Long COVID -- The "last" challenge to a new normal

Last update: Tuesday 6/7/22 

The bad news is that the CDC will soon certify that our COVID death toll has reached one million, a truly catastrophic outcome. The good news is that we are on the verge of a "new normal", but we are not quite there yet. As per Dr. Fauci's recent comments, the next phase will be about control. Our primary tools for controlling COVID will be (a) vaccines that greatly reduce the severity of infections and (b) antiviral medications that enable people to recover from severe infections. Unfortunately, there are millions of people for whom these tools will provide inadequate protection. 

Hypothesis: The adequacy of our tools will divide our population into two groups: the risk tolerant and the risk averse. 

• Risk tolerant
  The new normal for the majority of the population, perhaps 70 to 80 percent, will look very much like the old normal because full vaccination, up-to-date boosters, and antiviral meds will reduce their risk of severe illness and death to tolerable levels, i.e., to levels comparable to those presented by pre-covid diseases, like seasonal flu. 
  
  
• Risk averse
  The unfortunate minority, perhaps 20 to 30 percent, for whom the tools don't provide acceptable levels of protection against severe illness and death will be risk averse, i.e., their new normal will require that they continue to wear masks, maintain social distancing, and other mitigations. Some members of this group may feel an even greater need for vaccines, boosters, and antiviral meds than the risk tolerant
  

This tidy division of our near-future society into two parts assumes that near-future variants might be more infectious than Omicron sub-variants, but not more lethal, i.e., the virus will continue to pose challenges that will mostly fall within the limits of our vaccines and antiviral meds. It also assumes that avoidance of their own severe illness and death will be the primary determinants of each person's tolerance or aversion. Exceptions to this assumption will be noted in subsequent sections.

Risk averse subgroups

• Oldest age groups ... 65 and older
  The oldest members of our society have suffered 75 percent of the deaths from COVID even though they were less than 20 percent of the population. Vaccines and boosters have consistently proven to be less effective in preventing severe illness and death for them, so we should not be surprised if antivirals also prove to be substantially less effective. Common sense suggests that the oldest members of our society should remain risk averse for the foreseeable future.
  
  However, a better answer acknowledges the rule, especially relevant with regards to all things COVID, that one size does not fit all. So how should a person determine whether he or she is an exception to the notion that "older folk should be risk averse"? By consulting one's personal physician, of course ... :-)
  
  
• Immunocompromised 
  Vaccines and boosters don't work for this group, so they must remain highly risk averse. Unfortunately, this "solution" does not work for immunocompromised children who are too small to wear properly fitted N95 masks. They will not be able to attend in-person classes, but must continue to taught via remote learning. And they should avoid public indoor spaces.
  
  
• Other underlying conditions
  The CDC has a page on its Website that provides guidance for healthcare professionals seeking information as to which underlying conditions entail high risk of severe illness from COVID. It's a large list that does not provide data about the relative sizes of the risk posed by each condition. However, the following article in the NY Times asserts that "30 to 40 percent of all coronavirus deaths in the United States have occurred among people with diabetes."
  -- "Covid and Diabetes, Colliding in a Public Health Train Wreck", Andrew Jacobs, NY Times, 4/3/22  
  
  If this is true, then the vast majority of these deaths must have occurred to diabetics in the oldest age groups. Why? Because of a table of Covid deaths by age groups, whose data was obtained from the CDC's COVID Tracker page and was included in another note on this blog, shows that less than 7 percent of all COVID deaths occurred among persons under 50 years old. 
  
  So how should a diabetic of any age determine whether he or she is an exception to a notion that "diabetics folk should be risk averse"? Once again, by consulting one's personal physician.
  
  This same logic applies to persons having any of the other high risk conditions included on the CDC's list.  Living in a risk averse manner is likely to become increasingly difficult in a society where the majority becomes ever more determined to toss masks in the trash and get closer together again. One needs to be certain that it's worth the sacrifice.
  
  
• Other members of the households of persons in risk averse subgroups
  What about the other members of the households? How should they behave? If they become infected, their own risk of severe illness may be very low, but if they pass the virus on to the risk averse members, the risk averse may become severely ill. Perhaps the risk tolerant members should reclassify themselves as risk averse and postpone the benefits of normal living???
  
  

The challenge of long COVID

Long Covid is strange. There is no test for long COVID because long COVID is "defined" as whatever unhealthy symptoms an infected person displays after the infection should have left the person's body, symptoms that were not present before the person became infected. How long after the person became infected? The CDC says four weeks. (Note: The WHO sats three months.) 

In other words, long COVID is a persistent set of bad symptoms that may differ from one victim to the next. These symptoms can persist for weeks, months, even longer than a year. The CDC's list of about 20 symptoms that have been identified as long COVID can be found HERE

Most of these symptoms are serious, but not life threatening; many are just bothersome, the kinds of mishaps one learns to live with. Indeed, most long Covid victims were not diagnosed because of their initial symptoms.

• "Diabetes risk rises after COVID, massive study finds", Clare Watson, Nature, 3/31/22
• "Many long-COVID patients report symptoms 2 years later", Mary Van Beusekom, CIDRAP, 5/12/22
• "Over 75 Percent of Long Covid Patients Were Not Hospitalized for Initial Illness, Study Finds", Pam Belluck, NY Times, 5/18/22

Nevertheless, some symptoms impose severe disruptions on the daily lives of their victims. Here's a few:

• "Tiredness or fatigue that interferes with daily life"
• "Difficulty thinking or concentrating (sometimes referred to as “brain fog”)"
• "Depression or anxiety"

But there's a particularly ominous comment in the CDC's subsequent discussion, "Some people experience new health conditions after COVID-19 illness" such as "diabetes, heart conditions, or neurological conditions". This possibility is illustrated by a recent article in The Lancet regarding the onset of diabetes after COVID infection. 

• "Risks and burdens of incident diabetes in long COVID: a cohort study", Yan Xie and Ziyad Al-Aly, The Lancet, 3/22/22

This is scary stuff. This blog note hypothesized that most people would classify themselves as risk tolerant or risk averse, depending on the adequacy of vaccines and antiviral meds for safeguarding them from severe illness and death. But long COVID poses unspecified levels of risk of severe disruptions in daily life, perhaps severe enough to cause a substantial percentage of the population to remain risk averse for the foreseeable future out of an abundance of caution.

• "More than 1 in 5 adult Covid survivors in the U.S. may develop long Covid, a C.D.C. study suggests.", Pam Belluck, NY Times, 5/24/22  
• "Reporting Home Covid Test Results Can Be Confusing. Here’s How to Do It.", Knvul Sheikh, NY Times, 6/4/22
• "How long covid could change the way we think about disability", Frances Stead Sellers, Washington Post, 6/6/22

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Links to related notes on this blog:  

• "Long COVID", Last update: 5/23/22