The COVID-19 pandemic

[danbrotherston]

My estimate is that about 8% of people have some form of long COVID (...)

Long COVID is a serious issue. But it sounds like what you are referring to is not the usual, rather severe, long COVID, but the case where the person has not 100% recovered, even after a long time. Is that correct?

And is your estimate of 8% of the total population? 8% of people who had COVID at least once? 8% of infections? 8% of symptomatic infections? Something else? Because, at a glance, 8% is a huge number.

Yup...8% is a huge number...

That should be scary.

And I'm not sure why you think "someone that isn't 100% recovered" wouldn't have long COVID. Just because they aren't literally in a hospital bed unable to move as Dianna the physics girl is doesn't mean that this isn't a problem. In fact, as plam points out, her condition is so acute that its really treated better by our medical systems. It is people with long term chronic conditions (most long COVID) that are really left untreated.

So if 8% of the population has a significant impact on their long term health, lower mental faculties, or limited physical endurance, can you imagine how that will affect our society? Acr2 suggests "keeping healthy" as the solution but some growing percentage of people can no longer maintain their level of physical activity.

But again, I want to bring this back to healthcare, because that is the most poignant example. It is not the case that masks are used effectively. If I walk into an ER in the Netherlands and I believe Canada is the same, I will not be required to wear a mask, nor will my doctor or nurse. Of course, if I'm being operated on, some PPE will be deployed by the staff, that is nothing new and has been that way forever, but we now understand the enhanced risk of transmission of a serious disease in our hospital. When I sit down in the ER because I feel completely drained because I have a "mystery" cough for a week, and I am sitting in the same room with people with other serious medical issues that will make them far more vulnerable to this disease. The fact that our healthcare system would rather protect the feelings of people offended by the idea of being asked to wear a mask than they would the health of the vulnerable people around me that I could kill...is frankly, offensive.

As for the "we're just going to get it again and again so stop caring"...this could not be further from the truth. Not only is how much this disease transmits ENTIRELY within our control, and some very low impact but effective interventions available (masking, ventilation), we also expect medical science to progress. They are as far as I know, still testing muscousal vaccines in Canada which could be much more effective at limiting the spread of the virus. So we are still in a position where COVID could become much less harmful (to those of us smart enough to take vaccines anyway) in the future, ergo avoiding as many infections as possible is still worth it (and frankly, this applies to flu virus as well!)

[plam]

Long COVID is a serious issue. But it sounds like what you are referring to is not the usual, rather severe, long COVID, but the case where the person has not 100% recovered, even after a long time. Is that correct?

And is your estimate of 8% of the total population? 8% of people who had COVID at least once? 8% of infections? 8% of symptomatic infections? Something else? Because, at a glance, 8% is a huge number.

8% is a lot. It is not credible that 8% will have debilitating long COVID. It is credible that we all know someone who has debilitating long COVID, but they are going to be suffering quietly. I think the 8% is people who are not fully recovered after 3 months.

The other thing is that sometimes people with chronic conditions can present as well for 2 hours on one day and then relapse for a week after that.

This is a per-infection rate, though it is possible that it's somewhat lower on subsequent infections. Hard to say about asymptomatic infections. I can't remember what the estimate of asymptomatic infection rate is.

But again, I want to bring this back to healthcare, because that is the most poignant example. It is not the case that masks are used effectively. If I walk into an ER in the Netherlands and I believe Canada is the same, I will not be required to wear a mask, nor will my doctor or nurse. Of course, if I'm being operated on, some PPE will be deployed by the staff, that is nothing new and has been that way forever, but we now understand the enhanced risk of transmission of a serious disease in our hospital. When I sit down in the ER because I feel completely drained because I have a "mystery" cough for a week, and I am sitting in the same room with people with other serious medical issues that will make them far more vulnerable to this disease. The fact that our healthcare system would rather protect the feelings of people offended by the idea of being asked to wear a mask than they would the health of the vulnerable people around me that I could kill...is frankly, offensive.

Yeah. There ought to be masking around vulnerable people in a hospital plus adequate ventilation.

As for the "we're just going to get it again and again so stop caring"...this could not be further from the truth. Not only is how much this disease transmits ENTIRELY within our control, and some very low impact but effective interventions available (masking, ventilation), we also expect medical science to progress. They are as far as I know, still testing muscousal vaccines in Canada which could be much more effective at limiting the spread of the virus. So we are still in a position where COVID could become much less harmful (to those of us smart enough to take vaccines anyway) in the future, ergo avoiding as many infections as possible is still worth it (and frankly, this applies to flu virus as well!)

At this point we don't have evidence that the mucosal vaccine is going to be sterilizing. I really hope that it will be. But we don't know that yet.

* Status update on mucosal vaccines
* Why mucosal vaccines are hard

But we do have some really smart people working on this and I would say it's quite possible. It would be really silly to catch it before we have better vaccines.

My master's student gave a seminar a few weeks ago and 3 or 12 people seem to have caught something there. I wore a mask and I didn't

[danbrotherston]

Long COVID is a serious issue. But it sounds like what you are referring to is not the usual, rather severe, long COVID, but the case where the person has not 100% recovered, even after a long time. Is that correct?

And is your estimate of 8% of the total population? 8% of people who had COVID at least once? 8% of infections? 8% of symptomatic infections? Something else? Because, at a glance, 8% is a huge number.

8% is a lot. It is not credible that 8% will have debilitating long COVID. It is credible that we all know someone who has debilitating long COVID, but they are going to be suffering quietly. I think the 8% is people who are not fully recovered after 3 months.

I don't really understand the distinction you are trying to draw here. Is it time? Is it intensity? Why do you say it isn't credible that 8% have "debilitating long COVID"...someone who is suffering quietly after 3 months of an acute infection, to me, are definition-ally suffering "debilitating" (impaired functioning) "long" (past the acute phase of the disease) "COVID".

I don't think there's a settled or generally accepted medical diagnosis at this time so I don't think there are any right definitions, but in terms of one which measures it's impact on people's lives I think that's reasonable definition. If you want a definition instead relating to "this number of people will be unable to work and on disability long term or will die prematurely from COVID induced cardiovascular damage" impact on society, then the 8% is going to be an overestimate at this point.

The other thing is that sometimes people with chronic conditions can present as well for 2 hours on one day and then relapse for a week after that.

This is a per-infection rate, though it is possible that it's somewhat lower on subsequent infections. Hard to say about asymptomatic infections. I can't remember what the estimate of asymptomatic infection rate is.

But again, I want to bring this back to healthcare, because that is the most poignant example. It is not the case that masks are used effectively. If I walk into an ER in the Netherlands and I believe Canada is the same, I will not be required to wear a mask, nor will my doctor or nurse. Of course, if I'm being operated on, some PPE will be deployed by the staff, that is nothing new and has been that way forever, but we now understand the enhanced risk of transmission of a serious disease in our hospital. When I sit down in the ER because I feel completely drained because I have a "mystery" cough for a week, and I am sitting in the same room with people with other serious medical issues that will make them far more vulnerable to this disease. The fact that our healthcare system would rather protect the feelings of people offended by the idea of being asked to wear a mask than they would the health of the vulnerable people around me that I could kill...is frankly, offensive.

Yeah. There ought to be masking around vulnerable people in a hospital plus adequate ventilation.

As for the "we're just going to get it again and again so stop caring"...this could not be further from the truth. Not only is how much this disease transmits ENTIRELY within our control, and some very low impact but effective interventions available (masking, ventilation), we also expect medical science to progress. They are as far as I know, still testing muscousal vaccines in Canada which could be much more effective at limiting the spread of the virus. So we are still in a position where COVID could become much less harmful (to those of us smart enough to take vaccines anyway) in the future, ergo avoiding as many infections as possible is still worth it (and frankly, this applies to flu virus as well!)

At this point we don't have evidence that the mucosal vaccine is going to be sterilizing. I really hope that it will be. But we don't know that yet.

* Status update on mucosal vaccines
* Why mucosal vaccines are hard

But we do have some really smart people working on this and I would say it's quite possible. It would be really silly to catch it before we have better vaccines.

My master's student gave a seminar a few weeks ago and 3 or 12 people seem to have caught something there. I wore a mask and I didn't

I did say they *could* be more effective at stopping the spread. But even if they aren't as effective as we hope, I still think we can solve these problems, and I hope we will continue to research in this direction. Acute COVID is easily in the top causes of death right now and also in the top causes of long term disability. And the flu can likely be tackled by the same research and the flu is also in the top causes. I wish there was more attention put on this, but it's nothing new people ignoring real causes of suffering in favour of more newsworthy if incredibly unlikely causes of harm. There is no reason (beyond our broken society) that we shouldn't invest in these things. (FWIW...we should also invest in solving other diseases as well, generally, if we spent even 1/10 what we collectively spend on things like policing, on research solving our most pressing medical issues we would generally lead much longer healthier lives).

[tomh009]

Long COVID is a serious issue. But it sounds like what you are referring to is not the usual, rather severe, long COVID, but the case where the person has not 100% recovered, even after a long time. Is that correct?

And is your estimate of 8% of the total population? 8% of people who had COVID at least once? 8% of infections? 8% of symptomatic infections? Something else? Because, at a glance, 8% is a huge number.

8% is a lot. It is not credible that 8% will have debilitating long COVID. It is credible that we all know someone who has debilitating long COVID, but they are going to be suffering quietly. I think the 8% is people who are not fully recovered after 3 months.

The other thing is that sometimes people with chronic conditions can present as well for 2 hours on one day and then relapse for a week after that.

This is a per-infection rate, though it is possible that it's somewhat lower on subsequent infections. Hard to say about asymptomatic infections. I can't remember what the estimate of asymptomatic infection rate is.

Thanks. Very helpful. It does seem to be a spectrum type condition, with symptoms ranging from incapacitating to intermittent. And as the likelihood appears to correlate with COVID severity (hospitalized patients much more likely to have long COVID issues) those with mild  (or no) symptoms will be significantly less likely to get this. But even if you were to use only 8% of hospitalized patients, that's still a big number.

But I'll note that many other diseases do also have ongoing or lingering symptoms or issues, and the patients do not recover to "like-new" condition, so this is not unique to COVID. What is different is the huge number of people that suffered through COVID, and thus also the number suffering from long-term symptoms.

[plam]

8% is a lot. It is not credible that 8% will have debilitating long COVID. It is credible that we all know someone who has debilitating long COVID, but they are going to be suffering quietly. I think the 8% is people who are not fully recovered after 3 months.

I don't really understand the distinction you are trying to draw here. Is it time? Is it intensity? Why do you say it isn't credible that 8% have "debilitating long COVID"...someone who is suffering quietly after 3 months of an acute infection, to me, are definition-ally suffering "debilitating" (impaired functioning) "long" (past the acute phase of the disease) "COVID".

I don't think there's a settled or generally accepted medical diagnosis at this time so I don't think there are any right definitions, but in terms of one which measures it's impact on people's lives I think that's reasonable definition. If you want a definition instead relating to "this number of people will be unable to work and on disability long term or will die prematurely from COVID induced cardiovascular damage" impact on society, then the 8% is going to be an overestimate at this point.

Yeah. What I mean to say is that it's not credible that 8% of COVID infections result in long COVID such that the patient can no longer work, say. Sometimes it's a chronic cough for instance. That counts under some definitions. But there are enough cases of bad long COVID cases that I'd rather not chance it, thank you.

I did say they *could* be more effective at stopping the spread. But even if they aren't as effective as we hope, I still think we can solve these problems, and I hope we will continue to research in this direction. Acute COVID is easily in the top causes of death right now and also in the top causes of long term disability. And the flu can likely be tackled by the same research and the flu is also in the top causes. I wish there was more attention put on this, but it's nothing new people ignoring real causes of suffering in favour of more newsworthy if incredibly unlikely causes of harm. There is no reason (beyond our broken society) that we shouldn't invest in these things. (FWIW...we should also invest in solving other diseases as well, generally, if we spent even 1/10 what we collectively spend on things like policing, on research solving our most pressing medical issues we would generally lead much longer healthier lives).

Yes. The old flu vaccine just wasn't that effective, and mRNA flu vaccines might be much more helpful.

As you know, I do research, but not health research. Although I think it's great to put more money towards research, I don't think that the worldwide capacity for doing research is infinite. There is some upper bound on the number of useful research dollars. Canada is not there. I don't know about the US.

Thanks. Very helpful. It does seem to be a spectrum type condition, with symptoms ranging from incapacitating to intermittent. And as the likelihood appears to correlate with COVID severity (hospitalized patients much more likely to have long COVID issues) those with mild  (or no) symptoms will be significantly less likely to get this. But even if you were to use only 8% of hospitalized patients, that's still a big number.

But I'll note that many other diseases do also have ongoing or lingering symptoms or issues, and the patients do not recover to "like-new" condition, so this is not unique to COVID. What is different is the huge number of people that suffered through COVID, and thus also the number suffering from long-term symptoms.

Yes, agreed. Best to avoid all diseases, really. Immunity debt wasn't really a thing. But it's about tradeoffs. I'm also not a hermit, but I am not going to do low-value exposures.

BTW, there was one reasonably good study that showed that metformin decreased the chance of getting long COVID given COVID infection. Halved it in unvaccinated patients. Not quite as good for vaccinated. Though as our vaccines get stale, might be more useful.

[tomh009]

Yeah. What I mean to say is that it's not credible that 8% of COVID infections result in long COVID such that the patient can no longer work, say. Sometimes it's a chronic cough for instance. That counts under some definitions. But there are enough cases of bad long

I have an (extended) cousin now starting his fourth year after catching COVID, and he still has pretty debilitating issues, which affect his ability to work, for example. But that was the original strain of SARS-CoV-2019, with zero vaccines, so he got hit hard by the disease itself, and that may have also contributed to how long the symptoms are lasting for him.

[plam]

Note: even not very severe infections in vaccinated people can still lead to eg brain fog. https://www.medpagetoday.com/opinion/sec...ons/104481. The risk is lower but I'll still take measures to avoid it. I think I'm the only masked person on this BC transit bus right now for instance, but buses often have quite bad air quality.

[wiwi887]

Anyone had the virus recently? Does it get easier?

[plam]

Anyone had the virus recently? Does it get easier?

I'm still trying to avoid getting it more than once. I hear it's often not really awesome still though.

[Joedelay Highhoe]

I've had it a few times and the first was the worst (although none of them were terrible). Last time it was only about a day of symptoms.

[danbrotherston]

I'm definitely avoiding it. I've only had it once, and despite being vaxxed only two months prior, it was the worst illness I've ever had. I was in bed for about 3 days, and about a month before I could climb my stairs without getting out of breath.

[ludo643]

I wonder if there are still many frauds committed nowadays. They should get more MAC/RAC audits, in my opinion.

[tomh009]

Anyone had the virus recently? Does it get easier?

It appears that in most cases it's milder and more flu-like, consistent with how a virus might be expected to evolve over time, but there is still a chance of more severe (or more enduring!) symptoms.

[plam]

Anyone had the virus recently? Does it get easier?

It appears that in most cases it's milder and more flu-like, consistent with how a virus might be expected to evolve over time, but there is still a chance of more severe (or more enduring!) symptoms.

There's no real guarantee that a virus will evolve to get milder. My estimate of the chance of some longer term symptoms is about 3%, though the severity of such symptoms can vary.

[tomh009]

It appears that in most cases it's milder and more flu-like, consistent with how a virus might be expected to evolve over time, but there is still a chance of more severe (or more enduring!) symptoms.

There's no real guarantee that a virus will evolve to get milder.

No guarantees, of course, but it's bad news for a virus if its host dies. On the other hand, an extended period of marginal health with lots of coughing is good news for the virus as it gets to spread its genes further. That's why the probability is for viruses to get somewhat milder--and more virulent.