Here's some information about what most of us have been calling long Covid or post Covid, but which leading researchers prefer to call post-acute Covid. (The term PASC for post acute sequelae of Covid has been proposed but has not been much used in the media.)

This is a well done discussion of long Covid by a respected epidemiologist. The details may be confusing for those not experienced at following and evaluating medical studies. His summary conclusions (and my take-home analysis), though, are fairly straightforward:

    1    Long Covid is real and a serious problem.
    2    Both the risk of getting long Covid and the risk of severe/prolonged long Covid are related to the seriousness of the initial infection.
    3    Vaccination and Paxlovid both reduce the risk of severe Covid and reduce the risk of long Covid.
    4    Repeated Covid infections probably increase the risk of getting long Covid, but it is not clear how large that increase in risk is. The current scant evidence supports the theory that those most susceptible to long Covid are also most likely to get it after their initial infection, after which the pool shrinks, so the added risk of each sequential infection is small - but not zero.
    5    When reading stories about long Covid, it is important to remember the difference between incidence (the number of new cases in a given time period) and prevalence (the number of currently existing cases). These are related but not the same.
    6    The current incidence of long Covid (e.g., the number of new cases of long Covid every month) is quite low. This is probably mostly because of a combination of widespread immunity (vaccines and illness) and the use of Paxlovid to reduce the number of severe Covid infections.
    7    Even though the current incidence (rate of new cases) is quite low, long Covid is often a serious problem for those afflicted. It can be truly debilitating for some.
    8    A small percentage of a large number is still a large number. For example, a low incidence of 0.01% in a population of 330,000,000 people is 33,000 people. If we decide Covid is 'just another viral illness like a cold' and accept a 'new normal where everyone gets it once a year, that will mean as many as 33,000 new cases of potentially devastating long Covid every year in the US.
    9    The best protection against long Covid is to stay fully vaccinated, minimize the risk of exposure (e.g., use a good quality mask, avoid time indoors with large numbers of people and/or in poorly ventilated spaces), and get Paxlovid if one does get sick with Covid.

And this is an excellent and informative interview with Professor Akiko Iwasaki, one of the leading researchers and experts in post viral phenomena - and an excellent communicator. She notes 4 general root causes of post acute Covid syndromes and notes that there is good evidence for all of them, that they are not mutually exclusive, and that post acut Covid is not one disease but an umbrella term for a collection of related diseases. The four proposed causes are:

    •    Persistent infection or persistent viral debris
    •    Autoimmunity
    •    Reactivation of latent viruses such as herpes or varicella
    •    Dysregulated tissue function, including disrupted inflammatory cascades and disruption of the endocrine hypothalamic-pituitary axis.

(Here’s a very good recent article by Iwasaki and her colleague David Putrino about this, also detailed and informative.)

My current personal perspective is that I do not much worry about becoming critically ill or dying from Covid because I am generally healthy despite my 76 years, am fully vaccinated, and have access to a care system and Paxlovid. However, I am still strongly motivated to avoid Covid for four reasons:

    •    I don't like to be sick.
    •    The acute phase of Covid would be very disruptive for me, as it would interfere with many parts of my active life style like my ability to visit grandchildren, shop, exercise, and the like.
    •    Though the risk of post acute Covid is small and the risk of prolonged/serious post acute Covid is very small, these are risks I prefer not to take, especially since mitigating precautions are pretty easy for me.
    •    I don't want to be responsible for giving Covid to others.

I am slowly increasing my participation in public activities, but continue to consistently use a good quality mask indoors, will keep my vaccination status current, and avoid to the extent possible crowded indoor spaces (which involves balancing the value versus the risk of an activity, a personal and pretty fluid calculus).



Links to more on this topic: