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May 17, 2022

Why Ezekiel Emanuel is still worried about long Covid

Daily Briefing

    As Covid-19 restrictions continue to fall, many Americans appear to be operating under the assumption that "[t]he covid-19 pandemic is over." Writing for the Washington Post, Ezekiel Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania, explains why the threat of long Covid should not be diminished.

    'We still do not know enough about the complications that come after the initial infection'

    While recent data suggests that around 60% of Americans have already been infected with omicron or another coronavirus variant, Emanuel argues that those who assume "[t]he covid-19 pandemic is over" are falling victim to "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," Emanuel writes. "Indeed, the belief that omicron was more mild than earlier variants was wrong. It was just as deadly."

    Notably, Emanuel said he will continue to follow pandemic safety precautions, including wearing an N95 mask, limiting train and air travel, avoiding restaurants, and using a HEPA filter in while teaching.

    "Why?" Emanuel asks. "Largely because of long covid."

    A coronavirus infection "comes with worrisome complications," Emanuel notes. And while we now have access to effective prevention and treatment tools that help ward off severe illness and death, "we still do not know enough about the complications that come after the initial infection."

    Although long Covid was first described in May 2020, the condition still does not have a uniform definition. However, we do know that the devastating symptoms, including brain fog, fatigue with minimal exertion, severe shortness of breath, insomnia, and dizziness can last for months, Emanuel writes.

    "If the risk of long covid were low, I would agree that we should stop with masking and other precautions," he adds. "But while we don't know the precise frequency of the condition (a failure of the National Institutes of Health (NIH) and biomedical researchers), we do know it is not rare."

    In fact, estimates for long Covid cases range anywhere from 0.5%  of infections to 30%—with commonly cited risk of around 10%.

    In addition, Emanuel notes that "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."

    And vaccines seem to help reduce the risks of long covid, but not the prevalence.

    According to Emanuel, the data surrounding long Covid "are highly variable." For instance, a Veterans Affairs study estimated that the Covid-19 vaccine lowered the risk of long Covid by 13%. And two Britishstudies estimated a 40 to 50% lower risk after vaccination.

    Perhaps "the best study," according to Emanuel, involved more than 240,000 U.S. patients, and suggested that vaccines could reduce the risk of long covid from about 3% to 17%. "That is not rare," he notes.

    Unfortunately, there are still no treatments for long Covid, and NIH has not established a program to conduct accelerated clinical trials to evaluate potential treatments.

    Could there be a 'longer' Covid?

    According to Emanuel, "there might even be a 'longer' covid." Currently, researchers are still learning about the risks associated with long Covid, months or years after an initial infection, including heart attacks and diabetes.

    In particular, researchers have discovered that Covid-infected pregnant women face an increased risk of being hospitalized, being admitted to the ICU, and having an early delivery. Erectile dysfunction has also been documented as a risk of long Covid.

    "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," Emanuel adds.

    Ultimately, Emanuel argues, "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."

    If we continue to act like the pandemic is over, Emanuel argues that "we are creating a serious burden for the future."

    According to Emanuel, an increase in Americans who have severe, chronic symptoms, are unable to work, and require medical attention and support "will cost all of us in health coverage and disability payments."

    "Like everyone, I want this pandemic nightmare to be over," Emanuel notes. "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." (Emanuel, Washington Post, 5/12)

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