Good article. I see something else to think about. Using the % of people with antibodies, and info on the number of people vaccinated, and how well the vaccine worked, can you figure out how many people in the US have had covid? From that and the 1 million that are said to ahve died from it (but maybe use Excess deaths instead?), could we get a reliable death risk from covid?
It seems pretty clear that the acute consequences of COVID are mild enough for healthy, fully vaccinated people that for most people it makes sense to go back to life as it was before the pandemic. But I've seen many estimates of long COVID suggesting its prevalence is concerningly high, and very little discussion of this from public health experts or authorities. (Zvi had a post on this in Feb - https://www.lesswrong.com/posts/mh3xapTix6fFtd3xM/the-long-long-covid-post - which reached conclusions similar to your own post on the subject. But there have been a couple of posts since then making claims to the contrary, which he hasn't engaged with:
2) Since Paxlovid tends to reduce severity, it seems logical to expect it to help prevent long Covid to at least some extent (one exception might be smell loss, as mentioned in the this Paxlovid post.)
3) When you say "treat Long COVID" -- it almost certainly can't treat Long COVID symptoms once they have already manifested. The only way it would help with that is if there were still Covid inside someone after recovery, but I think the consensus is that is not something that happens with any frequency. My understanding is that Long COVID is more similar to, say, scars -- caused by damage done either from Covid itself, of from the person's own immune system. Similar to scars, one's body may, or may not, be able to heal much over time, and there's not a whole lot that can be done besides trying to make the best of one's new situation.
Old comment I'm responding to, but, I'd note that long covid is more complicated and probably has multiple causes. There's a group of people that get hospitalized with covid and end up with lingering symptoms similar to the damage done by the illness -- for instance, shortness of breath after lung inflammation. There's also a group of people who are young and healthy, have relatively mild covid symptoms, and go on to develop debilitating long covid issues like dysautonomia and neurological problems.
The cause of the problems for those people is much less clear. My best guess it's some kind of auto-immune issue because the patients skew female and because some (probably smaller) number of people get the same long haul symptoms after getting a covid vaccine. The latter part seemed relatively fringe last year but it's now being acknowledged and studied by major researchers:
It is possible that viral persistence is also one element to (some) long haul, I don't think we've ruled it out. I've heard anecdotes about long haulers taking paxlovid and having positive effects. I've also heard of cases where there seemed to only be a short term benefit. And also cases where it did nothing.
In general, I find the "covid is over" attitude a bit frustrating. I took an interest in long covid this year for various reasons. I've talked to a lot of otherwise healthy young long haulers that have had their lives totally devastated by a mild case of the virus. Some were vaccinated before getting covid. One woman had 3 shots, took paxlovid while sick, and still got a classic case of long haul with dysautonomia and other common issues.
And, of course, I've talked to people who got long haul symptoms from the vaccine, without having covid. Or who got them from the vaccine even after a case of covid. And I've talked to long haulers from both groups who got an increase in symptoms after a second exposure.
For me, the pandemic is over when I know I can get it and not face a risk of long term, maybe even permanent disability. I went back to a relatively normal life in 2021, after getting my first 2 shots. But, after re-evaluating the immune escape of Omicron and the long covid situation this year, I went back to N95 masking and a more cautious lifestyle.
Long Covid is real, but the long symptoms are rare. For most people, staying cautious wouldn’t pass a cost-benefit test (of course, your situation and risk preferences may vary!)
Yeah, I struggle a bit with that. The way the rationalist community runs this cost benefit analysis.
For instance, you could equally say that the pandemic was never important. Like, the loss of life was a few months, averaged over the whole population, and most of us spent a year or more worrying about it.
Ergo, no one should have ever worried, better to just let everyone get sick.
But that's equating the time "lost" due to restrictions with time "lost" due to death, which doesn't seem fair. I was still living during the pandemic, just differently.
It also averages the time lost due to death across the population. When it's really more like: some people lose nothing, others lose 2 years of life, some 40. So, some people should be more worried than others.
So then, there's the corollary: no one who wasn't old/fat should have worried.
But I know perfectly healthy athletes who got sick in 2020 and lost their ability to exercise for many months. Some never recovered fully. It's hard to put odds to it, in 2020 I would have guessed it at maybe 10% risk of significant long term issues, just from observing friends and forums I read.
I also know a lot of people that simply dealt with months of fatigue. Or more than a year of brain fog. Or months of anosmia. (it sounds like yours took 8 weeks? I know several people that had it for 6 months or longer)
If you factor the risk of death out of the picture, you're asking: what's better? 1 year of caution while waiting for a vaccine or several months of fatigue plus anosmia? And I think I'd still vote for 1 year of caution.
And then, there are the worst cases. Like the people that get dysautonomia so bad they struggle to stand up. That tends to last for well over a year, for some people it doesn't seem to heal at all. But I can't tell you what the odds are. Say it's 1%.
How do you compare that, mathematically? 1 year of more of being unable to stand sounds worse than 1 year of wearing a mask. But do you just average that out based on the 1% rate and say it's equivalent to each person being unable to stand for 3.65 days?
And I'm not really sure what to tell the person that is struggling -- "sorry you're disabled, but statistically you must agree it's not a big deal".
Where are you at, up to this point? In agreement that waiting for a vaccine and treatments was good? Or thinking that the whole pandemic response was excessive?
If you're in agreement that the first year of caution was worth it, at what point does that flip?
With a 95% effective vaccine, the calculus flipped very quickly in my mind, ergo I wasn't cautious for most of 2021. And I still wasn't cautious when I saw the data on delta (minor immune evasion).
As soon as I saw the immune evasion numbers on Omicron, I went back to masking, because I find the hassle is low and the potential benefits are high.
But that's probably also wrong, because the odds of long covid are probably not uniformly distributed, one would hope that the odds go down upon reinfection, and one would hope that you're not going to get some awful auto-immune response if didn't the first time. And yet, I've talked to people that did get it with the 2nd exposure and not the first, so I don't think we can say that with certainty.
Good article. I see something else to think about. Using the % of people with antibodies, and info on the number of people vaccinated, and how well the vaccine worked, can you figure out how many people in the US have had covid? From that and the 1 million that are said to ahve died from it (but maybe use Excess deaths instead?), could we get a reliable death risk from covid?
Does Paxlovid treat Long COVID?
It seems pretty clear that the acute consequences of COVID are mild enough for healthy, fully vaccinated people that for most people it makes sense to go back to life as it was before the pandemic. But I've seen many estimates of long COVID suggesting its prevalence is concerningly high, and very little discussion of this from public health experts or authorities. (Zvi had a post on this in Feb - https://www.lesswrong.com/posts/mh3xapTix6fFtd3xM/the-long-long-covid-post - which reached conclusions similar to your own post on the subject. But there have been a couple of posts since then making claims to the contrary, which he hasn't engaged with:
https://www.lesswrong.com/posts/vSjiTrHkckTPrirhS/hard-evidence-that-mild-covid-cases-frequently-reduce
https://www.lesswrong.com/posts/emygKGXMNgnJxq3oM/your-risk-of-developing-long-covid-is-probably-high)
I'll note three things:
1) The gold-standard studies I covered in my post on that issue found a clear correlation between severity and impact on the brain. (You mentioned the post; it is also here, for anyone who might not have read it: https://maximumtruth.substack.com/p/deep-dive-does-covid-cause-significant )
2) Since Paxlovid tends to reduce severity, it seems logical to expect it to help prevent long Covid to at least some extent (one exception might be smell loss, as mentioned in the this Paxlovid post.)
3) When you say "treat Long COVID" -- it almost certainly can't treat Long COVID symptoms once they have already manifested. The only way it would help with that is if there were still Covid inside someone after recovery, but I think the consensus is that is not something that happens with any frequency. My understanding is that Long COVID is more similar to, say, scars -- caused by damage done either from Covid itself, of from the person's own immune system. Similar to scars, one's body may, or may not, be able to heal much over time, and there's not a whole lot that can be done besides trying to make the best of one's new situation.
Old comment I'm responding to, but, I'd note that long covid is more complicated and probably has multiple causes. There's a group of people that get hospitalized with covid and end up with lingering symptoms similar to the damage done by the illness -- for instance, shortness of breath after lung inflammation. There's also a group of people who are young and healthy, have relatively mild covid symptoms, and go on to develop debilitating long covid issues like dysautonomia and neurological problems.
The cause of the problems for those people is much less clear. My best guess it's some kind of auto-immune issue because the patients skew female and because some (probably smaller) number of people get the same long haul symptoms after getting a covid vaccine. The latter part seemed relatively fringe last year but it's now being acknowledged and studied by major researchers:
https://twitter.com/VirusesImmunity/status/1573659800717742081
It is possible that viral persistence is also one element to (some) long haul, I don't think we've ruled it out. I've heard anecdotes about long haulers taking paxlovid and having positive effects. I've also heard of cases where there seemed to only be a short term benefit. And also cases where it did nothing.
In general, I find the "covid is over" attitude a bit frustrating. I took an interest in long covid this year for various reasons. I've talked to a lot of otherwise healthy young long haulers that have had their lives totally devastated by a mild case of the virus. Some were vaccinated before getting covid. One woman had 3 shots, took paxlovid while sick, and still got a classic case of long haul with dysautonomia and other common issues.
And, of course, I've talked to people who got long haul symptoms from the vaccine, without having covid. Or who got them from the vaccine even after a case of covid. And I've talked to long haulers from both groups who got an increase in symptoms after a second exposure.
For me, the pandemic is over when I know I can get it and not face a risk of long term, maybe even permanent disability. I went back to a relatively normal life in 2021, after getting my first 2 shots. But, after re-evaluating the immune escape of Omicron and the long covid situation this year, I went back to N95 masking and a more cautious lifestyle.
Thanks. Long Covid is real, as you say.
You may find this post of mine of interest: https://maximumtruth.substack.com/p/deep-dive-does-covid-cause-significant?r=3ppaf&s=w&utm_campaign=post&utm_medium=web&utm_source=direct
Long Covid is real, but the long symptoms are rare. For most people, staying cautious wouldn’t pass a cost-benefit test (of course, your situation and risk preferences may vary!)
Yeah, I struggle a bit with that. The way the rationalist community runs this cost benefit analysis.
For instance, you could equally say that the pandemic was never important. Like, the loss of life was a few months, averaged over the whole population, and most of us spent a year or more worrying about it.
Ergo, no one should have ever worried, better to just let everyone get sick.
But that's equating the time "lost" due to restrictions with time "lost" due to death, which doesn't seem fair. I was still living during the pandemic, just differently.
It also averages the time lost due to death across the population. When it's really more like: some people lose nothing, others lose 2 years of life, some 40. So, some people should be more worried than others.
So then, there's the corollary: no one who wasn't old/fat should have worried.
But I know perfectly healthy athletes who got sick in 2020 and lost their ability to exercise for many months. Some never recovered fully. It's hard to put odds to it, in 2020 I would have guessed it at maybe 10% risk of significant long term issues, just from observing friends and forums I read.
I also know a lot of people that simply dealt with months of fatigue. Or more than a year of brain fog. Or months of anosmia. (it sounds like yours took 8 weeks? I know several people that had it for 6 months or longer)
If you factor the risk of death out of the picture, you're asking: what's better? 1 year of caution while waiting for a vaccine or several months of fatigue plus anosmia? And I think I'd still vote for 1 year of caution.
And then, there are the worst cases. Like the people that get dysautonomia so bad they struggle to stand up. That tends to last for well over a year, for some people it doesn't seem to heal at all. But I can't tell you what the odds are. Say it's 1%.
How do you compare that, mathematically? 1 year of more of being unable to stand sounds worse than 1 year of wearing a mask. But do you just average that out based on the 1% rate and say it's equivalent to each person being unable to stand for 3.65 days?
And I'm not really sure what to tell the person that is struggling -- "sorry you're disabled, but statistically you must agree it's not a big deal".
Where are you at, up to this point? In agreement that waiting for a vaccine and treatments was good? Or thinking that the whole pandemic response was excessive?
If you're in agreement that the first year of caution was worth it, at what point does that flip?
With a 95% effective vaccine, the calculus flipped very quickly in my mind, ergo I wasn't cautious for most of 2021. And I still wasn't cautious when I saw the data on delta (minor immune evasion).
As soon as I saw the immune evasion numbers on Omicron, I went back to masking, because I find the hassle is low and the potential benefits are high.
Just flipped over to Twitter and happened across this old comment. Here's another way to think about the issue mathematically:
https://twitter.com/DavidSteadson/status/1546308765171224576
But that's probably also wrong, because the odds of long covid are probably not uniformly distributed, one would hope that the odds go down upon reinfection, and one would hope that you're not going to get some awful auto-immune response if didn't the first time. And yet, I've talked to people that did get it with the 2nd exposure and not the first, so I don't think we can say that with certainty.