Honey, We Have to Talk About All Those Long COVID Claims
Relying on Basic Data and Biomedical Intuition Would Have Yielded Better Results
During the COVID pandemic, there was this idea that we should be gravely concerned about the long term effects of COVID. We’re not talking about the obvious ones, like death and severe damage to the respiratory system. We’re talking about the idea that you might get damaged in ways that linger for years, even if you have asymptomatic or mild COVID. I call this the Strong Long COVID (SLC) hypothesis.
I’ve been skeptical about the Strong Long COVID hypothesis. As early as 2020, I argued that the media was over-stating what was reported in some medical journals (such as my review of Yelin et al. 2020). Over time, the evidence has piled up to suggest that SLC is probably not correct. Fortunately, some journalists in popular media have now begun to report on this evidence. I’ll give you a few clips of an article from Slate and then briefly discuss two powerful studies on the actual prevalence of long COVID that do not support the Strong hypothesis.
From an article in Slate called “Long COVID Comes Into the Light: We’re finally starting to see the truth about the vexing condition. It’s not what we thought” by Jeff Wise:
Now, three years later, the research is catching up to the anecdotal reports and the early evidence, and a clearer picture of long COVID has emerged. It turns out that, like COVID-19 itself, a lot of our early guesses about it turned out to be considerably wide of the mark. This time, fortunately, the surprises are mostly on the positive side. Long COVID is neither as common nor as severe as initially feared.
And:
One study of patients in an Israeli health network looked at the incidence of 70 commonly reported long COVID symptoms in 150,000 patients. The researchers found that patients who’d been infected were more likely than people in a control group to suffer for extended periods from certain symptoms, in particular loss of taste and smell, concentration and memory problems, difficulty breathing, weakness, hair loss, palpitations, and chest pain. But the difference between the infected and controls largely disappeared by the end of the first year, and to the extent that they remained, they affected a relatively small number of patients. For instance, 407 of the COVID patients reported having persistent concentration and memory problems at the end of the first year, while 276 of the controls also did. That meant that for every 10,000 people, only about 13 had cognitive difficulties that were attributable specifically to COVID.
Correct. Now, for the two studies that really started to confirm my suspicion that Long COVID was being wildly over-reported. This JAMA Internal Medicine article shows that in a large sample (26k) of French adults, reports of Long COVID are not statistically associated with laboratory confirmation that the person actually had COVID, with the exception of smell loss:
In this cross-sectional analysis of 26 823 adults from the population-based French CONSTANCES cohort during the COVID-19 pandemic, self-reported COVID-19 infection was associated with most persistent physical symptoms, whereas laboratory-confirmed COVID-19 infection was associated only with anosmia. Those associations were independent from self-rated health or depressive symptoms.
And this recent article in JAMA network reports on a similar study. This one shows that among young people, bad long-term effects are associated with bad initial effects and claims of long term negative effects are not associated with actual infection:
This cohort study included 382 SARS-CoV-2–positive individuals and a control group of 85 SARS-CoV-2–negative individuals aged 12 to 25 years who were assessed at the early convalescent stage and at 6-month follow-up. When applying the World Health Organization case definition of PCC, prevalence at 6 months was 49%, but was also comparably high (47%) in the control group. PCC was not associated with biological markers specific to viral infection, but with initial symptom severity and psychosocial factors.
COVID was horrible, but we don’t need to pile on the panic. It turns out that COVID is similar to other common contagions, such as influenza, which cause serious long term damage in a relatively small portion of the population. It would have been much better to work with a baseline informed by most infectious disease (some at risk groups will suffer enormously, most folks will not) instead of suggesting that the entire population is at risk for massive suffering, even if they have asymptomatic COVID.
Bottom line: Public health should be based on models drawn from previous illness and strong research design. Otherwise, you might jump to the strongest conclusion first.
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