Despite Zvi’s “Long Long Covid Post” concluding in February that Long COVID risk among healthy, vaccinated individuals is low enough that it’s worth pretty much going back to normal life, I haven’t felt comfortable doing so given the array of claims to the contrary.
Some of them have surfaced on LessWrong itself:
https://www.lesswrong.com/posts/emygKGXMNgnJxq3oM/your-risk-of-developing-long-covid-is-probably-high (March, by a poster who had not read Zvi’s original post)
Others I have come across from friends or on Twitter.
My skills at carefully evaluating scientific research are fairly limited, and I’d also like to avoid spending all of my free time doing so, so I’ve been kind of stuck in this limbo for now.
Compounding the challenge of deciding what risks to take is that MicroCOVID doesn’t seem to account for the increasing rate of underreporting or the much higher transmissibility of recent Omicron subvariants, making it really hard to decide what level of risk a given activity will pose. And given the transmissibility of those variants, and society’s apparent decision to just … ignore the risk of Long COVID and go back to normal, trying to avoid getting COVID going forward will be more and more socially costly.
I’m sure I’m not the only one in this situation.
So:
Is anyone confident going back to normal life despite claims to the contrary without feeling the need to read and evaluate each new study on Long COVID? Why? What logic / heuristics inform that assessment?
This seems to be Zvi’s current stance, given he seems to be focused elsewhere with his recent posts, so Zvi, if you’re reading this, I’d be curious to hear your thoughts!
Has anyone been tracking claims to the contrary and assessing their validity (e.g. based on the sorts of critiques Zvi covered in his post)?
Would anyone be interested in contributing to a systematic effort to do so?
Could we start some sort of centralized database of studies on Long COVID (a spreadsheet? a wiki?) and folks grab one or two here and there, evaluate them, and note their assessment / rationale?
Would folks be interested in contributing to a Kickstarter or something to pay a researcher (e.g. Elizabeth, Zvi, Scott—I don’t know if any of them have bandwidth / a price at which they would be interested in doing this currently, but worth asking, or maybe there are other folks with the right skillset/epistemics) to do this?
Any other ideas?
Yes, I have returned to normal life and am essentially ignoring Covid risk going forward.
I stand by my analysis in the Long Long Covid Post, but even if you disagree with that on the merits—and sure, I can see various reasons people might disagree somewhat—what’s the alternative? Covid’s not going to go anywhere. You can live your life or you can… never live your life and hide in your apartment forever. Your call, really. If you applied that level of caution generally it’s not compatible with life, and at a minimum it was certainly never compatible with living in a city, among the disease and the air pollution.
This seems to require the premise that ~all of the risk comes from your first covid infection (or perhaps from your first few). If that were true, then most people would indeed have to choose between accepting that risk or living an extremely restricted lifestyle indefinitely. But if it’s not true, the huge middle ground between ‘precautions necessary to avoid covid forever’ and ‘precautions necessary to significantly reduce the number of times you get covid’ comes into play.
There’s also the value of buying time. Our understanding of covid will only grow, and the future could bring any or all of much more effective vaccines, much more effective treatments, and new knowledge that meaningfully changes your personal risk calculation. In the first two cases, avoiding covid for [unpredictable but finite length of time] could have similar value to avoiding covid entirely, even if we never come close to literally eradicating it.
I find it plausible it’s better to be exposed to covid early and often, so your immunity never wains.
Even if the alternative is minimal exposure but regular vaccination? I would have expected that to give most of the immunity boost at significantly lower risk.
One thing I’m not clear on is the effect of exposure that doesn’t lead to a detectable infection. (I mean a situation where a person has definitely breathed in or otherwise ingested some virus particles, but they don’t last long enough or multiply sufficiently to cause symptoms or register on a test.) My current impression is that it probably tends not to make any significant difference to the body’s ability to deal with subsequent exposures, but I haven’t seen strong evidence either way. (It seems like observational studies would struggle to distinguish between those casual contacts who breathed in some virus and those who didn’t; and for household contacts who ~certainly must have got some virus in them, but didn’t get infected, it would be hard to tease out the protective effect of this exposure from the selection effect.)
How much more mitigation do you think you’re going to buy by stalling for time? We already have vaccines and Paxlovid, each of which reduces the likelihood of severe COVID effects by at least 90%, and that’s coming down from a baseline of less than 1% for people who are young and healthy.
The poster’s concern is with long COVID, which can certainly have effects that a lot of people would consider severe. The “severe” COVID that has a baseline of less than 1% for the young and healthy refers to COVID that requires hospitalization. Long Covid rates are higher.
Also, some LWers are neither young nor healthy, and/or have family responsibilities that would become problematic or impossible at some levels of lasting lung or organ damage, whether you call it “long covid” or not. So I’m definitely waiting for more understanding of long-term effects before I change my risk profile.
Thanks for chiming in! If I’m interpreting your response correctly, it seems you’ve stopped closely analyzing evidence on long COVID not because you necessarily think your original analysis is highly likely to be robust against further findings; rather, you think that the cost of avoiding COVID is high enough that even a significantly higher risk of long COVID wouldn’t change your behavior.
This suggests to me that for folks who weigh the cost of avoiding COVID differently, it would be worthwhile continuing to assess the risk of long COVID. (Not saying you should be the one assessing it further, given your relative priorities—just that this is useful information for other interested parties who may be thinking, “well, Zvi doesn’t think any of the new stuff refutes his analysis, so must be fine.”)
As tslarm’s comment suggests, I think there are a bunch of personal options that significantly COVID risk without having to “never live your life and hide in your apartment forever.” (For me personally, that looks like avoiding public indoor dining, bars, and large events, and avoiding even smaller indoor events when transmission risk is very high). That wouldn’t be ideal, but if the alternative is, say, a 30% chance of years of fatigue / brain fog, for me it would be very much be a price worth paying. (For the many reasons you articulate, I think the alternative is much less dire—just illustrating that at a certain risk of debilitating long-term symptoms, the cost-benefit analysis weighs towards avoiding COVID, so “live your life or never live your life and hide in your apartment forever” doesn’t seem like the right frame to analyze this from.).There are also a ton of societal investments that could be made to shift that cost-benefit analysis (e.g. broad deployment of better ventilation/filtration, UV light, continuing investment in vaccines, treatments, etc), some of which you cover in your posts.)
Look. This is dumb. Every week someone comes in and says things like 30% chance of brain fog, but think about that for a second. Half the country has had Covid. So this is saying 15% or more of the population is suffering from crippling brain fog? Wouldn’t we know? I mean come on.
Every time there is a new factoid or study the same impossible claims get made and I have to go through the same statistical fallacies and correlations and impossibility arguments again and again, life beckons.
If you want to go installing UV lights, I mean, sure, go nuts. But I wouldn’t try to convince the Feds to do anything, it won’t work.
Thanks—I find that (“Half the country has had Covid. So this is saying 15% or more of the population is suffering from crippling brain fog? Wouldn’t we know?”) compelling, and it usefully cuts through the new claims / studies that continue to pop up without needing to examine every one.
My personal logic here I think is the same as Zvi’s: I know at least ten or fifteen people fairly well who have had Covid, I think in at least one case twice, and only one of them seems to have had significant long term fatigue (and that was from a bad untested case in April 2020, and he is highly sensitive to health concerns—that is to say, I think he is a hypochondriac, but he probably doesn’t think he is one—and whose fatigue mostly went away after more than a year).
If there was a really high chance of healthy pepole having bad fatigue/ brain fog from each mild case of Covid, everyone’s anecdata would look different.
Thanks! I find that compelling.
To more directly address your initial question: to my mind, Zvi’s analysis isn’t obviously wrong, but it’s pretty far to the optimistic end of what I see as the reasonable range.
My best model suggests that for me (55 but very healthy), 1,000 µCoV of risk has an expected life cost of about 15 minutes.
Based on that, my approach to risk is very situational. Is eating in a restaurant worth 75 minutes of lying in bed with flu wishing I was dead (based on today’s numbers)? No, it isn’t. Is going to a friend’s wedding worth that? Yes, it probably is.
I am amused to note that some people do think that going out and drinking to excess with friends is worth 75 minutes of lying in bed with a hangover wishing they were dead.
Thanks! I’m curious what you think of his argument that if debilitating long COVID were common, that would be obvious anecdotally and in aggregate statistics:
I’m overdue for making another pass through the latest data, so my opinions on this are weakly held. But briefly: my current thinking is that many people (including Zvi and me) have made the mistake of conflating a number of different phenomena into the single category of “long covid”. I believe Zvi is correct that if a large number of people were suffering long-term debilitating impact, we’d know it.
I suspect that after I plow through the data again, I’ll update significantly in the direction of believing that:
“Long covid” is a debilitating phenomenon that affects a very small number of people for a long time.
“Post-acute covid” is significantly impactful and impacts a non-trivial number of people moderately for weeks or maybe a few months.
Anecdata: I don’t know anyone who’s been profoundly impacted by covid for a very long time. I know multiple people who’ve suffered significant impairment for weeks / months.
The impact of long covid is (small incidence #) x (large impact #), and the impact of post-acute covid is (medium incidence #) x (medium impact #). I think for most people, the total expected impact of getting covid will be somewhere between a day and a few weeks of useful live lost, with large error bars and much of the impact being in low-likelihood events.
Yes. At this point I am basically not taking any precautions. I have been to a concert in an auditorium of about 2000 people (only half of whom wore masks, despite a notional government requirement at the time). I routinely go to other concerts and to cafes. On the other hand, apart from the events mentioned, my daily life in normal times does not involve much face-to-face with people anyway, and I don’t routinely eat in restaurants or frequent pubs. I’ve never had flu, I rarely get colds, I’ve had my three Covid vaccinations, and I’ve not had Covid despite my lackadaisical attitude. I do see people wearing masks, but it’s only a minority now, and no-one requires it, except maybe in healthcare settings. (I am in the UK.)
I haven’t attempted to put any numbers to it, but I’m reckoning on that basis that it’s not going to happen. I see enough Covid news, here and elsewhere, to be aware if some drastic new thing comes along.
I usually go to a sci-fi convention of about 1000 people at Easter every year, but I skipped this year’s because they required masks to be worn in convention areas. I don’t want to go to a three-day event where I have to put on a mask every time I step out of my hotel room. Of course, this means that when I do go to such an event, it will be because neither the con committee, nor the venue, nor the government think masks are needed, which may well mean that they aren’t.
I’d love to see a more structured approach to the kinds of questions you’re raising here. LW does a good job of creating a space for smart people to share their thoughts about individual topics, but isn’t so good at building toward a coherent synthesis of all those pieces.
The original microCOVID white paper did a good job of summarizing a lot of relevant evidence back in the day, but (like the rest of the site) has been only sporadically updated.
Put me down as tentatively interested in being part of some larger project, if one comes together.
Also: may I humbly request that if this ever takes off, it be named LessSick?
This feels like a hole in LessWrong in general that would seem to be worth addressing. Maybe a general initiative for synthesis on various topics should be created, not just about COVID?
Eliezer, back in 2009:
This is not a small project, and I’m too new here to have a clear sense of how it might happen. But this feels important.
I dug into this a little, and right now I think serious, long-term illness from COVID is pretty unlikely. There are lots of studies on this, but in addition to all the usual reasons why studies are unreliable, it’s hard to avoid reporting bias when you’re analyzing subjective symptoms. (If you catch COVID, you might be more primed to notice fatigue, asthma, muscle pain, etc., that you already had or would have gotten anyway. Random, unexplainable minor medical problems are ridiculously common.)
Some worry that COVID will permanently disable millions of people, leaving them unable to work. This doesn’t seem to be happening, disability claims are down from 2019 and haven’t tracked infection rates:
https://www.ssa.gov/oact/STATS/dibStat.html
Disability insurance rates (per $ of coverage) went down in 2021; this makes me think that odds of serious long-term COVID disability must be <1%. Insurers would raise rates if there were a flood of new claims, especially given adverse selection:
https://www.meetbreeze.com/disability-insurance/cost-of-long-term-disability-insurance-report/
I think the press is just lying about how common long COVID is. Eg. this article describes a “flood” of COVID disability claims. But it admits there are only 23,000 claims—that’s a tiny fraction! That’s ~fewer people than have ever been hit by lightning:
https://www.washingtonpost.com/business/2022/03/08/long-covid-disability-benefits/
This article says “large numbers” of people are filing claims. This isn’t true! Filing for COVID-related disability is <1% of all claims, and <0.01% of US adults. Overall claim numbers are down vs. 2019:
https://www.nbcnews.com/investigations/got-long-covid-cost-dearly-rcna17942
Thanks for this!
Question: It seems possible that long COVID prevalence / impact falls short of the level that would qualify a significant proportion of the American workforce for disability, but would still be very concerning for folks with cognitively intensive professions (i.e., the majority of LW readers). How likely do you think this is?
[I removed the other question I’d included here earlier, quoting the insurer Unum from the last article you cited, because I only saw the part where “it has approved “hundreds of thousands” of additional disability claims since the beginning of the pandemic, with an increase from pre-pandemic levels of 35 percent” but missed the part where they said “In general, disability and leave claims connected to covid-19 have been primarily short-term events with the majority of claimants recovering before completing the normal qualification period for long term disability insurance.” Incidentally, per https://caveylaw.com/practice-areas/long-term-disability-erisa-lawyer/medical-conditions/ it seems like the threshold for LTD is to be out of work for more than 3-6 months.]
Other comments:
The stats you cited regarding disability claims seem compelling in assessing this question. (I wonder if there are countervailing (non COVID-related) forces that would drive down the aggregate rates of disability claims, but the stats on COVID-related disability specifically would seem to avoid that concern.)
I tend to be wary of arguments which say “the press is just lying” (perhaps because it’s really hard for me to assess that, and seems like a convenient way to dismiss evidence that doesn’t fit your favored model), but I could believe that the press’s assertions are driven by the desire for a dramatic headline, and full of sloppy thinking (and subject to the same sorts of issues that you and Zvi have noted). Regardless, if you have stats on disability claims, and the press does not have better stats, then that seems to settle the issue.
Some new data: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/selfreportedlongcovidafterinfectionwiththeomicronvariant/6may2022
New data from the CDC (may 24th): https://www.cdc.gov/mmwr/volumes/71/wr/mm7121e1.htm?s_cid=mm7121e1_e&ACSTrackingID=USCDC_921-DM82414&ACSTrackingLabel=MMWR Early Release—Vol. 71%2C May 24%2C 2022&deliveryName=USCDC_921-DM82414#contribAff
“The pandemic’s true health cost: how much of our lives has COVID stolen? Researchers are trying to calculate how many years have been lost to disability and death.” https://www.nature.com/articles/d41586-022-01341-7 (published May 18th 2022)