The fear of long COVID shouldn’t rule your life

Since the initial wave of omicron receded and inflation replaced COVID-19 in the headlines, the reopening debate has largely settled in favor of reopenings. But the debate over the wisdom of reopening and unmasking has not gone away. As COVID-19 cases rise again, there is still a vocal constituency that thinks too much normalcy is a public health mistake.

Lately, this constituency has shifted its focus somewhat from the dangers of death (diminished by vaccination and immunity) to peril of the long COVID-19, the potentially debilitating chronic form of the disease. In a recent Washington Post essay, health policy expert Ezekiel Emanuel wrote that a “one in 33 chance” of long-lasting COVID-19 symptoms (assuming for vaccinees, which it is, about 3 % of COVID-19 infections become chronic) is still enough to keep him in an N95 mask, out of indoor restaurants, and off trains and planes as much as possible.

There is a lot of uncertainty around the long COVID-19. As with many issues, there is also a noticeable intellectual clustering effect: people who still favor pandemic restrictions are more likely to point out its dangers, while mask and mandate skeptics seem more likely to suspect it. it is a kind of hypochondria in the blue state.

I have been, ever since vaccines became generally available, a pandemic dove who happily ripped off my mask once planes no longer needed it, which should make me skeptical of the long COVID-19. But I also have an in-depth knowledge of chronic diseases and their controversies, based on extensive personal experience, which has made me a lifelong supporter of COVID-19 from the start: its magnitude is uncertain, but it is clearly real and often terrible.

From Emanuel’s perspective, I shouldn’t be in those two positions. I’ve experienced in my own flesh how serious a chronic infection can become: what am I doing eating out, flying planes with my face uncovered, writing this column without a mask in a coffee ?

It’s an interesting question, and it inspired me to do some back-of-the-envelope math on another kind of risk — the risk my family takes by still living in Connecticut, a hotbed of Lyme disease. , my own chronic unwanted visitor.

Estimates of how often Lyme disease becomes chronic range from 5% to 20% of cases. Call it 12% and you get four times the risk of Emanuel’s 3% estimate for COVID-19. But luckily, Lyme disease is not airborne, so your risk of getting infected in the first place is much lower. If endemic COVID-19 ends up looking like the flu, your chances of catching it in any given year could be between 1 in 5 and 1 in 20, while your chances of catching Lyme are more like 1 out of 700.

However! Here in Connecticut, the incidence is at least three times the national average, and then there are six people in my house I have to worry about. So the odds of one of us getting infected each year could be close to 1 in 40. Combine that family number with the somewhat higher odds of Lyme disease becoming chronic, and our risks are in the same general range than the long risks of COVID-19 that Emanuel considers unacceptably high.

That said, we’re taking precautions: we no longer live on the Stephen King-style farmhouse where the eldritch powers of New England went to work on us; we check our children for ticks; we are extremely attentive to possible signs of infection. But we also lead fairly normal lives in Connecticut – hiking, nature, danger – despite my terrible experience.

The lesson I learned from my knowledge at Lyme is that chronic, infection-mediated illnesses can be so common that to lead a normal life is to put yourself at risk.

For example, we have new evidence suggesting that multiple sclerosis is linked to the extremely common Epstein-Barr virus; estimates of MS cases in the United States range from 400,000 to just under a million. Similarly, chronic fatigue syndrome may very well be triggered by viral infections; estimates of his victims range as high as 2.5 million. Start tallying up the myriad of other chronic illnesses that might have an infectious root, and you could justify Emanuel’s level of caution based solely on pre-COVID-19 threats.

But that is not how human civilization has traditionally dealt with chronic dangers. We take unusual precautions during unusually deadly outbreaks, but where dangers persist, we seek ways to treat and heal while trying to live our lives as normally as possible.

Chronic disease is a great scourge, which COVID-19 has long helped bring to light, and which calls for better diagnosis and better treatment. But doing the math and knowing the danger won’t stop me from showing my face on airplanes and in restaurants or my kids from walking — cautiously, I hope — through Connecticut state parks.

Ross Douthat writes for The New York Times.

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