I wish to encourage you to think differently about COVID in the coming year.

It is understandable why people have such a difficult time grasping the ongoing risks. It feels like we can cram back into airports, conferences & concerts safely because everyone is doing it and governments and health agencies are not acting. I can't be alone in finding it sad and shocking how easy it's become to ignore around 4,000 US COVID deaths a week and millions with disabling, chronic disease.

The problem is that we have not shifted our thinking about COVID as the risks evolved. Early in the pandemic, our fear was (appropriately) about severe acute illness, hospitalization, and death. We saw hospitalizations fill up, morgues overflow, and tents full of patients needing care. The message was: Save your life and protect healthcare capacity.

But the risks have evolved since then. They've changed, not disappeared, but it feels like few are paying attention. As vaccines and prior infections offered more protection from serious illness, the fatality rate fell and the surges of hospitalizations became more manageable. But neither vanished--COVID remains one of the top three causes of death in the US, and hospital capacity was recently an issue in many regions during the “tridemic” of flu, RSV and COVID. https://edition.cnn.com/2023/01/17/health/covid-death-reporting-2022/index.html

The risks we face today are still quite profound but are less immediate or apparent. Evidence is growing that COVID leaves a considerable portion with profound, disabling damage to their bodies. Some of this damage is immediately apparent as incapacitating symptoms that can last for months or years.

Of people who have had COVID, 11% still report they suffer from Long COVID. Among those reporting ongoing Long COVID, 79% of them report having limitations to their day-to-day activities and 27% characterize the limitations as significant. https://www.kff.org/policy-watch/long-covid-what-do-latest-data-show/

Studies are mixed on how long Long COVID lasts, but one study recently concluded that, "2/3 of the patients felt some degree of improvement and returned to work either partially or fully, but 1/3 remained complaining of symptoms and out of work as late as 22 months after COVID occurrence." https://www.mdpi.com/2077-0383/12/3/741

It's not just the Long COVID that is a concern. Studies tell us of the risks of serious diagnoses increases in the year after COVID, even among those with mild cases or who have recovered. One study published this week demonstrated those who had COVID had a 43% higher likelihood of acquiring autoimmunity in the post-acute period following infection. People who had COVID face higher risks of Rheumatoid arthritis (42% higher) & Diabetes Type 1 with Insulin (25%). https://www.medrxiv.org/content/10.1101/2023.01.25.23285014v1

Another study found COVID-19 survivors had an additional 90% risk of developing heart failure after COVID-19 infection in the long-term period. https://link.springer.com/article/10.1007/s10741-022-10292-0

One study found people with COVID had a 40% higher risk of cardiovascular disease in the post-acute phase. https://academic.oup.com/cardiovascres/advance-article/doi/10.1093/cvr/cvac195/6987834

Another study found that postural orthostatic tachycardia syndrome (POTS) risks are greater in the post-acute phase. Furthermore, full recovery was LESS likely for those who had post-COVID-19 onset of cardiovascular problems than for those who developed the issues during their acute illness. https://onlinelibrary.wiley.com/doi/10.1111/ene.15714

A study found 34.49% of people have memory impairment after COVID-19 recovery. https://onlinelibrary.wiley.com/doi/10.1002/jmv.28459

I could go on and share more studies. But, I want to make the point that while it is excusable for many not to realize these risks persist, it is inexcusable for public health organizations to simply give up.

The WHO is meeting to discuss if we're still in a pandemic. Look at the opening remarks from the WHO Director-General--entirely focused on deaths and hospitalizations. Not a single mention of Long COVID, chronic disease, or increased risks following infections! https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-14th-meeting-of-the-ihr-emergency-committee-on-covid-19-pandemic---27-january-2023

The US FDA recently recommended an annual COVID booster in fall. But it takes Pfizer/BioNTech and Moderna three months and Novavax six months to produce new boosters to match a variant. The current XBB.1.5 was only discovered in October, wasn't labeled a variant of concern until late November, and was added to the CDC tracker just four weeks ago. Do the math--how is an annual booster going to work given what we know about COVID's rapid mutation at present? https://www.reuters.com/world/us/us-fda-proposes-simplify-covid-vaccine-strategy-2023-01-23/

The point of this post is to try to raise your concerns about COVID's continuing risks. As always, I don't advocate isolation. Instead, I'd urge you to sensible but variable habits:

- Don't wait for public health agency advisories or mandates. They have given up in the face of so much political pressure and indifference from the population.

- Monitor the regional and local risks. What's happening with COVID in wastewater? Is the positive rate of testing up? What is local hospital utilization and capacity? These are easy to monitor. (Don't rely on case counts, which are useless due to minimal testing. And don't wait for headlines--once the media decides COVID is worth covering again, it's only after risks are peaking.)

- Treat the COVID situation like the weather. If it rains, you bring an umbrella, and if it snows, you wear gloves and boots. Likewise, if COVID is increasing, put your mask back on and avoid crowds. Stop treating COVID precautions as if they are constantly and evermore all or nothing. Be smart, and adjust for your local COVID forecast. (And when you #WearaMask, wear a high-quality mask--we know the protection offered by N95/KN95 masks is considerably greater than surgical or cloth masks.)