Where We're At: It's Still Here!

Several people have been screaming into the void about how Covid works, how bad it is, and what we need to do to stop it now that we're dealing with another dominating variant: We're on to Arcturus now (XBB.1.16), guardian of the bear. I've collected three threads here explaining the current situation and desperately trying to correct ongoing misinformation.

Tl;dr version: Covid is a vascular disease that stays in the bloodstream potentially coming back to cause more harm later - we don't know longterm how it will affect people. (Chicken pox becomes shingles decades later.) It's getting worse and will continue to get worse the longer we ignore it and allow it to spread and mutate into more evasive variants that no longer respond to our current meds, and it can cause dangerous brain effects that go unnoticed. We need to wear masks until we have really clean air in every public building evidenced with CO2 monitors on display showing 700ppm or less. (Actually we need to wear masks until we have eradicated the virus, but that might never happen, so it's nice to have an endpoint to rally behind.) 

Here's @1goodtern explaining the big problem with the reality that this virus causes brain damage:

So one of my friends/colleagues tests before they go to see their elderly mother, which was the only reason they found out they had a new covid infection. They stayed at home and said they have actually felt great for the first ten days of their infection, except every single one of their messages has multiple typos and disjointed sentences, when they're normally very precise. And the messages themselves are full of inaccuracies and contradictions and misrememberings.

Hey ho. At least they feel great.

Just imagine if that was your pilot or surgeon, or a truck driver, radiologist, gas engineer, politician, cardiologist, air traffic controller, judge, paramedic, sewage handler, biochemist, nuclear plant engineer, rail engineer, pharmacist, armed response unit... 

Feeling great and not realising they aren't great is not a good scenario for restricting spread of the disease. 

Dr. Claire Taylor reveals what she sees in her practice on a regular basis now: 

The people I see are so incredibly sick. Please don’t listen to mainstream media, your pals or someone random on here. There is a drive to pretend that Covid is not on the rise again and causing mass disablement- mainly of young people. The only way to avoid #LongCovid is to avoid Covid. You think it won’t happen to you, but have a 1 in 10 chance if you are infected. Not great odds. 

Common symptoms my patients have: Severe debilitating fatigue that worsens on any activity Fast heart rate Dizziness Severe headaches Numb hands and feet. Chest pain. Shortness of breath. Tremors. Muscle twitching. Rashes. Abdominal pain. Difficulty remembering words. Paralysis of limbs. Difficulty walking. Nausea. Reflux. Tinnitus. Cognitive impairment. Inability to read. Inability to talk for long (some not at all). Sensory overload. Vomiting. New allergies. Anaphylaxis. Bowel problems. Urinary problems. Early menopause. Neck pain. Muscle pain. All over pain. Purple feet. Swollen veins. Weak legs. Weak arms. Sore throats. Swollen glands. Adrenaline surge.s Some can’t eat now. Some can’t walk. Some can’t speak. Some cannot care for themselves. 

Do you want to try living with this? This is ‘living with Covid’ It breaks my heart every day to know that more and more will become like this. It is a very difficult way to live with little help. If you value your mobility and life and things you take for granted--be careful. The omicron is mild slogan forgot two things: (1) Reinfection: Long Covid Reinfection increases the risk of multiple health problems. (2) Long Covid can happen after mild illness. In fact that’s how it mostly happens. 

You don’t have to listen to me. But you should. I am warning everyone--long Covid is an horrific illness and the only way to avoid it is by not getting Covid. I am not on here warning people for the fun of it. And just to add: it is possible to suffer from all of the above symptoms at once. All of them. Together. Horrific. 

Finally, T. Ryan Gregory, evolutionary biology professor at U of Guelph, took on the idea that we need to get it in order to avoid getting it as if it's good for kids to be sick for most of their childhood. He includes backing from two doctors in the field.

Here's why I reject the notion that early and repeated childhood viral infections are an inevitable aspect of normal human biology, or necessary to build up immunity, or a "good thing" in any way. First, and so we can dispense with any cries of "epistemic trespassing!", this argument often comes with a false understanding of human evolutionary history as it relates to our immune systems. tl;dr We're not bats!

Second, we know of many viruses where immunity does NOT build up with exposure. Some damage the immune system (HIV) or cause immune amnesia (measles), some infections persist (herpes), some are worse the second time (Dengue), some we can get over and over (colds, flu). Viruses like those that cause seasonal colds or flu evolve continually, and I think most adults would agree that repeated infection throughout life does not free us from getting nasty colds or flus later. 

Third, we don't know what COVID does longer-term. There are indications that it affects the immune system at least in some people for at least a short period, and with repeated infections that could add a lot of people being sicker at any given time. That's not even to get into what it could mean if there are larger-scale and longer-term effects on immunity from repeated infections.  

Fourth, early childhood infections with some respiratory viruses mean worse health later. We don't know what early infection to COVID does long term, but there are already signs that exposure in utero can affect traits like lung development and birth weight, with potential adverse consequences later.link. 

Fifth, COVID infections can reactivate other persistent viruses. 

Sixth, coinfections with more than one respiratory virus makes things worse in children. Adding one more to the mix of colds, flu, and RSV will exacerbate this effect. 

Seventh, and I hope obviously, many children die or are disabled by viral infections. We're very fortunate in wealthy countries that this doesn't happen anywhere near as much as it used to and as it still does in many places, but so-called "immune education" comes at a huge cost.

Eighth, it's not just immune effects we need to be concerned about. SARS-CoV-2 seems to affect many, many organ systems and there is a rapidly-growing literature showing increased risk of everything from diabetes to infertility to hair loss to cancers. 

Ninth, long COVID. If you truly believe that each reinfection is milder, and if it's true that most people have already been exposed, then presumably you think we've seen most of the long COVID cases that will happen and that so-called "normal, healthy" people are not at risk. 

Tenth, adding another virus to the list of repeated infections, especially if it's happening all year and at a high baseline, will put unsustainable pressure on healthcare systems. Area under the curve matters. 

See also Dr. Deepti Gurdasani, who says, 

The argument that children getting exposed to viruses at a young age reduces severity in adults ignores the U-shaped mortality curve for most infectious diseases, where mortality is higher in under 5s. For many infectious diseases the curve of severity is U-shaped: higher mortality in under 5s and in the elderly. So mortality in very young children is higher than those in adults. One may argue that this is because of first time exposure, or because children are more vulnerable. But even if getting exposed as a baby reduces adult mortality, surely the higher mortality rate in this group should make us rethink exposure to infectious disease being beneficial.And we know that GAS even in childhood can have very serious long-term ramifications (heart disease) in adulthood. We know many respiratory illnesses (RSV, flu, SARS-CoV-2) are also associated with a significant burden of hospitalisation. I think if one is going to argue that exposure to infection in childhood is beneficial, given the U-shaped mortality curves for many infectious diseases, we really need much stronger evidence for this, given the clear impacts on children- both acute and long-term. 

Also interesting study here shared by @JennJVN showing childhood respiratory infection associated with higher risk of adult premature death from respiratory infection (but not other causes). While the causality here isn't clear, its concerning: ultimately, let's remember COVID was a new infection that hit children and adults simultaneously, and the mortality rate in under 5s is higher than young adults - so it's hard to argue based on current evidence that exposure in early childhood is beneficial. Its very clear this U-shaped curve is not a result of exposure in early childhood reducing severity in adulthood, because all these age groups encountered a novel virus for the very first time, and the death rate in under 5s was still higher.

Here's the curve for the 1918 Spanish flu pandemic - highest mortality in under 5s- to a novel strain encountered by all age groups together. Under 5s are more vulnerable to severe disease from infections- novel & established. We should be protecting them not infecting them. 

Also, very simply, if exposing children to infections at young ages was better, children in countries where this happens extensively would have great outcomes - but they absolutely don't. Mortality in children is much younger in countries where childhood exposure is low.Exposure to infectious disease is lower in more affluent countries because of less crowding, less poverty, better sanitation - we've never argued that that was a bad thing for children. So why in this specific case? It's no surprise that many arguing for this have never actually considered outcomes in LMICs, or had to deal with the burden of infectious disease in children in 'high exposure' conditions. You'd never see someone who's seen the impact of this on children arguing for this.  

See also Dr. Lisa Iannattone, who says, "Not catching a common virus for a year or two, or five, does not make you respond to it like an immunosuppressed person the next time you catch it. Avoiding pathogens doesn't damage your immune system. On the other hand, there are many pathogens out there that ARE capable of damaging your immune system. Pathogens are foes, not friends. The hygiene hypothesis refers to the role of exposure early in life to commensal organisms that humans co-evolved with--friendly microbes--not exposure to pathogens. A good article on the history of the hygiene hypothesis and how it's understood today."

If that's not enough to get you and your kid back into masks whenever you're in a public building, I don't know what could possibly persuade you! Remember it spreads through asymptomatic cases as well - about a third of the time. Lots of people feel great and don't even know they're infected, so don't test and don't mask, and then spread it around to people who die or who live only to be in pain 24/7, or who live to cause accidents and kill others. Please don't be one of those people!! But I get it because this isn't the story that's in the mass media:

And it's being balked at on social media as well: