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Long COVID risk: How to maintain an up to date risk assessment so we can go back to normal life?
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Tornus30

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.

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by Sameerishere
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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:

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?
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Long COVID risk: How to maintain an up to date risk assessment so we can go back to normal life?
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Zvi

180

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.

[-]tslarm270

I have returned to normal life and am essentially ignoring Covid risk going forward.

 [...] 

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.

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.

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2Elizabeth
I find it plausible it's better to be exposed to covid early and often, so your immunity never wains.
5tslarm
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.)
1jaspax
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.
3gabrielrecc
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.
3pjeby
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.
[-]Sameerishere80

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 sayi... (read more)

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[-]Zvi*130

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.

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[-]Sameerishere120

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.

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3Timothy Underwood
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. 
1Sameerishere
Thanks! I find that compelling.

Tornus

90

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.

[-]Richard_Kennaway90

Is eating in a restaurant worth 75 minutes of lying in bed with flu wishing I was dead

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.

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[-]Sameerishere10

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:

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.

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3Tornus
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.

Richard_Kennaway

*

70

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?

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.

Tornus

50

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?

[-]Michael K50

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?

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2Tornus
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.

alyssavance

40

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

[-]Sameerishere50

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 disabilit... (read more)

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DreamFlasher

10

"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)

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[-]Elizabeth120

I looked at doing this a few months ago, and my conclusion was that it was going to be a lot of work that would not influence very many people's behavior. Some contributors to this belief:

  • Recent LessWrong posts about long covid were not getting that much karma (example,  example).
  • People I know don't seem like they'd be moved on the margin by changes in the EV of long covid: people either think "you're gonna get it eventually so why work so hard to get it a little later" or "no risk is acceptable I'm staying in lockdown".
  • My assessment that, post-vaccination, covid was in the range of other health concerns, and most people had lower hanging fruit to pick on their health.
  • My belief that getting wide usage was going to require a fantastic UI, and that seemed like a lot of work. 
  • When I talked to people they liked the idea a lot, but when I framed it in terms of "what would you give up to get this?", the answer was always "not much". 
    • I don't think people would necessarily have predicted how much microcovid improved their lives, so this could surprise people too. But I think this is a harder environment in which to bootstrap a new tool than summer 2020, so I would need a much more developed MVP to get attention.
  • I think doing it right would involve multiple skilled/trusted people making frequent updates.  The appropriate people are really busy and often not very motivated by money (although you still have to pay for their time, especially over the long haul);  the thing that would keep them going was users and impact. For all the reasons listed above I didn't expect to be able to generate that momentum. 
    • I periodically have posts that take a ton of work but get minimal attention because the facts on the ground are too murky for anyone to say something simultaneously truthful and compelling. It's draining.
  • I was offered work on a more important project (my part on that is now finished, but it was definitely the right call to prioritize it from January until April).

 

If someone else is interested in running this with me as an advisor and estimator, please reach out, I'm happy to talk about my specific idea, which did get a lot of positive feedback. By far the most important thing you would need in PM-type skills like organizing contractors, keeping estimators and users engaged, and management. The next most useful would be the ability to design the UI or implement code yourself. Doing the medical research is not required, and I think there's an excellent chance I can find funding for a sufficiently good organizer.

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[-]Sameerishere*30

Thanks very much for looking into this, and sharing all those details about the conclusion you came to! 

I have the PM-type skills for this, but if the consensus of smart people far more numerate than I is that the risk of debilitating long COVID is low enough that it's comparable to other risks normal people routinely tolerate, it doesn't seem worth it. 

Some follow-up questions for you:

1) Is this still your assessment (i.e. how your assessment evolved since the post you wrote 8 months ago, if at all)?

  • My assessment that, post-vaccination, covid was in the range of other health concerns, and most people had lower hanging fruit to pick on their health.

2) How likely do you think it is that this would change with further variants? Do you think it is likely enough that this is worth keeping tabs on? (My guess is that this is covered in your overall comment above, but thought I'd check, in case your overall conclusion was about updating risk assessment to reflect new studies, rather than new variants).

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/selfreportedlongcovidafterinfectionwiththeomicronvariant/6may2022 which a couple other commenters shared seems to indicate that Omicron certainly hasn't been more likely to cause long COVID than Delta (based on a quick read of the summary at the beginning)
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[-]Elizabeth20
  • My assessment that, post-vaccination, covid was in the range of other health concerns, and most people had lower hanging fruit to pick on their health.

I haven't done any hardcore investigation since that post, and haven't changed my mind based on anecdata. 

How likely do you think it is that this would change with further variants? Do you think it is likely enough that this is worth keeping tabs on? (My guess is that this is covered in your overall comment above, but thought I'd check, in case your overall conclusion was about updating risk assessment to reflect new studies, rather than new variants).

I think this is where the real value of a covid assesment systems would pay off,  if it ever did. To do this it would need to cover both long term damage and acute disease parameters like severity and transmission. Unfortunately this means you need to:
 

  • invest a lot with ~no payoff, because you're not in a world where LessSick is useful
  • drop everything and respond really quickly whenever new data comes out, even though the answer is probably "no one cares", because your value prop is that if reality takes a bad turn, you will alert people immediately.

I've watched this play out with microcovid and "infinite readiness punctured by quickly doing a lot of cognitively intensive work" is just a very hard dynamic to keep going for years. It's also not obvious to me that covid is the best use of that energy, relative to other pathogens, and that monitoring pathogens are the best use of that energy relative to exercising and eating well.

However if you feel personally motivated to work on covid, for years, under taxing conditions, in a way you don't on other projects, I think it's plausibly worth doing, and there are some generalizable lessons that can be pulled from the project. 


 

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[-]William_S20
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/6may2022

Estimates 0.5% (346,000) of UK population reports long covid symptoms that limit their day-to-day activities "a lot" (possibly too high if other stuff mistaken as long covid?)

Another article (that I didn't look at beyond the headline) suggests 7/10 people have had covid https://www.theguardian.com/world/2022/apr/22/seven-in-10-people-in-england-have-had-covid-research-shows-omicron

Together seems to suggest risk less than 1% of the worst kind of it.

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[-]Zian20

Have you looked at other resources that do something similar to what you're asking? For example, what are the shortcomings of using Up to Date for this purpose?

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[-]Elizabeth*30

Up to Date is very conventional, conservative medicine, right? the track record of that kind of medicine on covid has been quite bad.

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[-]Zian10

While I haven't evaluated their covid stuff, I agree with your assessment for other conditions where I've done some digging.

I meant to elicit some comments about whether the value of new-thing-digging-in would be sufficiently greater than what we could get out of making more optimal use of existing resources.

I'm going to use allergic rhinitis as an example below but I could probably have called it "disease X".

There's the set of things (e. G. Buy Kleenex, take those red round things, etc.) that the average person knows to do from surrounding people, culture, advertising, instinct, and the contents of store shelves. Let's call this the low info & ultra conservative corner.

Then there's the higher info and less conservative ground occupied by something like the MASK ARIA guidelines that implies that anyone who puts forth a real effort should be in pretty good shape after no more than a week with occasional exceptions. And to use EY's idea here, the goal should be to get those Exceptions into the hands of Exception Handlers as quickly as possible.

Up to date is higher info than average-person-on-street but more conservative and certainly less efficacious than a pad of post it notes + MASK ARIA.

I'm not sure what the MASK-ARIA equivalent for long covid is but I imagine that if it exists, it might be good enough.

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[-]Sameerishere10

Thanks! I have not, but defer to Elizabeth's comment below on this.

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