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cristiano-potato t1_j26o1ro wrote

Reply to comment by the_Demongod in Is the BF.7 mutation of Omicron less severe than variants? by Active_Bedroom_5495

I have not seen strong evidence of a meaningful effect size when it comes to long term adverse outcomes in mild cases when limiting my search to robust, high quality studies, so given that this is a science sub, I’d love to see your citations. In my experience reading papers related to long Covid, the following applies:

  • findings are often limited to a cohort of older or hospitalized patients

  • when findings are generalized to mild cases, this is done by conducting a (voluntary) survey, almost always with abysmal response rates. It’s not viable to measure hazard ratios when 25% of your sample responded to your survey, since response bias has the potential to modulate those HRs by up to 4x.

  • findings are nebulous or poorly defined, for example “any Covid symptom after 28 days” is often considered LC, which groups someone who has a lingering cough at 29 days in the same group as someone who has debilitating fatigue 3 months down the line. This lack of granularity limits the ability to draw conclusions about what “nasty things” are happening.

To date, I have yet to find a study which combines the following:

  • uses health database data to avoid the bias inherent in voluntary responses

  • performs subgroup analyses by age and pre-existing health, as well as clinical severity of the case

  • adequately captures severity and duration of LC in the analysis.

Thus, the question “how much more likely is a healthy 30 year old to have lifestyle-limiting fatigue 6 months after mild Covid” remains unanswered.

The closest parallels I have found are studies which example very specific neuropsychiatric outcomes, such as this paper: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext

If you’re scientifically inclined it’s a fantastic read. It breaks down the neurological outcome trajectories for COVID patients compared to a matched control group with another URI by age and other factors.

If anything, what the study tells me is that we under-estimate the risks of regular old URIs that aren’t Covid.

Case in point, for the “adults” group, which excludes older adults and children, the total cumulative risk after 2 years was 29.2% after Covid, and 29.1% after another URI.

That difference is not statistically significant.

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the_Demongod t1_j26v48t wrote

I don't have time to read that entire paper, but it's also more focused on somewhat severe and specific neurological problems, which isn't really what I'm talking about.

https://www.mdpi.com/2218-1989/12/11/1026/htm

I don't have any giant studies about long covid outcomes relative to the population baseline, but here is one interesting one that takes a small random sample of post-covid (but fully recovered) and PASC (post-acute sequelae) individuals and does an in-depth metabolic panel. The noteworthy part here is that they excluded anyone who had hospitalized or had abnormal chest CT post-covid, limiting it to less severe cases.

The discussion mentions that, on average, PASC individuals were more likely to be younger. It acknowledges that this could be due to sampling error (younger people more likely to take sequelae more seriously), warranting further investigation, but could also be due to "exuberant immune response," which (if true) would go to show that there's more to it than just comorbidities.

And of course I am biased, as a fit and previously healthy mid-20s-year-old with VOR disfunction and persistent, nonspecific fatigue and digestive problems, 9 months post mild-Covid. But anecdotally, my doctors have described seeing many patients with similar issues (especially vestibular).

My point was also not to suggest that the average 30 year old would be debilitated by COVID, but simply that "it's getting less deadly on average" does not mean that it cannot still inflict unpleasant sequelae that are life-altering even if they seem mild compared to strokes and seizures. COVID is a disease of "manageable but weird and annoying debilitation" in my eyes, which is why long covid remains simultaneously a big problem but also somewhat elusive and difficult to characterize. It isn't going to bring down society, just leave some of us feeling shittier for an unknown/indefinite period of time.

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