Our Endemic COVID Future Is Probably Not What You Think--Why More Action Is Necessary Now (A long 🧵 ):
Many think we're already “post-COVID.” We're not, but it does beg the question of what the future has in store for us. If we ignore how tired everyone is of #COVID19 and instead explore the latest data and studies, we may see that we've not yet fully understood or adjusted to our COVID future. We've gone back to “old normal” when a “new normal” is necessary.
WHY WE'RE NOT POST-COVID
No, the pandemic is not over. The World Health Organization says we're still in a pandemic. WHO declared the public health emergency on 30 January 2020 and a pandemic on 11 March 2020, and it's the entity that gets to decide it's over--not you, me, or President Biden. Days ago, WHO held a meeting to discuss COVID, and it determined the pandemic remains a public health emergency of international concern.
https://www.euronews.com/next/2023/01/30/who-to-keep-highest-alert-over-covid-as-public-health-emergency-of-international-concern
BUT WHAT MIGHT OUR COVID-ENDEMIC FUTURE LOOK LIKE?
Too many folks repeat the discredited idea that COVID is “just the flu.” It's led to folks thinking that COVID will be a minor inconvenience for the vast majority of the public on some annual basis. First of all, "just another flu" would be nothing to take lightly. The flu hospitalizes between 250,000 to 600,000 people annually in the US most years, and it kills between 20,000 to 60,000 people.
https://en.wikipedia.org/wiki/United_States_influenza_statistics_by_flu_season
Some specific findings from this study include:
There's little individuals can do to protect themselves short of enormous sacrifice if we don't implement public health solutions. Vaccinated people wishing to reduce their frequency of infection by half will need to reduce their contact rate 10-fold. People who only reduce their contact rate by half will “experience infections rates only marginally less” than those who have a median level of contacts with others.
People who are vaccinated and not taking measures to reduce their contact rate can expect to spend an average of 6 days a year acutely sick with COVID-19 and be infected 1.4x annually. That's a #COVID19 infection every 8.5 months on average. Now is a good time to remind the "just the flu" folks that the average American gets the flu once every 10 years or so.
Not only isn't COVID like the flu in terms of its evolution, transmission and frequency, we're also learning #COVID19 infections are likely much more dangerous to long-term health. To focus on just three out of 150 studies demonstrating the ways COVID can damage hearts, brains, immune systems, reproductive organs, kidneys and organs:
One study found that people who had COVID have a 43% higher risk of developing auto-immune issues.
https://www.medrxiv.org/content/10.1101/2023.01.25.23285014v1
(1) Background: Long COVID syndrome is a significant cause of morbidity in COVID-19 patients who remain symptomatic with varied clinical presentations beyond three weeks. Furthermore, the relevance of considering cardiovascular outcomes in post-COVID-19 syndrome is important in the current COVID-19 pandemic; (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this systematic review and meta-analysis. Systematic searches were conducted from multiple databases without language restrictions until October 8, 2022, to find studies evaluating cardiovascular outcomes such as arrhythmias, myocardium and pericardium diseases, coronary vessel disease, and thromboembolic disorders in post-COVID cases. The pooled odds ratio (OR), and standard mean difference (SMD) with their corresponding 95% confidence intervals (CI) were computed to find the association; (3) Results: Altogether, seven studies with a total of 8,126,462 (cases: 1,321,305; controls: 6,805,157) participants were included in the meta-analysis. Pooled odds ratios of cardiovascular outcomes were significantly higher in post-COVID cases (OR > 1, p < 0.05) than in controls. However, the mortality (OR: 4.76, p = 0.13), and heart rate variability (SMD: −0.06, p = 0.91) between cases and controls were not statistically significant; (4) Conclusions: Significant cardiovascular sequelae in long COVID syndrome highlight the importance of careful cardiac monitoring of COVID-19 patients in the post-COVID phase to address cardiovascular complications as soon as possible; larger-scale prospective studies are required for accurate estimation.
And another study uncovered the much greater risk of cognitive impairment in people following a COVID infection.
https://www.sciencedirect.com/science/article/abs/pii/S0165178122005972
The CMI has issued its consultation to help shape the next version of its mortality projection model, which is used by the majority of pension scheme trustees and sponsors in setting their funding and accounting assumptions. The consultation focuses on how to respond to the very high mortality rates seen in England & Wales over 2022, to which the model is calibrated.
The biggest health story from 2022 isn’t Covid-19. It isn’t RSV or influenza, either. It isn’t cancer, diabetes, or cardiovascular disease. It’s something that encompasses all these diseases and much more. It’s the troubling decline in U.S. life expectancy.
HOW TO RESPOND TO OUR COVID-ENDEMIC FUTURE
There is a range of things we ought to do to create the conditions for a healthier, safer future. But, none of this will work on a voluntary basis. Public health can't be left to individual choice. It's called “public” health for a reason!
If you don't believe me, let me ask you three questions:
First, are you masking on long flights? No? Then you're ignoring the guidance provided by WHO to keep you and others safe.
https://www.reuters.com/world/whoeurope-backs-travel-checks-us-given-spread-latest-omicron-variant-2023-01-10/
Countries should consider recommending that passengers wear masks on long-haul flights, given the rapid spread of the latest Omicron subvariant of COVID-19 in the United States, World Health Organization (WHO) officials said on Tuesday.
Second, do you mask when in crowded indoor spaces? No? Then you are disregarding the latest advice WHO offers, which is masking “for anyone in a crowded, enclosed, or poorly ventilated space.”
A simple question to encourage you to think more about #COVID19 risks and engage in a discussion about equity in the workplace: If the world's top business leaders recognize and take precautions against COVID during an ongoing pandemic, shouldn't they ensure the same for employees and customers? Sho
The return on investment of simply requiring better air filtration in all public venues would be huge.
Unfortunately, it would be an investment of billions to save hundreds of billions over a decade, and societies are no longer interested in such investments.
I'm very interested to see how this plays out. I've mentioned this all, and sent links, to a few people I know in California and none of them knew about it, nor did their employers. Very small sample size, but seems like it's being ignored early on.
@augieray This is an excellent start.
I’m a little chafed about how it lets employers off the hook for paying their sick employees. But if that’s the compromise they had to make to get this vital workplace safety measure to stick, I can live with it.
Do Oregon next!
@MdPoppa @augieray the large majority of politicians, including school board members, make poor, unvetted choices all the time. Often it's because they trust the advice of career administrators, and they don't want to spend the time on validation or fact checking.
Board members that object to decisions on the grounds that they want to convince themselves before deciding on something are a small minority. They rarely convince a majority of board members that they need more information.
@Velenux Hence, the larger point of my thread around the need for public action on public health. Relying on individuals cannot succeed--we need government and corporate action.
But, I'd point out 8-15€ each pales in comparison to the personal and financial loss of a disability.
People's reactions are limited by the range of their vision, the depth of their comprehension, and their propensity to seek a perceived fixed normality vs. a fluid reality,requiring a decision, an action, a reaction.
Covid does not move people to action.
“… of the ***vaccinated***”
So, among those who’ve done all they can to protect themselves from the impacts. One presumes that the impact will be even higher among the unvaccinated.
I've read this paper a couple of times now and please point out if I'm wrong, but they don't ever define "long COVID" do they?
I also found it a little odd that their paper says:
"In this analysis, we used data on long COVID risk after infection published by the Minneapolis Fed...
Under these assumptions, we found that at steady-state, approximately 25% of unvaccinated individuals with the median contact rate have long COVID at any given time, while 12% of vaccinated individuals have long COVID..."
When the data they reference goes to a paper that states:
"I first find about 24.1% of individuals who have had COVID are long-haulers"
Which doesn't appear to discuss vaccinated vs non-vaccinated, so all I can assume is that there's underlying data there that they've seen, that I'm not finding.
I appreciate the fact that people are trying to apply modeling to all of this, though.
If it's of interest to anyone, to the best of my knowledge the most complete data I've seen is from last fall:
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00354-6/fulltext#back-bib0040
And seems to show varying numbers in each study they reviewed, along with the problem that everyone defines "long COVID" differently.
"First, the effects of vaccines on long-term post-COVID symptoms are scarce, since most studies identified in this review investigated the risk of long-COVID in people infected the first month after being vaccinated. Second, there was no consistent definition of long-COVID in the published literature."
"In conclusion, low level of evidence suggests that vaccination before SARS-CoV-2 infection could reduce the risk of developing subsequent long-COVID."
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