'Long Covid': Why are some people not recovering?
bbc.co.uk
bbc.co.uk
However I still have 'post-COVID' symptoms. I'm in my 40s and was very healthy prior: - Unexplained fatigue that happens 12-24 hours after exercise. I have to shut my eyes for 30 minutes, almost like narcolepsy or similar. - Random muscle aches that seem to be slowly going away. - Minor heart palpitations, slowly getting better. - Rare cases where I feel I need to take several deep breaths, maybe twice per day. - Continued GI issues.
Finally, everybody I know over 40 who has had COVID-19, approximately 7 people, have reported these symptoms, some of them marathon runners who can no longer run a mile. Please set your doubts at rest, this is a real thing, not an anomaly, and will have major health impacts to many people over time.
We don't have much experience with Covid and post recovery effects yet, so not catching it is my priority (rather than rolling dice and hope for the best).
I wish you full recovery.
Ditto.
Can someone tell me what GI is?
One does wonder about the 'nocebo' factor, too - if you've been told to watch out for lingering symptoms are an infection that certainly affects the way in which you are observing your own body, especially so if you're even minimally hypochondriac. There is an understandable media narrative to portray mostly severe cases (again, understandable from some sort of public health perspective) but that also adds to psychological add-on effects one might face with this disease.
I'm in no way part of the just-the-flu crew, but feel that the OMG-COVID crew hasn't necessarily thought the above aspects through either.
The incentives are all messed up for the media to provide a balanced information and with the economic devastation coming down the pipes I think both the flu and COVID will look like a walk in the park.
https://blogs.worldbank.org/developmenttalk/lives-or-livelih...
> Using those somewhat more generous – but still frugal – thresholds, the number of poverty years in the world (235 million) is 54 times the number of lost years.
And yes, without lockdowns things may be even worse, but the fact remains that the biggest impact on lives from this pandemic will likely not be directly from COVID but indirectly from economic devastation.
You say indirectly, I say directly. Even if everything was opened 100% tomorrow, many people are simply not going to go back to what they used to do. The way to avoid economic devastation was/is to deal with covid.
https://neckbeard.xyz/notice/9znbtKqgRaGgwdVxgm
..and the secondary effects of the economic and psychological devastation are pretty bad. I wrote this back in July:
https://battlepenguin.com/politics/secondary-effects/
It's been eight months! We cannot keep living like this. We know now the largest deaths came from a failure to protect the elderly and misusing nursing home facilities (Michigan, Kirkland/Seattle, NYC). We need to do more to protect the elderly, but other people need be able to assume their own risks again.
Most lockdown restrictions have ended in Ecuador. Florida and Mississippi are opening up. Pennsylvanian had a cord order by Stickman to open up, but it's been stayed pending appeal.
Humanity cannot be put into low power mode like a laptop. We are not cogs in a machine that can be stopped and started at will.
[0]: https://www.newscientist.com/article/2251615-is-swedens-coro...
Also, this whole ‘locked up’ straw man is growing tiresome. There is a large gradient between locked up and going out like there is no pandemic.
If politicians choose to do so anyway, they should know that economic devastation can be a very real outcome from going down that path.
If we hadn't politicized the virus every step of the way, we could have adopted some simple mitigation measures that would have already gotten us back to some level of normal. A national strategy of masks and distance could have kept things mostly open/got things re-opened. If people were generally trying to limit the spread, testing and contact tracing would work to control outbreaks.
Instead the US has a patchwork of rules with uncertain national leadership hoping the virus just disappears. All we have done is extend the time we have to deal with this mess, and possibly cause more deaths than necessary.
And, I just saw that the POTUS once again tweets it's just like the flu (which doesn't kill 100k Americans/year), further downplaying and extending how long any COVID recovery will take.
Ultimately, the 'economic devastation' you mention is not from the lockdowns, but our complete ineptitude around dealing with pandemic.
Do we have any reason to believe long covid is a real thing? Is this not just anecdotes being blown up by the media that is generally useless at science reporting?
It’s certainly a real thing :)
There’s many symptoms, but as most articles state, the main one being extreme fatigue, second one is probably brain fog. Another is breathing issues.
When it gets bad for me, I make extreme noises every so often when I sit down, or when I need to take a big breath of air, etc etc Eating can be exhausting - both because you’re spending energy chewing etc, but also you’re not able to breathe as much...
I agree with you, that since it coincided with lockdown, people out of jobs, not being active etc, then it could sometimes be misdiagnosed, but it’s very different and pretty easily spotted.
It feels great to see someone else with a similar experience.
As someone with a history of anxiety with somatic symptoms, I deal with this stuff, even digestive weirdness. How many times over the course of the pandemic have I felt like I can't breath?
I'm keenly aware of my mental health and how it affects me. I know that there are certain states of mind/dispositions that I need to assume in order to feel stable.
In normal times, I go about life and forget about my anxiety because my daily routine is a good distraction.
Maybe this isn't obvious to people without anxiety, but it's clear to me that way too many people are inhabiting unhealthy relationships with danger, fear, anxiety, etc.
And it's sad cause it seems like politics and technology is trapping people in that mindset.
I'm frankly sick and tired of the people condemning others as though it's immoral to not be afraid of COVID. You can understand COVID is potentially dangerous while not really worrying about it.
This is an essential technique for people with anxiety if they ever want to lead a normal and healthy life, but the zeitgeist is full on fire-and-brimestone moral righteousness and preaching if you're not absolutely consumed with fear and anxiety over a virus that almost all people survive.
I don't want to say "long COVID" isn't real especially since there so little understanding about any of this, but I would say it's more likely than not that many people are predisposed to somatic symptoms of anxiety, power of suggestion, etc. especially when large segments of the population are trapped inside for long periods of time and deprived of social activity.
The fatigue was really stange, like pushing my kids on the swing made me pause for strength. And chasing my kids for more than a few steps made me wheeze and gasp for breath.
The fatigue lasted at least a month. And was definitely different than the effects of anxiety that happened later. Especially since exercise tends to be invigorating for me in the face of anxiety.
This isn’t to say that there aren’t also lockdown related health problems conflating the issue, but I have personal reasons to think long covid is a thing, especially when looking at all the system the virus seems to ravage.
I can't tell if you're making a joke but anxiety has all those symptoms and it's obviously increasing and people are talking about it.
Do we have reason to believe that lingering fatigue, cough, etc. is a real thing? We do. Any serious infection can cause these things, and (as quoted in the article) some experts in the area say they're more common and severe than would normally be expected.
Do we have reason to believe that Covid causes some crippling disability that can never be treated or recovered from? Not strong ones, although of course even weak and inconclusive evidence should be investigated with a novel disease.
One thing I don't get is why saying C19 is "Just another Flu" is somehow taken as downplaying the virus. Seasonal Flu kills as many as 600,000 people annually. Do their lives not matter because they are taken by a regular old virus and not a novel coronavirus? And why doesn't the media report on every strain and mutation of the seasonal flu that could cause "long term effects"?
Here is a link for more information on 'excess death': https://ourworldindata.org/excess-mortality-covid
So, I don't see Covid-19 as "just like the flu".
Covid-19 has been around for less than a year, no vaccine and, with a lockdown and closing our borders, has already killed 3x more than the seasonal flu in the US
So it’s not like the flu
It’s not just another flu. Saying it is is downplaying it.
> Half of people in a study in Dublin still had fatigue 10 weeks after being infected with coronavirus. A third were physically unable to return to work.
> Crucially, doctors found no link between the severity of the infection and fatigue.
Study here: https://www.medrxiv.org/content/10.1101/2020.07.29.20164293v... 128 participants (49.5 ± 15 years; 54% female)
[edit] To downvoters, consider that the placebo effect is incredibly strong, much stronger than you give it credit for most likely, and has gotten stronger over time as our faith in medicine has.
A 2014 study showed that placebo was 50% as effective as real migraine medication in treating pain after migraines [1].
Similarly for the nocebo effect. A study showed that 20% of people getting placebo drugs in a clinical trial developed side-effects. The nocebo effect may be even stronger than placebo. [2,3].
I'm not minimizing COVID and I'm not saying these people are "making it up." I'm saying, humans aren't computers, and human viruses aren't computer viruses. It's not a case of X happens to you and the result is deterministically Y. There's a lot more to your subjective experience. Generally the more strongly you believe in a potential range of outcomes, the more likely you are to, basically, get them. COVID anxiety is huge, and some of these "long-haulers" symptoms could easily be nocebo.
If this long-haul syndrome really is nocebo, it opens up potential avenues for treatment.
We need to keep an open mind.
[1] https://www.health.harvard.edu/mental-health/the-power-of-th...
[2] https://www.health.harvard.edu/newsletter_article/The_nocebo...
* What is the measure of disease severity?
* Is there a correlation between measures of disease severity and anosmia in Covid-19?
* Is there a correlation between disease severity of other viruses that trigger chronic fatigue symptoms and incidences of CFS?
The anosmia question seems relevant if we assume that the virus damages the nervous system.
Be very careful with how you phrase that. Fatigue is very much a physical thing, not psychological. It's just that medically, we have no way to quantify it, so it doesn't show up easily in lab tests. That does NOT mean it doesn't exist, or that it only exists in the head. (edit: and before someone says "lactate", keep in mind that that only measures muscle strain, one of the few forms of fatigue that we do know how to measure)
How people experience fatigue has a psychological component, but saying to someone who has been fatigued for years that their issues are predominantly psychological is very dismissive. Odds are they've been hearing that from their physicians for a long time already.
Source: https://news.sky.com/story/coronavirus-more-than-half-of-cov...
So anywhere from 0.5% up to 2% seems to be the plausible range, which of course can differ depending on your age.
So I'm not sure why that article gives you the impression that any more than 2% is implausible.
When I see a medical journal article with n~150 saying that 50% experience fatigue after ~70 days, and an app reports that self-reported "symptoms" (may not be asking about fatigue?) are below 2% after 90 days, my takeaway is that much more data is needed because it could be that "a lot of people have long-lasting side-effects".
Think about if you (or a young healthy family member) tested positive and felt mostly fine for a week or two.
After reading both of the above, I'd be concerned that there's a decent chance (1%-60%?) that you'd be worse off in some way for a long time, possibly the rest of your life.
I had covid middle of March, and am maybe 50% energy most days, and have to do massive breaths every so often. After 7 months of “recovery”?! I don’t know if I’m even getting better... yeah extreme fatigue, brain fog, eating can be exhausting...
OTOH, A lot of people came out of it far worse...
But it seems to be rare enough that it is hard to establish a causal link / study it properly.
I wonder if there could be some common cause? Perhaps also common to CFS?
I'm not sure how common symptomatic mono is, but I suspect it (along with some things like maybe pneumonia and bronchitis?) is a good reference point.
How was your bout with mono? I recall having tonsils so swollen I was afraid I'd have to go to the hospital for a few days, and then being perpetually exhausted for ~6-8 weeks.
The article also highlights a study[1] finding over 50% suffered fatigue after 10 weeks and 33% were physically unfit to work. From that study:
> There was no association between COVID-19 severity (need for inpatient admission, supplemental oxygen or critical care) and fatigue following COVID-19
[0] https://www.reuters.com/article/uk-health-coronavirus-britai...
[1] https://www.medrxiv.org/content/10.1101/2020.07.29.20164293v...
Since we're all different, and will all fight viruses in different ways and strengths (depending on health/existing cnditions etc.), there'll be so many variations in how much of a 'toll' fighting it has taken on our bodies (and minds).
Since this ia a 'novel' virus, we can only really base any conlusions on the empirical evidence as it comes in.
https://www.youtube.com/watch?v=8vWaawiUteM
If your take is that Sars is just another flu, then I guess you just broadened the scope of the flu, and need to be open for the idea that the 'flu' could be more dangerous than you thought.
We do designate strains of influenza transmitted from animals (and indeed other coronaviruses transmitted from animals) as novel threats.
There are potential long term effects from most infections, especially in the elderly. Other infections can cause long term problems, and it's still super early for COVID to talk about long term effects. I remember getting pneumonia in my twenties and it taking 3 months for my lungs to fully recover.
We still don't understand exactly what happens with Lymes Disease. Is the immune system left in a state where it's continually fighting/reacting to an infection that's no longer present?
The 1976 swine flu vaccine also may have cause neurological issues for up to 4,000 of the millions who received it[1]. Would they have had the same symptoms from an actual infection from the flu? Potentially. It'd difficult to know, but people do have long term issues from other viruses, especially if they're older or have other underlying health conditions. It's not unprecedented.
[0]: https://jamanetwork.com/journals/jama/fullarticle/2768351
[1]: https://www.youtube.com/watch?v=4bOHYZhL0WQ (60 Minutes)
6 weeks later, I am suffering from occasional severe fatigue still - these days, it manifests itself after 8-9 hours or so and results in a crash where I have to sleep for 40mins+. If I don’t struggle through and go to bed then, it will screw up my sleep schedule. During the 2 weeks of COVID, it was way worse and I could sleep 3/4s of an entire day and still be tired.
This is getting better - I push myself everyday just a little more and now can exercise for 2 hours straight and carry on, but it’s night and day different to pre-COVID behavior and I imagine it will be through to Christmas before I am back to “normal” (touch wood).
I'm also experiencing the crashes you mentioned - fine one minute and crawling back in bed the next. It's usually in the afternoons or evenings. But as you say, it's much better than before when I slept ALL DAY for several days.
To end on a brighter note, I am back to exercising 45 mins, 3 days a week. And I go biking weekends, for 1.5 - 2 hours. My stamina isn't what it was, but it's building back. I even decided to go ahead with a (virtual) race I signed up for. I'll walk/run with the only goal of finishing.
We still barely understand Covid. No public health official with an ounce of ethics and concern for their career is going to be in favor of letting a poorly understood virus just rip through entire communities. The death rate is only one part of the equation. As this article points out, scientists are now concerned about the growing number of cases in which severe symptoms stick around or even develop long after infection. When compared to the cold or flu.
We also just recently learned that antibodies only stick around for a few months.
There are reasons that public health officials are being so cautious. It’s not just to be “draconian” for the fun of it.
We do not even understand well what it does to the brain of children. It definitively has neurological effects in some people and there could be really undesirable long-term effects we still do not know about.
Luckily, the estimates for the true Infection Fatality Ratio (IFR) are lower, between 0.6% to 0.7%, for industrialized nations. That's still a very high high number if we don't keep the disease in check or don't get a vaccine.
Scary bug. I could def see what I had killing people. I had no idea what it was, back then. I just thought I was getting pneumonia, and it broke, just as I was ready to go to hospital. I'm glad I didn't do that, as I would have just infected a whole bunch of vulnerable people.
Since then, I've had a persistent "throat-clearing" thing. Lots of "harUMPHf." My sense of taste never fully recovered, either (that was the weirdest part of it. I've never had that happen before).
I'm really grateful that it wasn't worse. I know some folks that died from it.
Antigen tests are not terribly sensitive. If you get tested to soon or too late your antibody level will not be high enough to trigger a positive result. If your family got them at varied times after infection, or if you got more than one test, it would be very unlikely you hadn't gotten a positive result.
Conventional wisdom is that it peaks ~3 weeks after infection, and is highest for 1-2 weeks around that time. In practice everyone reacts differently and it can be hard to predict. I was infected in March and I'm still testing positive every 1-2 weeks. That's because I had a fairly rough go round, and developed a very heavy immune response. Asymptomatic[1] people may mount a very limited response and never test positive for antigens at all.
> Since then, I've had a persistent "throat-clearing" thing. Lots of "harUMPHf." My sense of taste never fully recovered, either (that was the weirdest part of it. I've never had that happen before).
It took me an inhaler and 4+ months to clear out my lungs. Constantly coughing up thick sludge. That inhaler was a godsend during the worst part of it- helped me move stuff around when I needed air most. I still have breathing issues (damage to the blood vessels), but I can fill my lungs easily now.
[1]: NB that due to the way lung problems work, "asymptomatic" cases can still inflict a lot of damage. Since your oxygen demands and supplies are constantly changing -due to exertion, air quality, altitude etc- your body is used to quietly adjusting your heart rate and breathing rate up without you noticing. Your lungs can go through some serious losses of efficiency and put a lot of strain on your heart before you notice. This goes double for people with high anaerobic tolerance; if you run a few times a week you will just ignore co2 buildup to a much higher level than a couch potato.
It seems like RT-PCR is more sensitive than the IgM/IgG antibody test for mild, moderate and normal group.¹ And a negative result of a RT-PCR test a few days past the peak would reduce our estimate of the relative probability that a case patient was infected by only 3%.²
[1] https://www.researchgate.net/publication/343570266_Compariso...
> or the antibody tests are garbage (or both), since they reported negative
So you didn't have it?
I also know several people that have died from it. Directly; not hearsay.
I live in New York. We've been dealing with this for a while now.
Also, as is shown in this thread, just talking about it brings out the COVID-deniers, so this is the last post I'll make on the topic.
Have a nice day.
Nevertheless, questioning the motivations of my cohort of friends who do not seem to have actually had covid is not an attempt to invalidate covids severity. Clearly it is a terrible illness. Regardless, we can recognize hypochondrism without invalidating the experience of people who actually have diseases.
https://www.statnews.com/2020/08/26/long-haulers-dilemma-man...
>Harsh violent lockdown for 2 or 3 years can eradicate coronavirus.
>Soft lockdowns "flatten the curve". From the NYT study, this reduces death by 12% due to availability of ventilators, and find potentially other helpful drugs.
>No government lockdown, where people must be personally responsible for their own health. This sacrifices the old and obese that refuse to comply with voluntary lockdown.
And all of this effort is focused around a few percentage of the population, which is disproportionately unhealthy.
50 year old is only about a 0.14% IFR: https://www.nature.com/articles/d41586-020-02483-2
The IFR was close to zero for people between the ages of 15 and 44, increasing to 3.1% for 65–74-year-olds and to 11.6% for anyone older. The results of the study have been posted to the medRxiv preprint server1.
It's bad odds for sure and if 80 you wouldn't want to contract it. Only implies it's not a death sentence, roughly as dangerous as space flight.
I used to play a tabletop RPG that used percentile dice. For every action, there was a 1% chance of a miserable failure. Turns out, those cropped up quite a bit.
I'd love to imagine (actually watching would be sadistic) a lineup of folks claiming they would, step up to the M&Ms, one after another, be told of the chances, and watch them pluck one, or step away.
https://ourworldindata.org/mortality-risk-covid#case-fatalit...
This was the entire "15 days to slow the spread" narrative. It's been 8 months. None of our hospitals collapses or were overwhelmed, except in states like Michigan and NYC where governors send the infected back to elder care facilities.
Most hospitals in the US never even got close to peak usages. Many people died because they were afraid to go to the hospitals or couldn't get surgeries they were scheduled for.
Texas ICUs came very close to peak usage, and Florida was also running near capacity in many ICUs. Hospitals like TMC managed by making "surge" ICU beds and bringing in resources from out of state. We don't know the impact of these surges on quality of care, but Texas was losing a 7-day average of 325 lives per day at its peak in August. These happen to be the states with a combination of high population density cities and some of the fewest COVID countermeasures; more rural states and states with stronger countermeasures didn't approach capacity.
Individual risk is low, but collective risk is unacceptably high.
"Plenty" is not statistics.
And "healthy" is difficult at best. Is an overweight person healthy? Is a normal weight person that doesn't exercise healthy?
And "healthcare system would rapidly collapse." Makes no sense. You mean our hospitals would be full for a few months. It's not like the healthcare industry would be destroyed.
I would like to remind you of the situation in northern Italy in february. People suffocating in hospitals on chairs in the corridor, because there was no one to look after them and no beds for them to lay down. And that was not because the doctors were absent, it was because they were overwhelmed by the amount of sick people.
Perhaps you prefer an US example, I'd say it is sign of a collapsing health care system, if they have so many deaths, that they don't know were to put the bodies. That happened in New York City, not some rural place with too few hospitals.
And just for some perspective the flu season was filling hospitals in the US a couple of years ago. But it barely made the news.
https://time.com/5107984/hospitals-handling-burden-flu-patie...
And the linked article isn't about north Italy. From where do you have the information that north Italian are regularly collapsing, because of the seasonal flu? Full hospitals are not the same as hospitals out of space to keep patients and bodies. Have a look at this impression https://news.sky.com/story/coronavirus-they-call-it-the-apoc...
Reference please
Is that really the case though? We keep hearing of a lot more infected, but at the same time the hospitals have a lot of capacity now (across several countries) so what is the risk for the healthcare system right now?
You can consider some of the ways it could go:
(1) people/businesses do voluntarily substantially the same things as soft lockdowns codify. In that case, the impact on the economy, deaths, hospitalizations, etc, are about the same.
(2) people/businesses do substantially less. Deaths/hospitalizations increase. I think the economy probably does worse -- many people get scared and avoid many kinds of economic activity, take their kids out of school, etc. Other businesses are disrupted as employees and owners get ill. In the US, the large number of seriously ill uninsured/underinsured throw an anchor on to the economy for years to come.
You suggest to "sacrifice the old and obese", but it's not clear there's a payoff for that sacrifice. We may end up with 2x-5x dead and a worse, longer-lasting economic situation.
Politicians indeed, but a large part of the blame lies on the general public - especially those parts who believe and spread beliefs that mask wearing is unmanly/dictatorship, that vaccines cause autism and the likes.
> A post-viral syndrome can follow many types of viral infection, from the common cold to influenza and pneumonia. Yet no one has compiled and publicised data sets for those suffering from such a syndrome, let alone anointed it Long Flu or Long Cold ... There is a reason why the threat of Long Covid is being talked up right now, when the serious but manageable nature of Short Covid is becoming increasingly clear. It provides the often draconian response to the pandemic with the justification it increasingly lacks – that is, something for all of us to fear.
Some journalists are without a doubt hyping this up, but to blanket long covid as some sort of media hoax can do a lot of harm. People aught to know that their symptoms may linger and even worsen far after two weeks. Censoring this just because you don’t like it or it scares you is harmful.
How many people complained of chronic fatigue 2 years ago? Maybe COVID has been spreading for decades making people tired and depressed! /s
Any severe case of pneumonia that damages your lungs is going to cause long term breathing issues, but that’s obvious and outside the scope of this conversation.
Public health officials needs to adapt to the latest understanding and work with data and statistics accordingly. It’s extremely boring and un-sexy (i.e., it’s not like scientists in the movies making a sudden breakthrough), which is I suppose why so many jump to conspiracies. We crave clear and spectacular reasons for the things we fear and have no control over.
> But he warned that until we figure out what is causing long Covid "it is difficult to figure out treatments."
If scientists don't know what is causing "Long Covid", then they don't know what is causing "Covid". Yet, many treatments have been developed for Covid.
If we accept our ability to treat without full knowledge of origin, then "Long Covid" can be treated, as has been done for Covid.
If "Long Covid" deserves a different status due to unknown origin, then the same standard can be applied to the unknown origin of Covid.
disclamer: IANA scientist or doctor, but it looks like long covid might be very similar to allergy (and similarly treated)
Speaking as someone in the tech space still suffering from fatigue and brain fog (with no real signs of improvement) 7 months after infection. My productivity has certainly gone down.
https://www.sciencefocus.com/news/coronavirus-aggressive-l-t...
https://www.biospace.com/article/mutated-covid-19-viral-stra...
There are two labs in Wuhan. The institute of virology, and the wuhan CDC. The institute of virology is 12 km from where the virus started spreading. The CDC lab -which does not study viruses- was the one at the center of the spread.
The amount of bullshit associated with the origins of the virus is embarrassing. It would be one thing if it was planted propaganda- there are obvious lies and embellishments, but the sheer number of mistranslations, misunderstandings, and hilariously implausible theories taken as fact is insane. Potholer54 did a rather methodical takedown: https://www.youtube.com/watch?v=ab-r0capbzk
Viewed through that lens, it is surely a cunning plot of Mother Earth do bring down our insane resource consumption, no? Maybe a bat conspiracy against humanity?
You'd also expect to see these same complaints from people who have not gotten covid which I'm not seeing.
The previous SARS-COV1 epidemic in 2003, created lung scaring and reduced lung function in patients, this damage was persistent even after 7 years post-recovery. [0]
There is zero evidence that the reported endothelial damage in SARS-COV2 is any 'milder' than SARS-COV1.
If this “endothelial damage” were happening at even a 1% rate, there would be millions of people with obvious symptoms. There simply aren’t.
Basically on top of lung damage, SARS-COV2 can also cause blood vessel and cardiac tissue damage, there are multiple cases of myocarditis post-infection.[0]
Most of the symptoms are hard to study like shortness of breath or fatigue. Unless you have a prior VO2max study it's hard to _prove_ that you are worse off post infection but that is exactly what is happening with athletes being infected (loss of VO2max, which pretty much is a loss in peak performance for many athletes).
Another aspect is that a loss in cardiac output or lung capacity is likely also a loss in life expectancy but it is the type of thing you would need decades to prove.
My point is, with the information we already have the sensible approach is to use caution rather than trying to be stoic about it.