And I was right, unfortunately.

For the last couple of years, whenever I’ve written about long COVID, I’ve wondered if I was having my ‘reasonable not-completely-lunatic scientist goes full batshitloonitarian on COVID’ moment–sadly, there have been quite a few scientists who have had this moment. Given the lack of discussion about long COVID, especially by policy makers (leaving aside very non-specific bromides), maybe there were some obvious data, a set of studies that I had missed, which shows that vaccinated people are really unlikely to contract long COVID, instead of the one to two percent I’ve been estimating.

Well, it turns out I’ve likely been on target, at least according to White House COVID czar Ashish Jha (boldface mine):

Faust: All right, before we get to some reader questions, let’s talk about long COVID. I think you’ve been quoted as saying maybe the real risk is in the single digits. I think there are some people who say it’s higher, some people say it’s lower than that. If it’s 5%, that’s still 16 million people in this country….

Jha: Let’s talk about long COVID. Here’s how I think about it and how the administration thinks about it.

First of all, it’s a real thing. Clearly there are people who get infected, who recover, but then have persistent symptoms for long periods of time. The reason I say it’s single digits is there are a bunch of badly done studies that don’t have controls that at 4 weeks ask people, “Are you still tired?” and people say, “Yes,” and then you get 35%. That’s not long COVID. But there are well-done studies that look out to 3 months and 6 months and find a series of patients who still are really suffering. Some of them are incapacitated, some of them just have significant issues. That number probably is in the single digits in terms of proportion of people.

The second thing we know about long COVID is that you can reduce your risk of long COVID by 50%, 80%, 90% depending on the study, by being up-to-date on your vaccines. The single biggest thing you can do beyond avoiding infection is making sure you’re up-to-date on your vaccines.

Third, there is a little bit of evidence, it’s not very good and I don’t want to over-torque on this, that antivirals, and by the way, if you think about the mechanism of long COVID, it stands to reason that antivirals should reduce your risk of long COVID, and so there is a little bit of evidence. Little, I don’t want to overstate that, and work is being done.

Okay. Now, here’s what else we know. Long COVID is probably three or four different conditions that are all getting lumped into one category, right? For some people, it’s persistent antigen or persistent virus. For some people, it’s immune dysfunction. For some people, it’s organ damage from the original infection. For some people, it’s about endothelial damage that comes and then the sequelae of that. That’s not meant to be a comprehensive list. A lot of research is being done to both sort that out and figure out how we treat folks.

I have seen one study that suggests an 80% reduction, but there also are others that have a much smaller reduction of fifteen to twenty percent, so 50% probably is a good policy peg. What this means is long COVID is likely affecting around 1-2% of vaccinated people, which some asshole with a blog has been shouting about for a couple of years now.

If one thinks about the implications of this, if we have 100 million people who did what they were supposed to do (get vaccinated), we will wind up with one to two million long-term disabled people (possibly permanently disabled). This is a public health disaster, and, potentially, a political one too. And how can one declare the ‘pandemic is over’ or that we don’t need to mask anymore in light of this estimate? We also really don’t understand whether the odds of long COVID increase, decrease, or stay the same with multiple infections. Given our unwillingness to encourage masking or improve ventilation, we likely should assume many people will have multiple COVID infections, so that 1-2% rate is… not good.

Maybe if major news outlets took this more seriously we might have some good answers–by the way news media, this has the potential for a great story, if you’re willing to cover it.

You aren’t the weirdo if you’re still trying to avoid getting COVID.