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Opinion Stop dismissing the risk of long covid

An usher holds a sign to remind fans to wear masks during a spring training baseball game in Scottdale, Ariz., in March 2021. (Ashley Landis/AP)

Ezekiel J. Emanuel, an oncologist, medical ethicist and professor at the University of Pennsylvania, served on the Covid-19 Advisory Board for the Biden-Harris transition.

The covid-19 pandemic is over. That is what most Americans seem to believe as they cram together for Formula One in Miami, sell out basketball stadiums and fill restaurants without masks.

This conventional wisdom is gravely wrong. I will continue to wear my N95 mask, limit my air and train travel, and avoid eating at indoor restaurants. When I teach, I will run a HEPA filter and require all my students to wear N95 masks, too.

Why? Largely because of long covid.

Many Americans will think me either stupid or foolish. They will point to recent data suggesting that about 60 percent of Americans have already contracted omicron or another coronavirus variant. So, they argue, covid is endemic. Just accept the inevitable.

This position reflects a triumph of desire over data. A wealth of evidence shows that covid-19 is not a mere cold or mild flu. It is a serious infection. Indeed, the belief that omicron was more mild than earlier variants was wrong. It was just as deadly.

And it comes with worrisome complications. Of course, we now have effective interventions, such as vaccines and treatments, to prevent acute illness and death. But we still do not know enough about the complications that come after the initial infection.

Though long covid was originally described in May 2020, there is not even a consensus definition for the condition. Yet we know many devastating symptoms can persist for months, including brain fog, fatigue with minimal exertion, extreme shortness of breath, insomnia and dizziness.

Your covid-19 questions, answered by Dr. Leana S. Wen

If the risk of long covid were low, I would agree that we should stop with masking and other precautions. But while we don’t know the precise frequency of the condition (a failure of the National Institutes of Health and biomedical researchers), we do know it is not rare. Estimates range from 0.5 percent of infections to 30 percent, with 10 percent being a commonly cited risk. Furthermore, there does not seem to be a correlation between the severity of the initial infection and the odds of getting long covid. Plenty of people with mild symptoms struggle with it.

Vaccines seem to help reduce the risks of long covid, but they don’t make it uncommon. Again the data are highly variable. A Veterans Affairs study estimates vaccination lowers the risk by 13 percent, while two British studies estimate a 40 to 50 percent lower risk. Maybe the best study, involving more than 240,000 U.S. patients, suggests vaccines cut the risk of long covid from roughly 17 percent to 3 percent. That is not rare.

Worse still, we have no treatments for the condition, and NIH has yet to establish a platform to rapidly conduct robust clinical trials to evaluate treatments, such as prolonged antiviral use, immune modulators and other shots in the dark such as anti-cholesterol drugs or antidepressants.

And there might even be a “longer” covid. We are just learning about the risk of heart attacks and developing diabetes months or years after infection. Covid-infected pregnant women faced an increased risk of being hospitalized, being admitted to the intensive care unit and having a preterm delivery. And erectile dysfunction is a newly documented risk. The long-term effects of covid infection on the brain are not well established, but depression and loss of gray matter have been documented, though we don’t know how serious or common they will be.

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I am not a worrywart. I am happy to take plenty of risks — maybe too many, according to my family. I ride an electric motorcycle, for which the chance of dying is 1 in 100,000. Dying in a car accident is about 1 in 16,000 over a normal year.

But a 1-in-33 chance (or a 3 percent rate of long covid) of brain fog, debilitating fatigue, shortness of breath or any of the other serious post-covid symptoms is way too high for me to forgo unobtrusive precautions.

Consider that just last week, the Food and Drug Administration restricted the use of the Johnson & Johnson vaccine because of 60 cases of a blood-clotting syndrome and nine deaths among nearly 19 million doses. That is a 1-in-300,000 chance of the blood-clotting syndrome and a 1-in-2-million risk of death. Similarly, the risk of myocarditis in young adult males from the Pfizer and Moderna vaccines — the cause of much alarm — is about 1 in 15,000 and 1 in 4,000, respectively. The risk of long covid is far greater than any of these outcomes.

Remember also that millions of Americans with severe, chronic symptoms are unable to work and need medical attention and support. This will cost all of us in health coverage and disability payments. By behaving as if covid is behind us, we are creating a serious burden for the future.

Like everyone, I want this pandemic nightmare to be over. But I also desperately fear living a debilitated life of mental muddle or torpor. Keeping protective measures such as wearing masks and running HEPA filters is not too much of an imposition to avoid that.