COVID risk assessment

I hesitated posting this at all, because I am profoundly uninterested in hearing guesses framed as facts from all of the armchair epidemiologists out there, and this is catnip for them... But here's how I've been seeing things these last few months. Maybe you have too.

My goal is to not catch COVID at all. CDC tells me that my goal should instead be just "don't fill the hospitals past 100%", but I'm a little more ambitious than that.

Back in July, when Delta hit, the CDC maps started looking like something from the pre-credits scene of a Milla Jovovitch movie:

But while the whole country was turning red, the Bay Area was still orange, and the SF.gov graph looked like this. At the time, though I was still terrified, I judged it to be reasonable for me to be masked in a crowded room with other vaccinated people:

Then in December, Omicron happened, and the graph did this, and I nope'd out:

December-ish was also when I started hearing more about Long COVID, with numbers that seemed to move it into the category of "this is something you actually need to be concerned about", not some one-in-a-million thing that only a small number of people were unlucky enough to get.

So now here we are in March, and three things have happened:

  1. CDC has recolored their maps to reflect their new advice that so long as there is still freezer truck morgue capacity available in your area, you don't need to worry about COVID;

  2. Mask mandates are gone, and CDC has told everyone that masks are for your own protection instead of being a tool to reduce community transmission;

  3. And the SF graph now looks like this:

I don't want to be fused to my couch any more. I really, very much, very very much, wish to be standing on a sticky floor in a dark room full of people, listening to mediocre music. My standards are very low at this point. You don't even know.

But what I'm struggling with is, once that graph drops back down to pre-Delta levels, like, say, 50 new cases per day, should I go back to feeling comfortable being back in those crowded rooms full of purportedly-vaccinated strangers? Or do the facts that:

  1. Absolutely none of those fuckers will be masked, and
  2. I know more about Long COVID now,

mean that I should still be cowering at home, terrified?

I don't know how to do this math. The organization that is supposed to be providing this guidance, the organization that is chock-full of actual full-time professional epidemiologists, is now just transparently gaslighting us in the interest of... what? Political expediency and the economy instead of public health, I guess?

I also wonder whether that graph of new cases is as accurate today as it was last year, since, with both vaccinations and availability of home tests having increased, more and more people are probably getting infected but not reporting it.

Again: opinions not solicited! While my question is not rhetorical, as such, I am still very much not asking for your opinions or guesses as to the answer. You and I both know that you don't know.

Previously, previously, previously, previously, previously.
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96 Responses:

  1. Dara says:

    This isn't an opinion, and I am not giving you an answer. What I'm giving you is published data brought to my attention by a research scientist who lead development on one of the mRNA COVID vaccines.

    To wit:

    Two-dose vaccination, even time-distant, reduces the odds of acquiring Long COVID to statistical zero, with symptom occurrence returning to non-covid-affected population baseline.

    Make whatever opinions you like from that.

  2. Aaron says:

    I've been finding Bob Wachter, chief of medicine at UCSF, to be a steady source of evidence-based wisdom on these kinds of questions throughout the pandemic.

    most recent threads:
    https://twitter.com/Bob_Wachter/status/1497271651431444481
    https://twitter.com/Bob_Wachter/status/1495165503106543618

  3. Jacob says:

    Man, I’ve been struggling with this same exact math problem myself.

    I figured at some point we’d hit a baseline of infections/deaths per day and we’d collectively sigh and go back to normal. But I really didn’t expect these numbers to be where we’d land.

  4. Miguel says:

    I'm in the same boat, never want to catch it. In keeping with the new "personal responsibility" policy I've switched to a N95 one-way masking strategy but it's tough in food/drink situations and other peer pressure situations.

  5. Narr says:

    Two of my cloth-masked cow orkers, one boosted one week before, caught covid (one probably from the other, the other from risky behaviour). They both got a few weeks of difficulty/painful breathing, lethargy, et alia.

    One has since switched from a cloth mask to exclusively N95’s, even though he’s boosted and now ‘recovered’. They worked beside each other all day, and those of us who merely walked by or hung out for a bit wearing cloth masks (2-3 layers) have come through unscathed and/or asymptomatic.

    TLDR: ¯_(ツ)_/¯

    • jwz says:

      Yeah, so, random-assed anecdotes about strangers are also very firmly in the category of "I really don't care." Feel free not to share these with me.

  6. Vespers says:

    I've been frustrated by the same change in approach here in NZ, where things were less awful for quite a while, but once Omicron hit the govt made the same gear-shift from 'public health advice for not getting sick' to 'public health advice for hitting that sweet balance point where caseload almost but not quite overwhelms health services but also businesses are happy'.

    The clear shift in direction from 'trying to keep you safe' to 'a lot of you are going to get sick and that's okay, please keep working from the office even if you can work from home safely because our local hospitality businesses need your lunch money' is... deeply depressing as a person who still wants to not get sick, thanks.

    • Elusis says:

      The clear shift in direction from 'trying to keep you safe' to 'a lot of you are going to get sick and that's okay, please keep working from the office even if you can work from home safely because our local hospitality businesses need your lunch money' is... deeply depressing as a person who still wants to not get sick, thanks.

      Seattle media is constantly trying to inform me about how dangerous and scary it is to come downtown (the "Seattle is Dying" narrative) while also simultaneously trying to convince me how important it is that I return there immediately to get on with my work because everyone is tired of the pandemic existing. As someone who perversely refuses to be reflexively afraid of unhoused people, but who stubbornly insists that I don't care for any more acquired disabilities than I already have, I find the rhetoric both insulting and infuriating.

      Meanwhile, I have no idea whether I should actually go to see Gary Numan in a couple of weeks or not.

  7. Penguin Pete says:

    You guys all do you. I am a nutcase.

    For me, I am likely not going out without a mask for a long time. I also have no desire to set foot in a nightclub, movie theater, or amusement park again. I'll keep it down to the level of "popular restaurant / museum on a quiet day" exposure. Masked.

    I'm doing this not just because of COVID. But because of the next pandemic and the one after that, because they're going to start happening much faster. COVID already forked off into a bunch of variants. We've had SARS in waves now. I've seen how you people handle yourselves. You're walking zombie bait.

  8. CSL3 says:

    I still have to go out and review shows because capitalism. I'm glad more places are requiring boosters (though not at Lounge-level scrutiny), but the folks inside still treat masks like they're Hans Gruber: "Thank you, Mr. Cowboy; I'll take it under advisement."

    I, on the other hand, take so many precautions and constantly scrutinise of COVID policies in my reviews, so now folks "recognise" me. Seriously: when I was at the SF Ballet over the weekend, several people asked who I was by name.

    'Course, it might have something to do with the fact that I spent the whole show lookin' like this:

    • jwz says:

      I'm just gonna point out that there are a lot of really excellent plague doctor masks on Etsy. Some are a little pricey, but with one's lower entertainment and dining budget, maybe there's room for supporting more cottage-industry crafting.

      • CSL3 says:

        No joke: you post so many cool-looking plague masks that I've honestly considered it. Aside from price, I also know that most of them are leather, so I'd have to look into how to properly clean them - plus, a leather mask would be stifling in the summer (it's why I was always just an observer during the Folsom Fair).

        I've also considered this Eyes Wide Shut piece, as well as one of the Lumen Couture masks you showed on this blog some time back. With my new DNA Lounge card coming, I can definitely see one of these being easy to slip a straw under or lift up to eat pizza.

        Priorities, y'see.

        • Elusis says:

          I like the GIR silicone straws for slipping under a mask to drink from. Requires almost no adjustment at all and the flexibility works better than a stiff straw, I find.

          • CSL3 says:

            I'm fine with regular straws, as far as masks go. I've found it super easy to just lift it up a smidge for eating things. I heard about the kosk mask weeks back, thinking it was a fold-up thing. Turns out it's just a nose-only thing, which... why?

            Then there's this this beauty:

              • CSL3 says:

                And it was the walking, talking AI (Ash) let them in. Thus adding more proof that Musk Oil is just creating Weyland-Yutani at this point (complete with flame throwers and those shitty trucks that look like the Marines' vehicles).

                In other news: SF lifts mandates the same week that Waymo is allowed to pick up paying passengers. I'm sure that'll turn out well.

    • sleepdedication says:

      that's a strong look. keep up the good work!

  9. Red says:

    You've summarized pretty much exactly where my thoughts have, and continue to be.

    The only difference is that in four days my kid's school is going to go mask-optional which means the probability of our household successfully repelling this virus indefinitely has taken a significant hit.

    Until we see treatment for long covid, my interest in becoming a member of the mass-disablement is zero.

  10. apfrod says:

    When we all get nuked, maybe we'll wish we had been on a sweaty dance floor one last time.

    • tfb says:

      That is in fact one of the sums people ought to be doing. What's the risk of being killed/disabled by CV19 vs the risk of Ukraine escalating to WWIII? And it's one of those things you can get horribly wrong: if WWIII happens it kills or disables pretty much everyone which makes it look really bad, but I think you have to do the risk per person which makes it look much less bad.

      (Also who knows what the risk of Putin doing what he is threatening to do is, exept that it's not as low as it ought to be?)

    • Igelau says:

      My spouse accidentally botched some current events smalltalk and made it sound like we were actively going to war. I was literally unwrapping a Covid test and I pretty much said "we are fact checking you right now, because if that's true, I'm throwing this thing out."

  11. Mark says:

    Bordering on advice but here goes anyway: You’re right about the reasons to be skeptical about the accuracy of reported case counts. Supposedly a better indication of how things are really going is hospitalizations. In my county, at least, those paint a far less rosy picture.

  12. tfb says:

    I had a similar dilemma with being in cinemas, taking photographs, and other things ('had' because I finally did get it three weeks ago, at a show of my own photographs where I really could not avoid being, so the sums are different now). Cinemas are obviously much lower risk than gigs: you can pick early morning showings, sit far from where anyone else sits (I like to sit at the front, which helps) and people are not jumping around and shouting.

    So this is not, I think, an opinion, but here are some things I worked out.

    If you know you will behave well if and when you get it, you can do the selfish thing and only worry about transmission to you, which makes the sums easier as you only need to worry about your risk, not the risk you kill or disable someone else. I did that by being very sure I spaced out things I went to by long enough that, if I was symptomatic I would know, and by doing a couple of tests before I went anywhere (but see below), and then when I did get it being very careful to isolate. You have to fight off other people if you do this: I had to explain to my mother (who is in her 80s and who I really do not want to take the risk of killing) why I could not go to see her after I'd done something else, for instance.

    You have to compare the risk with other risks. Every time you ride a bike there's some chance of death or long-term disablement. It's a bunch lower than the risk of covid, probably, but if you're not doing the comparison you don't know.

    You have to do the awful QALY thing that health services do. In my case I'm in a position where I could probably keep the risk very close to zero, but the cost of that is doing nothing other than going out for walks for ever, and why be alive in that case? So I ended up doing some risk-benefit sums based around that ('I am careful not to risk other people, so one choice is living indefinitely as a hermit and the other is accepting some probability of death or disablement of x per year and in return I get to do y z & t', and put numbers on that.)

    Bayes theorem (I know you know, but I was a mathematical physicist and I had to teach myself this stuff as it never mattered in what I did).

    You need good sources of risk data, infection rate data and so on. I don't know what they are: I keep finding ones I think are good but then things change and they get out of date. There is a lot of rubbish, for sure. I don't know about the US but the UK government has recently done things which I strongly suspect are designed to make infection-rate data appear lower than it really is so I no longer trust their data.

    The tests are not as reliable as I thought they were, but I've not even been able to find good recent data on this. I thought PCRs were both very sensitive (low false negative) and very specific (low false positive), while LFTs were also very specific but not so sensitive. But I tested negative on both (one PCR, lots of LFTs) for the whole period I had covid, so, well. This may be because I've had three vaccinations and so the amount of virus was just really low (I am (almost) certain I had it because my partner had multiple +ve LFT tests (but -ve PCR), and we were both symptomatic). Since then I've been trying to find good information on test reliability but I've failed.

    You can't make the risk zero.

    • Joe Shelby says:

      Maybe it can't be zero...but it can be a LOT lower if restrictions weren't removed so drastically before prevalence got to a lower point (the WHO standard had been 5 cases per 100,000 - maybe not that low, but we should do better than 500).

      And as for risk/rate data, this is getting harder to find because as restrictions lift, so does the attention span of local and state governments (particular those of a certain bent) for bothering to track and report.

      Virginia's been a pain in the arse to figure things out during Omicron because after Delta, they stopped reporting/publishing on weekends, which means we have ridiculous daily spikes and a 7-day average that is unreliable until Tuesday at the earliest.

      • tfb says:

        Oh, yes, sorry: my comment that you can't make the risk zero was meant to fend off 1-bit-brain thinking ('it's either the end of the world or it's nothing') not to mean it can't be lower than it is: it can always be lower than it is! It was poorly worded, sorry.

  13. Dave Polaschek says:

    Fwiw, David Scrase, the acting chief of the Health Department here in NM says he’s still wearing a mask any time he’s indoors with other people, and we’re following his lead.

    We’re anxious to get out and do things we’d planned to do two years ago, but there’s an awful lot of people out there running around unmasked, so we’re not getting “back to normal” until we see data about how this all [waves hands] is working out. Maybe May or June?

    By which time we’ll have done our spring plantings here at our house, and we’ll be stuck at home watering the new plants until July when hopefully the monsoon has established itself and we can leave for a couple days.

    Mentally, I’m trying to prepare myself for a third summer of mostly staying home and working in the yard, but we both retired in 2019, so we can both stay home. It’s just not what we’d planned.

  14. JohnD says:

    Have you been following Ziv's posts on Covid?
    Here's his long post on long covid. Generally he feels the risk is low:
    https://thezvi.wordpress.com/2022/02/10/the-long-long-covid-post/

    I highly recommend all of his stuff.

    • jwz says:

      I was on page 4 of longwinded assertions with nothing to back them up when I stopped reading.

    • jal says:

      I have no idea who Ziv is, but a quick perusal of their output shows (a) they seem like the kind of hyperverbal know-nothing that destroys the few useful Twitter threads that happen, and (b) they refer to lesswrong.com a lot, which reinforces (a).

      If they want to tell themselves ghost stories about Roko's Basilisk some more, I'll maybe be bored enough at some point read for humor value.

      Me, I'm just going to keep in mind that polio didn't really freak people out at first, either. It wasn't until people figured out what "long polio" did that something was done.

  15. MrSpookTower says:

    My goal is to not catch COVID at all.

    A worthy goal. It's my goal as well.

  16. s1mon says:

    While far from perfect, the MicroCovid project has a risk tracker which I have found helpful in framing what activities I do and don’t want to take chances with at a given time. https://www.microcovid.org/

  17. JMM says:

    Also:

    C. Vaccine effectiveness wanes considerably. The 4th month after the third dose it drops as much as a third (source).

    So a room of fully vaccinated people depends on your definition of "fully vaccinated". I just bought several boxes of N95 masks, I don't think I'll have too many in the months / years to come.

    • Eric TF Bat says:

      Last I heard (and I have NOT been following the minutiae closely, for my own sanity) there was talk of redefining "fully vaccinated" to mean "two shots + booster" (with the exception for Johnson & Johnson or any other one-and-done jabs). Some people/places/organisations were saying let's make that the standard now; some were saying yes but not yet; some were saying there's just no way they could pull that off without confusing people unrecoverably. Where is San Francisco on that particular road?

  18. keithzg says:

    Up here in Edmonton, Alberta, my city is being a bit more cautious with removing mask mandates and such (to risk armchair epidemiologizing: I've personally bet more on a strategy of just not being around people, since with an airborne illness it always felt like even fairly decent masks were a roll of the dice). But our provincial government is moving to ban all municipalities from keeping any Covid measures in place, so even my city's meager remaining measures are going to end soon.

    With them (unsurprisingly, if ghoulishly) having long ago now largely dismantled the testing infrastructure I was getting numbers and graphs to base decisions off of, and as you point out people are less likely to be getting centrally tested now anyways, I've personally turned to wastewater testing numbers. I've barely heard it covered in our local media, but several Alberta universities have teamed up to collect wastewater Covid data, and as far as I can tell, the ones collected and published in my area seem reasonably reliable; maybe the same is true where you live?

    It really is quite difficult to make decisions with such an absence of trustworthy authority out there. Alas.

  19. B says:

    This is not an answer, but I offer two thoughts:

    1) We have been running the most amazing experiment ever: a huge swath of the country has been "mask free" for literally a year, and another swath has been "mask everywhere." When do you ever get such a great control group? So: I don't think the media narrative (or blue-check Twitter) has the whole story, because both things can't be true. Do we see crippling rates of long covid in Arkansas but not SF? Kids dying in Missouri but not Oregon? These questions can be answered, because of the amazing data and difference in response. We desperately need those answers, because living in Florida is either (a) grim meathook or (b) as risky as riding a bike in SF. I don't know which one, but it has an answer. I want those papers!

    2) Cost-benefit. Some recommended Bob Wachter and I do too, because he focuses on cost-benefit and "how likely am I get get covid, and then how likely am I to die?" Perhaps tellingly, he does not discuss "how likely am I to get long covid." If that's not his concern, should it be yours? Maybe? Or maybe you'd be OK, because long covid is 1-in-a-million (like getting hit on your bike boy a car - I have a friend who just spent a month in a coma from that, he'd like to say that sucks too, and we should ban cars).

    I don't know the answers, but I do know the cost-benefit can't be "we need to be safer than cars." As Jaime knows with self-driving that's a _low bar_, and you expect a different result here?

    • jwz says:

      As I tried to say above: if I thought that Long COVID was one-in-a-million, I'd be out licking doorknobs right now. But nobody can tell me that with any confidence, and some say it might be as high as one-in-four but takes many months to manifest.

      • B says:

        I know! I agree! All I can say is, in my county (San Diego) there have been ~ 800,000 cases (confirmed and reported, so assume there are >50% more? So half+ the population, with a 90% vax rate). Omicron took me from knowing "count on one hand" cases to "damn near everyone I know" cases. It tore through the schools - a majority of kids got it. Yes, you didn't want anecdote so I proactively apologize in advance. But I do not see long covid stories locally, nor "kids are dying" stories (they'd sell papers; they'd be written). I don’t know anyone with long covid but I know hundreds of people who had Omicron.

        So I can say with reasonable certainty it is not 1 in 4 (at least not presenting in year 1, half our local 800k cases are a year+ old). But, I assume, more than 1 in a million? This is hard to study - I've read some literature, the questions are basically "are you tired?" and "do you have a headache?" One study found people who _didn't have covid_ feel worse, by those metrics, than those who do! But who isn't old, tired, with a headache? Is it Covid, or diabeetus, or asthma, or hard living? Who knows! Covid? Or just beaten down by the pandemic?

        Full disclosure, and please don't be angry with more anecdote: but my boosted kid did a bad masking job and gave boosted me Omicron in January (not my wife, and not all my kids, more useless anecdote). No issues thus far. Unhelpful when we have so much data out potential out there? Given the magnitude of infection, we ought to see more carnage - 50% of the schools open for a year without masks, they should be clearly worse off than CA? LAUSD, with outdoor masking, should be clearly better than Florida or AZ? But the data doesn’t seem to be there, nor the anecdote. I should know people with long covid, and I don’t.

        So I can't square what I observe (nearly 1/2 of _everyone_ I see each day has had Covid, including me) with “and we have to take every human precaution because it’s end of days if you get it.” I tried really hard and failed - and I personally know unvaccinated horror stories (dead at 55, e.g.) so this is not abstract. I wish we could deny medical treatment to the unvaccinated - but I’ve been informed that is unethical. So the solution is some sort of cost-benefit balancing, and I just don’t know how you do that? I want real debate here - Bob Wachter and Eric Topol and Zeynep Tufeki and yes, even David Leonhardt and Nate Silver. This is not black and white - it is absolutely NOT the trolley problem - and it does not help to treat it as such.

        • jwz says:

          "I know you explicitly asked not to hear a whole bunch of useless anecdotes, but here's four paragraphs of them anyway."

          People, please don't do this.

          • B says:

            Sorry, I could have written your response, but I don't know how else to even discuss this issue? Maybe discussion and debate aren't the point?

            I read Bob Wachter, Eric Topol, Zeynep Tufeki, David Leonhardt and Nate Silver. Doctors, social scientist, pundit. I think this informs me the best I can be informed (read Topol for primary source literature links, cut out the interpretation). I assume you do the same.

            Beyond that, my strong belief is your answer will not be forthcoming soon (read up on the Eppstein-Barr / MS link - 160 years later we know EB causes MS, but we don't know why only a few people get MS when 90% of humans have EB). Covid might be equally complicated.

            So what do you propose we do in the intervening time? I expect it will be years to even begin answering your question authoritatively, and potentially decades to know nuanced information about who is vulnerable.

            And, how do you propose dealing with the "large portion of the world that has decided anecdote is good enough for them to make the risk-reward call to move back to normal." Although framed as American, it's not - see the UK's "don't isolate when positive" rule.

            These are real questions that I don't think can be answered by data alone (Tufeki in particular focuses on the sociology aspect). These are real cost-benefit questions to discuss, not black and white problems a computer can spit out the answer to. And we might have to rely on anecdote while sorting out the actual data. I guess "the real world is messy"?

            • jwz says:

              Sorry, I could have written your response, but I don't know how else to even discuss this issue? Maybe discussion and debate aren't the point?

              I thought I made it clear that I am not interested in "discussing" or "debating" any of this with any of you. None of you have answers and I don't care about your opinions.

              So what do you propose we do [...] And, how do you propose dealing with [...]

              If you were under the impression that I'm in charge, you have been woefully misinformed. Go ask your questions of an actual epidemiologist.

      • tfb says:

        I'm pretty confident it is lower than 1 in 4 (in the UK), but not perhaps orders of magnitude lower. Our World in Data claims just shy of 20 million cumulative cases in the UK. The ONS state 1.5 million self-reported long covid cases. So that's about 1 in 13. However the true cumulative cases will be higher, and almost certainly the self-reported thing means the real long covid numbers are lower. My guess is it's no more than a few percent and it might be significantly less.

        I also think that a rate significantly higher would start showing up in things like employment / productivity statistics, which are things our overlords probably care about – you can't have too many of your serfs incapacitated – unless they're just getting all their money direct from Russian kleptocrats now, which they may be.

        But a 1% risk still sounds like a lot.

        Note that 45% of the reported long covid cases are from infections at least a year ago, so there probably isn't much data on infections significantly longer ago than that.

        I believe the ONS are competent and not too infected by johnsonite lies (yet, perhaps).

        • jwz says:

          Employment statistics, you say?

          Insurance company OneAmerica said the death rate is up a stunning 40% from pre-pandemic levels among 18-64 year olds:

          "Just to give you an idea of how bad that is, a three-sigma or a one-in-200-year catastrophe would be 10% increase over pre-pandemic," he said. "So 40% is just unheard of." [...]

          They explained that they're seeing deaths months after workers "recovered" from Covid from infection-related health consequences (heart attacks, vascular problems, etc.). These deaths don't get classified as "from Covid" because they're no longer "positive."

          • Douglas Knight says:

            If the CDC told me that heart attacks were up, I would attribute them to long covid. But it doesn't. It's true that deaths among 18-64yo are up 40%, but the CDC describes the deaths as synthetic opioids.

  20. Carlos says:

    Where I am, it is extremely difficult to even know what the current level of transmission is. Health officials have explicitly stated (since the rise of Omicron) that people who get sick but do not have severe symptoms - basically anything that doesn't require hospitalization and oxygen - should not even get tested for Covid. So the official case counts are not undercounts so much as counts of "people possibly on the road to death".

    Sewage monitoring of levels of viral DNA have shown incidence in the community has never been higher. But the government/health authorities have stopped providing daily stats, so you can't even follow it correctly.

    The balance of "how likely am I to get Covid and suffer long Covid" vs. "how badly do I want to live a relatively normal life" is one of the most difficult ongoing decisions I've ever had to make.

    C.

  21. Owen W. says:

    I sympathize with you 100%. The existence and uncertainty around Long Covid changes the calculus completely. Absent long covid I would be much more willing to go to public unmasked events, relying on vaccines to prevent severe disease.

    But if there's a possibility of never tasting again, or not being able to exercise, or permanent brain fog... no thanks. Even with that, I feel pretty good about 100% mask+vax situations (like, say, nightclubs!). I feel Not Great about eating inside at a busy restaurant but have done it a couple times. I am not going to go to a Sports.

    As there is more real research about Long Covid, I'll continue to re-evaluate. A useful question might be: How similar is the risk of Long Covid as compared to catching Lyme? I have been really concerned about the increase in Lyme, but I still go camping.

  22. thielges says:

    This is just further evidence that even people who are good at science and math will pull the wool over their own eyes if it pleases the boss. Anyone who tries to steer the team back into a course defined by true facts risks being accused of disrupting organizational momentum.

  23. David Konerding says:

    I sympathize. It takes most people a long time to recognize how well and truly fucked health care is in the US, and how few actionable rules our public health bureaucrats can provide given the ambiguity of the underlying scientific knowledge.

    Good luck not being infected.

  24. Dan mca says:

    Electric hugs! I hear you.

  25. Nick Lamb says:

    This is unlikely to be at all comforting, but is perhaps at least not merely my unsolicited opinion: Long Covid is almost certainly not a weird new disease. People got similar symptoms from previous viruses under labels like "Chronic Fatigue Syndrome", but society didn't give a shit.

    So, on one one hand, if this is terrifying you were actually late to the party, and should have been terrified for pretty much your whole existence (what else is new), but on the other hand, the "Long Covid" label means this whole category of problems is now interesting again and might get some serious work done on it, rather than going in the bucket of "Shrug, the other 99 patients are OK now, guess you were just unlucky".

    Thus, you actually probably aren't more likely to get "Long Covid" than say, CFS as a result of Influenza, but, if you get "Long Covid" you will probably (modulo insurance since you're an American) actually get a diagnosis from somebody with a degree in less than a year, whereas if you had got CFS as a long term result of a nasty Flu in 2018 chances are everybody would have just told you that you were lazy and should stop whining. And there's some hope that even if they don't come up with a cure per se, they can do much better at mitigating the effects now that celebrities people care about are affected.

    • jwz says:

      Implicit in your speculation that it's not some weird new disease is your hope that it will also have the low prevalence of those older conditions. And if someone could show me evidence of that being true -- by which I do not mean anecdata -- I would be a lot more at ease.

      • rjs says:

        One bit of research that could be done would be to see if there is a statistical link between people getting Long Covid now and them having had CFS after a virus in the past as well.

        If there is a link then knowing whether you personally had ever got CFS could help you decide how much to worry about Long Covid.

      • It is hope, something in short supply when the doctors are stumped. You really don’t want any chronic illness.

      • tfb says:

        I think it's unsafe to assume that the older conditions have / had low prevalence. People just chose not to look, may be.

      • Douglas Knight says:

        If I could prove that it's exactly like the four common cold human coronaviruses (which I believe), I couldn't deduce much. All that shows is that it's harmless to children and after getting it many times as a child, it's not so bad for adults. It doesn't tell you anything about what happens when you get it for the first time as an adult, which we only know about from the new one. Nor the question of whether 3 vaccinations as an adult is equivalent to a normal childhood of who knows how many infections.

        On the other hand, the comparison would add to the conclusion that it's going to remain endemic, and you're going to get it.

        • jwz says:

          I've read this three times and I have no idea what you are trying to say or what your goal was with saying it.

      • Nick Lamb says:

        "Low prevalence" seems like the wrong term. CFS is very common. Millions of Americans probably have (undiagnosed) CFS accordingly to estimates from the CDC. But as to whether it's more or less prevalent try e.g.:

        https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003773

        This paper estimated a hazard ratio from 1.44 to 2.04 for "Long Covid" type symptoms from COVID-19 compared to Influenza, a pretty common virus that presumably didn't stop you visiting nightclubs back before March 2020 started. So, think of it as being about twice as bad. Maybe you'd once have gone to six nights varying between Good and Terrible, to keep the same estimated risk how about three nights you're pretty confident will at least be OK instead?

        Or maybe just accept that 2x "A risk I never worried about" = "A risk I still won't worry about" after all none of us gets out of here alive.

      • Martin says:

        This long flu study gives evidence that flu could cause similar, though less common, long effects to Covid. So this may not be a new thing.

        But I'm not reassured. The way I understand it, just like COVID-19 gave us an another virus to kill us off in addition to flu, COVID-19 is also giving us another vector for long term symptoms in addition to existing viruses.

        Yeah, maybe in the long run knowing the cause will help us figure out how to fix or mitigate these long-term effects, and yeah, maybe doctors will no longer treat you as lazy if you suffer, but it will still suck in the mean time.

  26. I thought the whole reason we had expert organizations like the CDC was so that us non-experts wouldn't be left to our own devices to make these sorts of risk assessments. It's infuriating.

  27. I’m assuming that eradication is impossible. Our crisis management institutions are going back to focusing on the acute crisis (hospital capacity).

    I think this is the new normal.
    Time to start finding comfortable full time face-wear.

  28. Cameron says:

    Here's my $.02: I don't know what to tell you. (I guess that means that you were right.)

    Your concerns do seem reasonable, though.

  29. Bog says:

    So I know this’ll get lost in old comments purgatory, but I must rant…

    Here (Sydney) we’re just YOLOing it now. ~10,000 cases a day state wide and here are no practical restrictions to anything any more.

    So fuck it, I’m gonna go see a band.

    One song in the headline act stops “Are you people all OK? What’s going on out there?”

    A big chunk of the dance floor collapsed, and people were bouncing around on the carpet stretched over the hole like it’s a trampoline…

    https://www.abc.net.au/news/2022-03-04/enmore-theatre-floor-collapses-during-genesis-owusu-concert/100880928

  30. NT says:

    > My goal is to not catch COVID at all.

    You're not going to get to 100% so the question is how many nines you need.
    Based on your age you get one nine, unless you already have respiratory issues.
    Wearing a N95 mask gives you, at best, one nine.
    Being 3x vaccinated gets you two nines against severe disease (but less than one nine against having a really shitty few weeks).
    Not being in the middle of a wave gives you another one or two nines.
    Being outdoors is good for two nines.
    Staying glued to the couch gives you an additional two or three nines.

    How many nines do you need? You don't want to get hit by a car either, but you ride a bike in San Francisco. And there's way more evidence for "long car accident" than for "long Covid". After about four nines, I would guess that a daily bike ride in SF is a bigger risk than Covid, but I haven't looked up statistics. That's probably easier to calculate than the comparative risk of couch-induced depression.

    If you threw enough money at ventilation you could maybe buy another nine at DNA lounge, it's not clear anybody but you would care though.

    If I were you I would at least go to the best show each month.

    • jwz says:

      Let me summarize that: "Based on no information and with no citations, I have decided that Long COVID is not a credible threat." Thanks, Doctor. This is exactly the sort of speculation and opinion that I pretty clearly said I'm not interested in.

      • NT says:

        That's a piss-poor summary of what I wrote.

        • jwz says:

          Dude, you don't know shit about the long COVID numbers. Do you know how I know that? Because nobody does. So you are fucking guessing. I hope you're right. I really do. But I'm absolutely uninterested in hearing your guesses. Even if you dress them up in pseudo-probabilistic nines you pulled straight out of your ass.

          • NT says:

            You explicitly asked for math. This is not something I just came up with and the numbers are not pulled out of my ass. The point of using decimal orders of magnitude is to allow for a very high degree of uncertainty.
            You picked one sentence to best focus your contempt and ignored the rest. Sorry to bother you!

        • thielges says:

          You guys are talking past each other. You provided a good analysis of how to stack preventative measures to decrease the probability of catching covid. While your analysis is clearly off the cuff, I find it pretty solid and is very close to how engineers of safety critical systems do their initial back of envelope analyses. Good info but not what this post is about.

          JWZ's concern on the other hand isn't about what to do but rather what to believe. The general public is fabulously bad at interpreting statistical and probabilistic information. So organizations like the CDC are in the habit of dumbing down information to the point that it becomes incomprehensible and useless to answer questions like "what is the current relative risk of contracting long covid?" or "how much can long covid degrade my life?". The public really needs answers. Is going to an indoor music sports or music event now as dangerous as eating a bacon wrapped hot dog or taking a sip of gasoline?

          Since this thread is already off topic: as far as listening to music standing on sticky floors in a dark room goes, it looks like several SF Bay Area outdoor venues are on track to open this year. The Big Room is the safest room so there's two nines right there. That won't keep me away from indoor concerts but will influence my decisions.

          • NT says:

            Related.
            I guess I've gotten used to the idea that the public health agencies see their job as social engineering, not science communication. It made me angry as hell two years ago though.

  31. jwz says:

    Me: "Based on the piss-poor amount of information that we all have seen, here is my comfort level. Also I am not asking your opinion."

    Half of you: "No you're wrong."

    • rjs says:

      As someone who will have had Long Covid for two years next week, I think you are right to carry on being careful.

    • sleepdedication says:

      i happen to agree with your reasonable assessment of piss-poor info (which nonetheless has pretty obvious implications; we should all be worried than most of us are), but i can't say i'm surprised people are opining despite your guidance. as much as (or more than) anybody else, surely you realize this is the internet

  32. madopal says:

    At least Slate is trying here. Without following a rabbit hole of linked papers, I can't tell how accurate many of these estimates are of risk. But 1) at least they're trying to categorize more than the CDC range of freezer trucks to ???, and 2) they address long COVID with some links to papers that clearly have no consensus but are nonetheless papers.

    https://slate.com/technology/2022/03/covid-risk-death-hospitalization-illness-adults-children.html

  33. sdp says:

    We are still at the stage where we don't know enough. There are suggestions of genetic risk factors, but how would any of us find out if our genetics increased or decreased risk? Other risk factors point to immune system stressors (age, BMI), which make for a weak immune response, but I can't choose to be younger, and bad luck can overrule risk factors. In the absence of better information, and continuing bad habits of others, all I can do is act according to what risk I'm willing to accept. For me, I'm avoiding crowds, air travel, and am planning on wearing a mask for several more years.

    • tfb says:

      The surprising thing is that we don't know enough. Somewhere around 20 million people have died of it (14m to 23.6m with 95% likelihood, and yes this is a lot more than confirmed numbers. Source The Economist, updated today). So that's somewhere around 2 billion infections, and perhaps more. That's a lot of data to fail to be able to do statistics on.

  34. Greatevil says:

    Thank you for voicing much of how I'm feeling. This math course sucks.

  35. Thomas Lod says:

    Another thing I think about is how in some cities and/or counties, even perfect knowledge of the case rate of residents can not tell us the transmission rate in public spaces. My reasoning is that in "destination" cities with lots of people still being personally very cautious, a night at the club or restaurant will likely include rubbing elbows with people from areas with higher case rates than the resident population. And people who get covid that night rather than bringing it won't all be residents and their cases will be attributed elsewhere.

    Anecdote but not about the disease itself: I really wish one my Berkeley's mayor's staffers would maybe tap him on the should to explain it's probably not making him sound smart to keep saying, with a tone of optimism, that "hopefully by then it will be endemic" or "luckily as we are nearing a change from a pandemic to endemic....".

  36. jwz says:

    Your comment is just such complete bullshit it's not even worth responding to.

  37. I read somewhere (probably here) that if Polio came out now, based on how we're handling COVID, we'd probably call the outcome acceptable.

    That really hit home.

    • Eric TF Bat says:

      That really is a soundbite that should put an end to all "debate" about Long Covid. Pretty sure it was here, a couple of weeks ago, that JWZ quoted someone saying in effect that (a) the primary symptom of polio at the time was a bad case of the runs, (b) the actual polio symptoms that we remember now were RARER then than Long Covid is now, and (c) if polio were to appear for the first time in a Covid-free alt-2022, no government on Earth would bother to change its behaviour to compensate for such a minor issue.

      Nobody should be apologising for taking Long Covid way more seriously.

  38. icodestuff says:

    I've been doing the same math, but I think the (probabilistic) availability of Paxlovid changes the calculation too. It seems (this is not a scientific study, just my impression of them plus media reports) that shorter viral courses lead to better outcomes, particularly re: long COVID. My latest thinking is that I'll wait to see what the actual availability of Paxlovid is, and how much people unmasking causes another spike, before I reduce my own precautions.

    • Nate says:

      Paxlovid is promising, but it also has some heavy interactions and is very expensive, even once it is more generally available. Will they give it to a healthy, boosted 40-something just to reduce the potential of long COVID? Likely not.

  39. Nate says:

    I'd rather focus on what's known to be changing in the near future:

    * More Paxlovid availability
    * More monoclonals that actually work against omicron
    * Pan-coronavirus vaccines
    * Nasal vaccines, likely to be much more effective at blocking infection

    While these will be helpful, the ones that are most likely to make a difference to your infection risk are still in development. I feel like we're in a weird place with 3 shots of Vaccine 1.0 having done its job pretty well but 4 shots not being very useful and no clear idea what will become Vaccine 2.0.

    So we're stuck: you got 3 shots, then maybe a booster of Vaccine 1.0 each year to deal with waning immunity for a few months during the winter surge. But it's very likely you'll eventually get omicron if you resume regular unmasked indoor activity. And nothing coming in the near future will change this.

    I'm just keeping track of case counts, wastewater concentration, etc. and creating my own "is indoors safe?" metric. I've chosen 5 cases per 100k daily as the threshold for indoor dining and parties, after all my young kids have been vaccinated. Wachter chose 10 / 100k for himself (no vulnerable household members but older).

    On top of everything else, now we each get to be your own health agencies. It sucks but people with chronic illness have lived that their whole lives. I have more empathy for them now.

  40. Matt Lee says:

    Good luck not getting it. I wish I’d been in the same place.

    Instead a friend went to Wuhan in early 2020, came home and a few of us were very sick for a few weeks afterwards. Forced to work from the couch in a tiny apartment which subsequently flooded forcing a hotel stay and moving everything into a storage unit before a quick move to another apartment, only for my partner to die of a heart attack a few weeks later right after getting her second vaccination with hopes of seeing her family for the first time in a year. Instead I had to go masked up to a funeral.

    9 months later and I got COVID-19 a second time, despite masking up and booster shots and everything. It wasn’t so bad the second time around but I am just waiting for some sense of all this being over and hoping it happens soon.

  41. James M says:

    I sympathize and feel similarly. The suffering created in this pandemic has been enormous for everyone.

  42. K says:

    Two years ago I said 'Getting in to this is going to be easy. Getting out of it is going to be hard.'

    I didn't want to be right.

    I feel you on this one, doing the math sucks when you don't have most of the numbers. Personally I've decided to roll the dice a bit, but I will freely admit it's not based on anything solid. I hope you and I both find something to support a real decision sooner rather than later.

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