.

In 2023, Fei Gao et al found that SARS-CoV-2 infection damages the CD8+ T cell response.

One of the most concerning conclusions of Gao et al was the description of the findings as “an effect akin to that observed in earlier studies showing long-term damage to the immune system after infection with viruses such as hepatitis C or HIV.”

Clinical Evidence
 
In a large retrospective study, Lindsay Wang et al found that a history of COVID-19 was present twice as often in RSV-infected children as in noninfected children. Barak Mizrahi et al also observed that streptococcal tonsillitis was to occur 34% more often in post-COVID-19 patients. Finally, SARS-CoV-2 has been associated with the reactivation of Epstein-Barr virus, further supporting a drop in generalized immunity.

Conclusion

Unfortunately, post-COVID-19 immune hypofunction and dysfunction are only one of the many post-COVID-19 sequelae. Even stronger evidence exists regarding SARS-CoV-2’s cardiovascular and central nervous system damage. Unfortunately, the damage caused by reinfections is additive to the damage from previous infections. These, along with many other sequelae, make it imperative that we at least slow down the spread of SARS-CoV-2 and reduce reinfections and the emergence of new viral strains.

Slowing spread will be difficult, and SARS-CoV-2 is aerosolized. Prevention strategies include using N95 masks, vaccinations, and boosters, along with maintaining high indoor air quality. Unfortunately, these interventions have fallen by the wayside in the United States, explaining our marked decrease in life expectancy. Making improvements in indoor air quality is 1 intervention that can only be implemented with widespread public support. It has been observed that for every 100 ppm increase in CO₂, there is a 9% increase in aerosolized pathogens. The public can utilize affordable handheld CO₂ monitors to measure indoor air quality. Optimal CO₂ levels are below 700 ppm, with outdoor air around 400 ppm.

We can declare the pandemic has ended, but the virus is an unrelenting adversary that does not respond to political pressure. We must continue to build, not dismantle, our public health system and implement a layered approach to protect even the frailest in our society.