Though I think Ezekiel Emanuel’s estimates of long COVID incidence likely are too high–more about that later this week (boldface mine):
The covid-19 pandemic is over. That is what most Americans seem to believe as they cram together for Formula One in Miami, sell out basketball stadiums and fill restaurants without masks.
This conventional wisdom is gravely wrong. I will continue to wear my N95 mask, limit my air and train travel, and avoid eating at indoor restaurants. When I teach, I will run a HEPA filter and require all my students to wear N95 masks, too.
Why? Largely because of long covid…
This position reflects a triumph of desire over data. A wealth of evidence shows that covid-19 is not a mere cold or mild flu. It is a serious infection. Indeed, the belief that omicron was more mild than earlier variants was wrong. It was just as deadly.
And it comes with worrisome complications. Of course, we now have effective interventions, such as vaccines and treatments, to prevent acute illness and death. But we still do not know enough about the complications that come after the initial infection.
Though long covid was originally described in May 2020, there is not even a consensus definition for the condition. Yet we know many devastating symptoms can persist for months, including brain fog, fatigue with minimal exertion, extreme shortness of breath, insomnia and dizziness.
If the risk of long covid were low, I would agree that we should stop with masking and other precautions. But while we don’t know the precise frequency of the condition (a failure of the National Institutes of Health and biomedical researchers), we do know it is not rare. Estimates range from 0.5 percent of infections to 30 percent, with 10 percent being a commonly cited risk. Furthermore, there does not seem to be a correlation between the severity of the initial infection and the odds of getting long covid. Plenty of people with mild symptoms struggle with it.
Vaccines seem to help reduce the risks of long covid, but they don’t make it uncommon. Again the data are highly variable. A Veterans Affairs study estimates vaccination lowers the risk by 13 percent, while two British studies estimate a 40 to 50 percent lower risk. Maybe the best study, involving more than 240,000 U.S. patients, suggests vaccines cut the risk of long covid from roughly 17 percent to 3 percent. That is not rare.
…a 1-in-33 chance (or a 3 percent rate of long covid) of brain fog, debilitating fatigue, shortness of breath or any of the other serious post-covid symptoms is way too high for me to forgo unobtrusive precautions.
I think, and hopefully I’ll be able to discuss a few papers this week that justify my conclusion, that, for vaccinated people, the frequency of long COVID is between one to three percent. At a population level, given our ‘let ‘er rip’ strategy, that could result in hundreds of thousands, if not millions of vaccinated people–people who ‘did everything they were supposed to do’–contracting long COVID. That’s a bad outcome, not only in terms of health, but politically* too.
As Emanuel concludes:
Like everyone, I want this pandemic nightmare to be over. But I also desperately fear living a debilitated life of mental muddle or torpor. Keeping protective measures such as wearing masks and running HEPA filters is not too much of an imposition to avoid that.
You’re not a weirdo if you’re doing things like wearing masks, so you don’t contract long COVID. Kind of normal, grown-ass adult behavior akshually.