We don't talk about COVID
but there are some things I think everyone should know
I’m ready for this whole pandemic thing to be over just like you. Trust me, it’s hard living in it using precautions. But just because it’s hard doesn’t mean we should throw caution to the wind and ignore it.
We need to work together to stop the spread of infection. Until we do that successfully as a world, people will continue to suffer. This suffering will be especially severe in those who are immunocompromised and those who live in poverty, but for those privileged folks not in those groups: you’re at risk too and you should work to protect those who don’t have your privilege.
I know for many people it seems like COVID infections are “just a little cold” but hear me out. It’s not the acute illness that’s worrying me. The risk of long term effects after apparent resolution of the acute infection are concerning. At this point no one knows how to predict how the virus will affect any individual in the short term or over time.
In recent months, the acute infection for many people has been mild - though we’re still seeing over 2000 people per week die from COVID in the US. Some young, healthy people suffer from infections.
The severity of acute infections can change with each new variant, so we should not get comfortable thinking an infection will be mild and quickly fully resolve.
Rates are high
COVID rates are rarely discussed anymore and we cannot look at positive tests as a marker for how much COVID is out there due to home testing and many people simply not testing.
Wastewater levels can show community rates in areas that the data is available.
The US wastewater map clearly shows that we are at a higher level now than most other peaks. Even the trough (low point) between this uptick and the last peak was nearly as high some other peaks. The pandemic is NOT over.
The more the virus spreads, the more chances it has to mutate and cause long term damage to those it infects. You can look for your county’s level on biobot.io/data.
Anyone can get infected
Kids, vaccinated people, and people who have already been infected can all get infected.
Kids can get infected. Some get only mildly sick, but others get very sick. They all can spread the virus to others who could get very sick. We are learning more about the long term risks in people thought to have recovered from an infection, including in kids.
If you’ve had an infection already: you can get sick again. People have been shown to be re-infected in as little as 3 weeks after a previous infection. Sometimes the 2nd (or 3rd/4th) infection is more mild. Sometimes it’s worse. Many people’s immune system doesn’t work well after infections, putting them at risk for new infections.
If you’re vaccinated: you can get sick. Immunity wanes over time and the vaccines were developed to prevent serious illness, not infection. Keeping up to date with boosters helps, but we cannot rely on vaccines to prevent getting infected or to prevent spreading the virus to others.
If you’ve been vaccinated and infected: you can still get sick again. The virus keeps mutating and not only is learning to evade immune memory cells, but it also damages our immune system.
In short: we are all at risk of an infection and there’s no way to be certain how significant it will be.
Reinfections are common – risk may increase each time
As if it’s not enough damage to your internal organs to get infected once, many are getting re-infected.
The idea of herd immunity we once looked forward to will not happen. The virus mutates too much and damages our immune system, so we cannot ever reach herd immunity.
We’ve learned that it is possible to get infected with a new variant even shortly after recovery. In fact, the immunosuppression after an infection may increase risk of other infections.
According to research done at Washington University, people with COVID reinfections were twice as likely to die and 3 times more likely to be hospitalized than those with no history of previous COVID infection in this study. They were also 3.5 times more likely to develop lung problems, 3 times more likely to suffer heart conditions and 1.6 times more likely to experience brain conditions than patients who had been infected with the virus once.
If you’ve already been infected, avoid another infection - the cumulative effects may be worse.
The acute illness is bad, but isn’t the whole story
Yes, the acute illness is horrible for those who are sick enough to end up in the hospital, but even those with mild or moderate illness can have annoying symptoms that keep them from doing what they want to do.
For those who don’t have bad respiratory symptoms, but who have the worst headache of their life, it’s bad.
Some variants led to loss of or altered smell and taste more than others. Some variants seem to hit the upper respiratory tract, while others the lower respiratory tract. For some infections, vomiting and diarrhea are predominate symptoms. Each variant seems to have its own set of symptoms and severity of the acute infection.
What will the next variant bring?
Who knows. I’d rather not get infected to find out.
It amazes me how so many people are able to minimize their symptoms shortly after their infections - especially when the symptoms caused so much suffering while they were happening.
Feeling better isn’t the end
What many people fail to realize is that recovering from an acute infection does not always indicate the virus is done.
Investigators are learning that the virus can cause inflammation and continued damage in kids and adults.
Long term and late effects may be worse
COVID is NOT a just a respiratory infection. It inflames the lining of blood vessels in every organ of the body and can cause blood to clot. This explains why infection in different people presents in different ways. Every organ system can be affected, and each new infection a person has can lead to an attack on a different organ system.
Yes, lungs are one of those organ systems. This study shows lung damage in kids who have recovered from COVID. Are these children really recovered? No. But we don’t always recognize when the virus continues to cause damage internally.
We’re seeing cognitive issues, immune dysfunction, seizures, diabetes, and heart attacks in previously young, healthy people after even mild COVID infections.
Kids and healthy adults can have these long term consequences.
The cardiovascular system is commonly affected. The U.S. Centers for Disease Control and Prevention now reports that excess deaths from strokes rose 23 to 34 per cent among young people between the ages of 25 and 44, and rose 13 to 18 percent in older age groups since the beginning of the pandemic.
COVID effects on the brain are also possible and variable. Brain fog, psychosis, dementia, and seizures are some of the effects SARS-CoV2 has on the brain. Even a mild acute infection can shrink the brain.
I’ve spoken with many people who admit to having brain fog, but minimize the symptoms. They continue to try to work and live like they did. They don’t believe that they have brain damage. We need to call it what it is and lose the minimizing term “brain fog.” It’s brain damage.
Sadly, there are no clear guidelines of what we should to to test after infections to know who is at risk for unseen complications. Most people recover and never get tested to see if they’re at risk of any of the complications listed in the images above. These complications might show weeks to months (years?) after an infection, but we have no way to project who will suffer from them.
Here’s a visual representation of long term effects of SARS-CoV2 in adults:
In kids and teens there’s a slightly different distribution as pictured below:
Unfortunately, vaccines may not protect well against these long term consequences and we don’t yet have ways to identify and treat many of the issues.
What can protect us and our kids? Not get infected in the first place.
Avoid infections
I do not want to get infected.
I also do not want the world to shut down like it once did.
We know a lot more now about how the virus spreads so we can prevent infections while still doing most of what we want and need to do with a few precautions.
If you’ve been infected, try not to get another infection. Reinfections increase your risks. It’s not worth the risk.
Prevention helps
The best way to avoid infection is to use layers of protection. I’ve shared various versions of this swiss cheese model from Ian Mackay many times over the past few years, but it continues to have solid advice.
COVID-19 is airborne. It can linger in air long after an infected person leaves an area, so it is safest to wear a well-fitted quality mask whenever you’re in a public area. Despite what you may have heard, masks work and are safe if quality masks are worn properly. To learn how to choose and use masks properly, see the Masking resource from the People’s CDC.
If nothing else, if you’re not masking, please don’t bully people who are. What if they’re on day 6 of an infection, just out of isolation but still contagious? If you question their mask, they might remove it and infect you. Is that what you really want?
Avoid unnecessary exposures. Watch local rates and adjust your activities accordingly. Much like we adjust our clothing based on the weather, we can limit indoor activities significantly if rates are high and wear quality masks when necessary.
Vaccinations help keep people from getting severe acute infections, but they do not prevent all infections. Vaccines can have risks, but studies show that risk is MUCH lower from a vaccine than from an infection. This holds true for neurological, cardiovascular, and other vaccine side effects. The infection carries much larger risk no matter what risk you look at. Get vaccinated and boosted to help yourself avoid serious infections.
Ventilate and filter the air. Open windows when possible, or better yet, go outside for gatherings. Use HEPA filters in homes and businesses. Inexpensive DIY filters can be made at home. See Clean Air Crew to learn how.
Stay home when sick. I know that it’s hard to risk missing work or school, but if you go to public areas when you’re sick (especially if everyone is not wearing a quality mask) you risk giving someone a deadly infection or chronic disease. Do you really want to take that risk? I would personally feel awful if I made someone else sick.
Test and retest as needed. We’ve all known people by now who have negative tests early on in their infection and spread it to others because they trusted the negative test. Test if you have been exposed, have any symptoms, or plan to join a public gathering where people will not be masked, such as a dinner event. This may also include work/school if masks are not routinely used. Serial testing weekly or a couple of times a week can help avoid getting others sick if you routinely go places, such as work or school unmasked. Most insurance companies offer up to 8 masks per insured person per month. The US government is giving another 4 tests per household.
Wash hands and surfaces frequently. COVID and other germs can spread through touching surfaces. Proper cleaning and sanitizing can help.
For more details on prevention, see this Safer In Person Gatherings tool kit.
We’re all in this together
The more people who take precautions, the better prevention strategies work. Be kind and be safe!