CDC ditches 5-day Covid isolation, argues Covid is becoming flu-like | Hacker News Reader

CDC ditches 5-day Covid isolation, argues Covid is becoming flu-like

arstechnica.com

59 pointsBender131 comments

They didn't argue the disease Covid is becoming like the disease flu. They argued the prevalence and common impact is. That's an important distinction.

Hospitalization and death is different, long covid is different, and they mention both, specifically.

Even WSJ coverage of this emphasized that point, and it's hardly a liberal rag, phrasing as "Treat it more like flu" not that the disease itself is flu-like.

On the contrary, WSJ point out:

However, public health officials cautioned that Covid still isn’t the same as the flu or other respiratory viruses. “Let’s be clear. Covid-19 is not the flu,” said Jackson at the CDC. “It still causes more serious illness and leads to more lasting effects,” he said.

Public-health experts and physicians note that Covid is still a disease that is cited as a cause of death in more than 1,000 people a week, according to CDC data. And long Covid, with symptoms that can linger months and even years, hasn’t gone away.

https://www.wsj.com/health/wellness/covid-guidelines-2024-cd...

Finally, CDC didn't ditch 5 day precautions. The part most coverage isn't headlining, CDC say if you're not isolating, wear a well-fitting mask, keep your distance from people, for five days.

They also say during that 5 days have clean air, which they define as outside air, higher fresh air mix, and purification. An office demanding people come in should ask their building if they've adopted the post-pandemic ASHRAE directional guidance (not yet formalized).

With recent research attributing long covid brain-fog to leaking blood in the brain, and research is still finding other unexplained effects, it may be worthwhile to weigh that we have a pretty good handle on the flu, but ...

TL;DR: We are still learning about this thing.

Comments suggesting the CDC is telling sick people to go to work or airports are not consistent with the recommendations. The CDC is recommending people stay home/isolate during fever and symptoms, and consider returning to work after the fever breaks and symptoms start to improve.

FTA: "The CDC acknowledged that the eased isolation guidance will create 'residual risk of SARS-CoV-2 transmission,' and that most people are no longer infectious only after 8 to 10 days. As such, the agency urged people to follow additional interventions—including masking, testing, distancing, hygiene, and improving air quality—for five additional days after their isolation period."

Given that many people were ignoring the prior advice before this advice came out, I doubt it will effect little change. The same recommendations should have been applied to all influenza-like-illness even before Covid, but people mostly just try to work until they can't, then stay home until they can, and come back to work anyway.

The problem is people are infectious for up to 16 days and almost all are still infectious on day 12. Its not a policy based on the reality of the virus or the disease it causes.

I will agree with those numbers if you're including the incubation (presymptomatic) period which is quite long with COVID-19, estimated at 7 days on average.[1] Unfortunately that just stresses how little we can accomplish in preventing spread after someone has symptoms. They were already contagious (perhaps 1-4 days) before the onset of symptoms. 10-day isolation periods after infection don't reflect the reality of the virus either, and permanent isolation forever even less so. Like I said, I don't expect anything to change from this new guidance. They have different guidance for healthcare settings and very few people were following the previous general guidance anyway.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9396366/

Sadly, this is what Corporate America ultimately lobbied hard for this and the CDC has caved to them. I'm sure this is a move to exploit workers even more, causing more preventable permanant sickness (Long COVID) and deaths as a result. [1] [2]

[1] https://skepchick.org/2024/02/the-cdc-gives-up-on-covid-19/

[2] https://med-mastodon.com/@luckytran/112021781878554992

The CDC is saying it's okay to infect other people because pretty much everyone on earth has already been infected with the novel sars-cov-2 virus and taken their risk already with the first infection. Anyone that would have bad outcomes has died or been taken out of productive life so they don't matter. And the rare few of us that have still avoided any exposure to sars-cov-2 virus in our upper respiratory mucosal immune compartment don't matter because we are so few and the humoral immune compartment is protected by intramuscular vaccination.

A very pragmatic position but not one that has much to do with the science of sars-cov-2 shed duration or infective window.

>And the rare few of us that have still avoided any exposure to sars-cov-2 virus in our upper respiratory mucosal immune compartment don't matter because we are so few and the humoral immune compartment is protected by intramuscular vaccination.

As one of the rare few, I'd rather not take risks, especially since there's still so much developing science behind the long term effects of COVID. Good to know the CDC does not in fact care about disease control for those who heeded their advice up until now.

> Anyone that would have bad outcomes has died or been taken out of productive life so they don't matter.

That's just not how it works though. Each subsequent infection increases the risk of bad outcomes (1)

The CDC must know this

1) https://www.unmc.edu/healthsecurity/transmission/2023/12/27/...

https://time.com/6553340/covid-19-reinfection-risk/

https://www.theguardian.com/world/2023/jan/23/repeat-covid-i...

True enough. I didn't want to complicate my message. I only meant the risk of the first exposure is much, much greater than subsequent ones.

It is unarguable that the risk of the first exposure to a novel virus is much greater than subsequent exposures. I say this because T-cells generalize across mutations. And T-cells stay tissue resident for years to decades (unfortunately sars-cov-2 IgG and IgA antibodies are gone by 6 months).

Your T-cells from the first sars-cov-2 exposure will start killing infected cells much faster once you've been exposed. This limits the replication earlier and reduces the viral load. This reduces damage done.

Weird side effects like the collection of things called long-covid have been shown in study after study not to be related to viral load. So whatever risk is associated with reinfection does not decrease in that sense. But in the dying sense? It decreases a lot.

> I only meant the risk of the first exposure is much, much greater than subsequent ones.

I have heard of some people whose second case of COVID (Dec 2023) was significantly worse than their first (summer 2022). This might be due to the amount of time since last vaccination, or the amount of exposure to an infected person. But I was interested to hear from a couple friends that the second time isn't always lighter than the first.

This is not mutually exclusive with what I have said. The risk is greater in the first infection. It does not mean risk goes away with subsequent infections.

> The CDC is saying it's okay to infect other people because pretty much everyone on earth has already been infected with the novel sars-cov-2 virus and taken their risk already with the first infection.

Spreading respiratory viruses is really called living in a normal human society, and for whatever reason medical professions abandoned every conventional advice and emergency plan of the past that was prepared for responding to novel respiratory contagious disease of the sort a coronavirus would be, that spares the vast majority of healthy people, and resorted to what I call Open Air Surveillance Fascism.

I'll never forget the absurdity of healthy people on a beach, which was probably the safest thing a person could do with maximum ventilation and full sunlight, with some moron shaming everyone while dressed in a reaper outfit.

I’m not a zero COVID person and just got on to living my life as normal after the acute pandemic, but about a year in I started developing autoimmune symptoms I’m still struggling to figure out. There’s a chance I was always going to develop it, but I definitely wonder about long term COVID dysfunction.

First I had muscle spasms and twitches, then intermittent joint pain, trouble sleeping, hives on occasion while running, now exocrine pancreatic insufficiency that seems like it’s idiopathic (MRI is confirming today). I’m scared as hell and any attempt at diagnosis or treatment is a dead end or makes things worse.

We have barely any idea what happens long term. Chicken pox becomes shingles later in life. One infection of covid can disable you, and it happens more often than people think. Basically for every dead person, there is now a disabled one.

2021: https://www.americanprogress.org/article/covid-19-likely-res...

NHS study from 2022: "Results Of 206 299 participants (mean age 45 years, 54% female, 92% white), 15% were ever labour market inactive and 10% were ever long-term absent during follow-up. Compared with pre-infection, inactivity was higher in participants reporting Long Covid 30 to <40 weeks [adjusted odds ratio (aOR): 1.45; 95% CI: 1.17–1.81] or 40 to <52 weeks (aOR: 1.34; 95% CI: 1.05–1.72) post-infection. Combining with official statistics on Long Covid prevalence, and assuming a correct statistical model, our estimates translate to 27 000 (95% CI: 6000–47 000) working-age adults in the UK being inactive because of Long Covid in July 2022." https://academic.oup.com/eurpub/advance-article/doi/10.1093/...

Exactly, it's a nasty virus.

* I know someone that contracted Covid late fall of 2020 and is still disabled from Long Covid/PASC with daily fevers and fatigue. If they don't get a good night's sleep and eat enough, they're wiped out for 1-2 days afterward.

* Have another friend that is still dealing with smell and taste changes a bit over a year out. Luckily the "rotting garlic" smell and most everything tasting "bitter" (their words) has significantly improved. Now most things have a little bit of normal smell and some taste has returned.

* Another friend's step dad, in his mid 60s, had a heart attack and died a couple months after a week long hospital stay due to Covid. Hard to say exactly if Covid damaged something that lead to it, but his doctor thinks it's probably likely but can't prove it. He was maybe 25-30lbs overweight, which of course does raise the chances of bad outcomes from Covid, but no other chronic conditions like diabetes or COPD. He walked a few miles nearly every day before getting sick.

I once saw someone point out that AIDS is "Long HIV" and Multiple Sclerosis is "Long Guillain-Barre Syndrome", so in 20 years we'll have a new name for Long COVID and people will memory-hole being dismissive of symptoms.

Is that accurate though? Do most people who get HIV never develop AIDS, without needing any drugs to keep it at bay? It's a nice analogy if it works, but if not then it's more misleading than anything.

Not everyone who has GBS develops MS and not everyone who gets COVID develops Long COVID so far as we know; HIV/AIDS is the odd one out of these analogies. I don't know to what exactness the comparisons in terms of percentages of people who develop the chronic syndromes, time to onset, severity of symptoms etc, would need to be in order for an analogy to have any utility to you, so I suppose we'll see in 20 years.

In reality, most people have never even had the flu. They often mistake a severe common cold for the flu. The true influenza hits you hard, like a brick wall, and has a significant fatality rate among the elderly. The primary contrast between COVID-19 and the flu has always been the R-factor, which indicates how many people an infected person will spread the virus to. The flu typically has an R-factor of around 1, just enough to sustain itself. On the other hand, COVID-19 has an R-factor closer to 2, meaning that one person can infect 2, then 4, 8, 16, and so on. This is why many countries implemented drastic measures initially. Now that vulnerable populations are vaccinated and the general population has some level of herd immunity, the situation is not as alarming. The CDC implemented severe measures, but the new guidance does not imply that "COVID-19 was not a big deal" as some individuals are suggesting. It falls somewhere in between - there were valid reasons for the initial actions taken, some measures may have been missteps, but overall the situation has improved.

This didn't sound correct, so I Googled it.

"Researchers analysed blood samples from volunteers in Southern China, looking at antibody levels against nine different influenza strains that circulated from 1968 to 2009.

They found that while children get flu on average every other year, flu infections become less frequent as people progress through childhood and early adulthood. From the age of 30 onwards, flu infections tend to occur at a steady rate of about two per decade."

https://www.imperial.ac.uk/news/164239/adults-only-really-ca...

>Adults over the age of 30 only catch flu about twice a decade, a new study suggests.

Oops, I was wrong there, thank you for the link.

Symptomatically. Cases of influenza a where the person thinks they only have a minor head cold do exist and are a good fraction of all cases. Almost everyone gets influenza a every few years. It's just that many cases are asymptomatic or minor.

Reconstructing household transmission dynamics to estimate the infectiousness of asymptomatic influenza virus infections https://www.pnas.org/doi/10.1073/pnas.2304750120 "Symptomatic cases account for 68% (95% CrI: 63%, 72%) of infected children and 59% (95% CrI: 53%, 64%) of infected adults."

Nearly half of adult influenza a infections are asymptomatic and go unreported and untested.

> In reality, most people have never even had the flu. They often mistake a severe common cold for the flu.

Really? My understanding is that high fever and body aches are the distinguishing factors between flu and other illnesses, and I distinctly remember having the flu a few times (including when I had it a few years ago and was given a test to confirm). I'd be very surprised if fewer than 50% of the population had ever had the flu.

I would agree that people sometimes use the word "flu" to refer to things that are not actually the flu, but I doubt that there are that many people out there who have been around for ~4 decades but never got the flu.

Sample size one, but I’ve only had the flu once in my life (29 yo). It was back in 2007 when the vaccine whiffed on the dominant strain. I remember a two week period of little energy at first and then some energy I could expend on one task a day (for example, a shower). The flu is no joke, but getting it seems pretty hard from my anecdotal experience.

The lockdowns were irresponsible (people didn't obey them anyway), and now this is stupid and irresponsible again. Don't judge a disease by it symptoms - most cancers don't have any until it's too late! The piling evidence of the damage every COVID-19 reinfection does is overwhelming! This is NOT flu-like! Many other diseases, some very serious, share similar symptoms, but they don't call them "flu-like", because it would be crazy!

On top, this is now the most contagious virus!

I suppose that depends on your physical location to say if they weren't obeyed. It's true they weren't followed 100% in spirit or in practice, but they were to enough degree. At least in my area, from when lockdowns started until probably mid 2022 traffic wasn't something I had to worry about anymore. Now it seems to be back to normal. Stores seem even busier now than they were before Covid, etc.

In our lockdown capacity, it demonstrate how fast the virus spread and how much damage it did with a population largely immunologically naive to Covid). I can only imagine what would have happened in the US had it just been business as usual.

There was enough science to avoid lockdowns. Face masks (not the surgical kinds though) work, but they needed to educate people to wear them consistently and that there's no point in wearing a mask and then taking it out to eat or drink water for 1 minute. They also changed it to "face covering," allowing people to wear germ-infested cloths and surgical masks.

My family of 4 traveled internationally during COVID-19 and wore N95 and FFP3 face masks, didn't eat at the airplane, we only ate briefly at airports in secluded areas, and never got COVID-19. In fact, we only got COVID-19... at the pool, i.e., outside. My daughter was without a face mask and her friend, who was later tested positive, was 10-15 minutes away. We know for sure it was him infecting her outside in a larger than the standard "social distance", because she was home for 2-3 weeks and didn't see anybody else. Only she was positive and had symptoms.

> her friend, who was later tested positive, was 10-15 minutes away

Is "minutes" supposed to be "meters" or something else?

Yes, 10-15 meters.

I often give my friends an example: we're on the beach in 20 meters away a couple is walking and you can smell their strong perfume. Aromas are molecules, alright, but viruses are not so much "heavier." They can be carried away pretty far away. Of course, the further you are, the smaller the chance gets, but it's possible. The longer you stay, and the more people walk by, the more real the chance of infection gets.

Wow, I've never heard of anyone getting COVID when separated by such a distance when outside.

There's no magic outside. UV rays take minutes to deactivate the virus. Breeze can be a friend of a foe.

https://medium.com/@jurgenthoelen/belgian-dutch-study-why-in...

Is there any similar guidance from later in the pandemic? Much of what we thought we knew in April 2020 turned out to be incorrect.

It's perhaps not impossible to get COVID from 30+ feet away, but I sure haven't ever heard of such a thing happening, nor have I seen any guidance that indicated this distance presents a risk.

TBH, I would think it would be more likely that the infection happened at a different time, when the kids were not actually 30 feet apart (even if they were supposed to be, and said they were). I say this as a parent, and as a former kid.

Some scientists have been studying airborne virus transmission and respirators' effectiveness well before COVID-19. I recommend following the work of Linsey Marr [0].

Measless is known to have infected people at a stadium 100 feet away [1].

Influenza is known to infect through dust particles [2]. I can't find the study, but this is valid outdoors, too.

[0]: https://twitter.com/linseymarr

[1]: https://www.statnews.com/2019/02/14/measles-infection-virus-...

[2]: https://www.ucdavis.edu/news/airborne-viruses-can-spread-dus...

Regarding the 30-foot distance, my daughter was home and had not seen anyone for 2 weeks. If she got it from us, the 4 PCRs we've had would have shown us being the source. She had symptoms - headache, a fever, a sore throat, and nasal congestion. She had several positive PCR tests after the first one.

It is possible, given the right conditions. My point was that if I can smell somebody's perfume from a great distance, I can also inhale their virus.

...do you have anything constructive to say as well, or did you just need to vent some very understandable frustration?

I'll get down voted for this but when COVID was a thing I wasn't wearing those cloth masks.

I was wearing a 3m respirator with p100 cartridges.

One because the paper masks were hard to find, two they reduce but do not eliminate the risk of infection, and three those cartridges last way longer.

Never caught it either.

At this point, unless you've been living in a cabin in the woods, it's almost guaranteed you've had at least an asymptomatic infection.

Slight exaggeration here. I have several older family members who have not had COVID yet. They wear masks in grocery stores and don't go to movie theaters anymore, but they live in the suburbs are several notches from living in a cabin in the woods.

The things is - you can't actually know for sure - it is entirely possible to get covid and have nothing more than a sniffle or nothing at all - so I think what the OP you are responding to is saying is that just because someone thinks they never had covid, it might not be true.

I know people who never had symptoms, but tested because a household member had tested positive (with symptoms) and found out they were positive too - it happens.

In my opinion, that is the best case scenario - you got it, didn't know it and your body fought it off like a champ.

> just because someone thinks they never had covid, it might not be true.

Definitely true. But there are some people who have been very careful and/or tested multiple times with every illness in the last 4 years, and who are fairly certain they have not had COVID.

Yeah my the time of general unmasking, I took off the full respirator. Probably picked it up since then since I had some nasty head colds these past few years.

Cloths masks really don't do anything against a virus that persists in tiny droplets that hover in the air making it airborne spread. They might have worked against droplets fairly well if both parties are wearing them but by the time they introduced cloth masks the authorities knew the science said it was airborne. However N95/FFP2 and definitely P100 masks are highly effective and there are plenty of people who have used them since the beginning of the pandemic who have never caught Covid as confirmed by antibody tests. Proper PPE works very effectively against Covid (and Flu, measles, colds etc) and reduces the risk drastically.

You have and are doing the right thing to protect your health against a virus where about 250,000 medical papers all show is very bad news for humans.

Is it possible to pay for a private Covid vaccine? In which country? Or are all countries still only allowing the most vulnerable to be vaccinated?

In greater NYC area you can just make an appointment and walk into any CVS or Walgreens and add a booster of your choice, every 2+ months (which is the frequency CDC mentions, though research graphs suggest moderate booster effect doesn't disappear for 6 - 9 months), and supposedly your insurance will cover it if you're in a window the federal government isn't covering it, but so far they still seem to be covering it.

Visitors from outside the US are still being able to walk in and get it as well.

YMMV etc. etc., but this is accurate in greater NYC area as of January/February 2024.

counterpoint (well one of many)

https://www.bloomberg.com/news/articles/2024-02-26/covid-mad...

This is insane again as it was just found that an infection lowers your IQ by 3 points (2 big recent studies)*. The average person now has over 3 infections to date. We aren't even far enough in the research to understand the compound effects on the brain (and body). And basically, everyone in society, even the smartest people are losing IQ points at a time when we need people to become more intelligent and aware and able to adapt to an accelerating future...

"Extrapolation to Loss of IQ points, compared to uninfected controls:

Mild Covid, Resolved Symptoms: 3 points

Unresolved Symptoms: 6 points

Covid requiring Intensive Care Unit admission: 9 point

Reinfection: Additional 2 points "

https://erictopol.substack.com/p/long-covid-and-cognitive-de... https://www.nejm.org/doi/full/10.1056/NEJMoa2311330 https://www.nejm.org/doi/full/10.1056/NEJMc2311200

The virus is a massive vascular infection attacking every cell on the lining of the body (blood vessels, endothelial cells) and even organ organs, heart damage etc... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8771611/

Do IQ tests have a resolution that is good enough to notice a difference of 3 points?

I think when measuring a big enough populations they likely would show that small of a shift, though would be interested in the range of it, like is it a smaller group highly effected vs being pretty consistent.

I wonder if they account for the noise of the test itself though in their CIs

Looking at the first study, it's not showing a "shift" at all. It's comparing a group of people who recently had covid to a group of people who haven't had covid. Seems like there's some confounders in there, some of which could correlate to IQ.

The second study uses a test with 13 question. I don't think you can ascertain IQ very accurately with a 13 question test (especially if the same test is given to people with a wide range of ages).

"Disability policy experts have long warned that the COVID-19 pandemic would likely be a mass disabling event. New analysis of the U.S. Bureau of Labor Statistics’ (BLS) data on the civilian noninstitutional population aged 16 years and over shows that, in 2021, 1.2 million* more people were identified as having a disability than were in 2020. Within the portion of that population participating in the labor force, there were 496,000 more people with a disability."

https://www.americanprogress.org/article/covid-19-likely-res...

> it was just found

Don’t you think we should wait a bit before putting credence in these studies? Just a quick glance is enough to see plenty of potential flaws.

Jumping at the latest study isn’t much different than “just trust me bro”. These things take years if not decades to understand. We’ve been wrong far, far too often to keep repeating this behavior.

What flaws?

Unless you specifically infect a treatment group in an RCT, your 'recently had COVID' and 'no recently documented COVID' groups will vary in ways you're unlikely to be able to fully control-for, no matter how hard you try.

Given that by now pretty much everyone has had COVID, it would have been possible to design a study that ran long enough to capture a very large swath of the population. That would eliminate some of these confounders, but would be further complicated by the fact that different variants may have different effects.

But I agree with your sentiment. The first study doesn't follow people at all, and the second study has a 13-question test. IMO this is very overblown — these studies do not give cause for alarm that would justify shutting down the world again.

The first article you linked to seems to agree with what the CDC is saying. The initial variants of COVID-19 were much worse, that's where the "infection lowers your IQ by 3 points" comes from, but the disease has become much more mild.

"The adverse cognitive impact was worst with the original (ancestral) virus and the Alpha variant, compared with subsequent Delta and Omicron variants"

https://erictopol.substack.com/p/long-covid-and-cognitive-de...

Is there a methodological concern about how the uninfected "controls" are established? (I have not read the papers you linked)

It seems like:

(a) Obviously they're not intentionally infecting one group and keeping the other in rigid isolation so ...

(b) it seems like it would be hard to rule out that there's something else that's characteristic of people who avoided infection which could be related?

To be clear, I'm not trying to throw skepticism at the conclusion that infection causes deficits -- but isn't it kinda hard to measure? In the same way that, e.g. it's hard to measure the very long-term effects of forever chemicals or microplastics or other things that are so inescapably pervasive.

There is growing evidence that the flu has similar effects, so I'm not sure that this means it shouldn't be treated like the flu. Maybe we should test them both more seriously?

> Multiple findings indicated that the association between Covid-19 and cognitive deficits attenuated as the pandemic progressed. We found smaller cognitive deficits among participants who had been infected during recent variant periods than among those who had been infected with the original virus or the alpha variant. We also found a small cognitive advantage among participants who had received two or more vaccinations and a minimal effect of repeat episodes of Covid-19

Also look at Fig. 1 in the first study

from the first study:

> participants who had recovered from Covid-19 in whom symptoms had resolved in less than 4 weeks or at least 12 weeks had similar small deficits in global cognition as compared with those in the no–Covid-19 group, who had not been infected with SARS-CoV-2 or had unconfirmed infection

So they're not comparing people over time, they're comparing people who've recently had COVID to people who have not ever had COVID. Given that white collar workers like lawyers, consultants, and software devs can stay home and not get COVID more easily than blue collar workers like grocery store clerks and the like, it isn't surprising that there's a very small IQ differential here.

This is published in a very prestigious journal, so I'm hesitant to assume my critique is correct. But at first glance I wouldn't take this to mean that you're likely to lose any IQ points from getting COVID, especially now.

It also says

> Larger deficits were seen in participants who had SARS-CoV-2 infection during periods in which the original virus or the B.1.1.7 variant was predominant than in those infected with later variants

and

> longer-term persistence of cognitive deficits and any clinical implications remain uncertain.

I'm really sick of guys like Eric Topol who are basically covid influencers, bc they love to post studies but are completely unable to critically examine any studies. Pre-covid I thought that's what scientists did, but if they're doing that, they're not doing it in the public eye at all.

The last chart in the first study section is really quite special. The authors seem to have normalized a bunch of outcome measurements in units of standard deviations and then sorted them by something resembling the average differences, but they couldn’t be bothered to normalize the sign of the measurement? If you’re trying to tell me that 30-ish scores are all Gaussian enough to be worthy of using standard deviation units but that they don’t even all agree as to whether large or small numbers are good, I’m suspicious of the normalization procedure. (If “accuracy” means what I think it does, it’s obvious not even close to Gaussian. 90% might be good, 100% is perfect, and 101% is not “just z standard deviations better.”) There are decent techniques to deal with this (e.g. nonparametric models), but blindly normalizing, sorting, and adding a little caption to indicate that you did in fact notice that a bunch of the tests are backwards is not one of them.

I hoped the article would make some mention of how believable the results were, but no.

(Also, maybe mention that the pre-Omicron strains are not much of an ongoing risk and that those results, while potentially interesting, are probably unhelpful for informing future policy decisions?)

edit: It seems worse than this. Quoting the first paper:

> This invited subsample comprised participants who reported positive results on a SARS-CoV-2 test or who suspected that they had had Covid-19 and whose symptoms persisted for at least 12 weeks; participants who, as part of the REACT study, either had a positive result on a polymerase-chain-reaction (PCR) test for SARS-CoV-2 or were unvaccinated and had a positive test for SARS-CoV-2 IgG antibodies on an at-home lateral flow immunoassay device16; and participants who were randomly selected from the remaining REACT study population.

Eric Topol calls this a “prospective” study, although the study, fortunately, does not advertise itself as prospective. This is a retrospective study with an obviously biased study population. And the >12-week-symptoms group contains self-selected participants who may never have even had COVID!

Getting sick for 12 weeks sucks. Finding a detectable effect on an intelligence test should not be remotely surprising. Going from that to anything that should print COVID policy seems like quite a leap.

Topol may or may not be an idiot, but his tweets certain read like they were created by someone incapable of critical analysis (i.e. an idiot).

I still don't want to get the flu :(

I wish we could have a culture of "wear a (good) mask when you're sick". I don't think I'm going to die from the Flu or Covid, but it is going to make life miserable for awhile.

Exactly this. I had COVID two years ago, the flu last year, and COVID again a couple months ago. Last year's flu was absolutely miserable; just as bad as COVID was the first time around.

I really don't want either one. Putting a piece of cloth on your face when you are/recently were sick really isn't much of a burden. I did.

Funny, you two purport to agree, but the parent specifically requested a “good” mask (which can be effective, with the right training and protocols, which are almost never followed), and you advocate a “piece of cloth”, which is almost never effective. Two people agreeing in their advocacy for highly visible, yet ineffective, remedies.

There is a difference between wearing a mask to prevent spread to others and wearing one to protect yourself.

The parent was concerned with reducing spread to others. Interestingly, one meta study [1] concludes that cloth masks are actually better than "good" masks if they are not worn and used correctly.

[1] https://academic.oup.com/jpubhealth/article/46/1/e84/7337687...

Cloth masks may be still be useful for RSV/cold/flu.

I don't think this needs to be absolutes. Properly fitted N95 > N95 > Surgical > none.

If sick people work an average N95/KN95 mask off of Amazon (which is the 'good' I was referring to), it'd help. It's not perfect, and you can do better, and you can do worse. But it's a reasonable intersection of "easy to do" and "effective".

Other comments disagree with you. An N95 that isn’t absolutely perfect would seem to be worse than a piece of cloth, if whatever arbitrary study financed by some unknown group with unknown incentives referenced by said commenter is to be believed. Which it probably isn’t. But it’s as good as any of the other “research” of such heavily politicized topics.

Yes, this logic seems like a backwards rationalization.

> “Reported deaths involving COVID-19 are several-fold greater than those reported to involve influenza and RSV. However, influenza and likely RSV are often underreported as causes of death," the CDC said.

So it’s not that COVID isn’t as bad as it seems, it’s that flu and RSV are much worse than they seem. Seems like the guidance should be about how to spread all respiratory viruses less, not about how to be as bad at controlling COVID as we are at controlling the flu.

> So it’s not that COVID isn’t as bad as it seems, it’s that flu and RSV are much worse than they seem. Seems like the guidance should be about how to spread all respiratory viruses less, not about how to be as bad at controlling COVID as we are at controlling the flu.

This would IMO be worth actual study. One would expect that what seem like basic precautions (wear a mask if you feel at all sick, stay home if you have or recently had a flu, RSV or COVID) should meaningfully reduce overall infection rates. But this may or may not be true in different contexts, and any of these precautions have costs as well. For example, keeping kids away from school seems fairly well established as being bad. Keeping kids from getting sick is not entirely obviously good for them. And plenty of people have allergies — making them all wear masks all the time has its own issues. (On the flip side, a decent, clean enough mask can help with some allergies. Choose your poison.)

(There are cases that people get wrong to degrees that seem absurd. I know someone who worked at a tech startup pre-pandemic. The founders knew that the startup had a norovirus outbreak and nonetheless kept themselves and everyone who wasn’t acutely sick at the office. If they had closed the office and switched to WFH for a few days to break the transmission strain, they surely would have had happier and more productive employees.)

Going through an airport last week was very jarring. Some people do wear mask. But they look healthy, they mostly don’t want to get sick. People coughing like crazy, looking visibly sick with tons of symptoms, none of them had mask.

If you know you’re sick, why not wear a mask? How hard it is really?

Seems like this is somewhat our culture.

Not wearing a mask has zero impact on the person already sick. Them wearing a mask is 100% about being nice to others. There is no benefit to them.

Airports are excellent places to get sick, and getting sick while traveling is no fun. Wearing a mask in an airport seems like a great idea regardless of COVID.

Airplanes usually have pretty good ventilation and filtration.

The ventilation is great when you're airborne. When you're sitting on the tarmac, it's not running the same way.

Are you sure, at least as far as keeping airborne critters away? The real nasty part is when the plane is on the ground, engines running, and it’s not a 787 so it has a bleed air system, and it stinks. As I understand it, this happens because the ventilation system does work the same way as it does in the air, and it’s a bad idea!

It still boggles my mind how we managed to make it so politicized. I mean, there's really no clear reason I can pinpoint.

I was wearing a mask early on in the SF Bay Area. Back when the health authorities were saying that there's nothing to worry about and that masks don't help anyway. I remember so many people giving me the stink eye for no reason. I guess my behavior was the "anti-science", tinfoil-hat stance back then.

Then it all flipped on its head pretty much overnight. And when later, having been vaccinated and having had COVID, I stopped wearing a mask out in the open, I remember the same people getting angry at that. But if you traveled 50 miles outside the SF Bay Area, the reactions were exactly the opposite.

It just bugs me so much that we find ways to turn every single thing into a culture war. We go out of our way to find reasons to lash out against others. I'm not sure if social media is the source of it, but it sure provides a positive feedback loop.

> no clear reason I can pinpoint.

The virus has been naturally selected to make people this way. It's like cat owner brain parasites.

Cat parasites: Outrage! Downvote!

Cat people: We exist to serve.

There's some (very weak and contentious) evidence that the flu virus makes people more social and outgoing. So in theory Corona might encourage people to spread itself (and therefore not mask) before they get too sick.

Getting any type of evidence and research on this theory is impossible ethically and socially and even something like "are cat parasite infected humans more likely to oppose masks" is something that is impossible to test for even though its probably a factor because there's too many other strong social factors.

It's a fun science fiction theory at least and worth a think about how infections effect human behaviour.

It's even weirder because in Asian cultures it's been perfectly normal pre-pandemic to wear a mask when the feel sick (or if they under no circumstances want to risk getting sick. e.g. Right before a big exam). So it's not like such behavior and recommendations are a radical idea in the world.

I guess this is another result of an individualistic culture? A lot of Americans really don't like being told what to do, wear, or say. Even if it's in their best interest to do so.

It’s actually a very weird combination. Many Americans won’t wear a mask even though they know their individual risk is greater, because they don’t want to appear as if they’re part of the wrong collective. Americans are very individual and very tribal at the same time. Hostility can come from either not respecting their right to individuality or by asserting your own right to individuality if your behavior conflicts with their in-group. [source: several decades of being American]

We were also lied to by capitalist mass media and both political parties of capital, which helped people double down in their cognitive dissonance to their own detriment:

https://www.thegauntlet.news/p/how-the-press-manufactured-co...

In America, wearing a mask is a political statement. For a while it was: “we don’t like Donald Trump”. But now, it’s basically, “we want to protest something, we don’t want to show our faces, if the situation gets out of control we’ll be unaccountable”.

There are plenty of others I see (admittedly less so, but still daily in the affluent Bay Area) who drive around in their cars, alone, with masks on (non-Uber) and people who show up at the gym everyday wearing a mask while walking on a treadmill. I toured a preschool earlier this week where the teachers were all still required(?) to wear masks in the classroom (a bilingual Chinese immersion Montessori program).

Admittedly, I’m pretty anti-mask, and for those reasons: it dehumanizes interactions. That said, (for those still reading) I wish masks were a norm for when people were sick and carried no additional activist messaging. I fully support that use case and appreciate my fellow humans who wear them in those circumstances.

But then also, I’d expect those interactions to be rare, because if you’re sick you shouldn’t be hanging out with others, but self isolating.

But why is it a problem if someone's wearing a mask alone in their car? It doesn't affect you at all. Your opinions on the matter are just unsolicited noise.

It shows they they are doing it to make a statement and not for any scientifically backed reason.

That being said, there are many situations where it still makes sense:

- Feeling sick and on your way to pick up someone else

- Just dropped someone off and haven't taken it off yet

- It's not easy to take on and off so you just leave it on

- You're only driving for a minute and will need it when you get out.

So they're still wrong, but I see why they said it.

The first one makes sense, but the other ones don't resonate for me. Is it hard to take off a mask? When would I ever need a mask when I get out of my car (I only ever exit to the outdoors, unless I'm parking my own garage). If I'm going to need to put it on before going into a store, I would just put it on before going into the store itself.

> But now, it’s basically, “we want to protest something, we don’t want to show our faces, if the situation gets out of control we’ll be unaccountable”.

I wear a mask when out in public and my reasons, which are multiple, include but are not limited to "I have an immune compromised family member and don't want to be the one who kills them" and "I myself have been sick only once in the last 4 years and I'm pretty happy about that".

“ For a while it was: “we don’t like Donald Trump”.”

I’m about as liberal they come, and so are many in my circle. But not one person wore a mask for the sole purpose of not liking Donald Trump and then using a mask as a statement. That’s a bizarre take.

Oh yeah, probably not causation. Definitely correlation. My point was that mask retention was greater in blue areas as compared to red areas.

It may have been absurd how quickly masks were given up in red areas (don’t know; wasn’t there), but our laggard approach in Santa Clara county certainly was and felt reactionary.

Don't these measures incentivize selection for organisms that can stay infectious in the body for longer? They would need to suppress or fight the immune system harder. If everyone coughed down each others throat the variations that spread do not need to have these super powers

> It still boggles my mind how we managed to make it so politicized.

Having been raised by 2 Republican extremists, I can tell you exactly why it was so politicized:

1. "YOU CANT TELL ME WHAT TO DO!" Is the refrain of government telling people what to do or not. And remember, that corporations are legally people, so the same applies.

2. Higher education leads to 'librul ideas', with things like gay people should have the same rights as straights, racism is still a thing, and other higher thinking. And this 'education' is seen as indoctrination.

3. Because of disdain for higher education (which is seen as indoctrination), comes the idea that "My upbringing is worth just as much as your book knowledge", throwing away bodies of evidence. Journals are equivalent to scribbles.

A lockdown is going to be controversial no matter what. Sides were chosen because almost any response would cause an economic slowdown, which looks bad for the party in power. They'd get no credit for lives saved. And if they had been right that it would vanish all by itself, like a flu season, they'd improve America's financial state compared to countries that took the economic hit.

Once the sides were drawn, American polarization kicked in. There's no room for mere difference of opinion. The other side must be evil, stupid, and intent on destroying America.

I'd argue that that's especially true for the party in power at the time, though you have to take that with a grain of salt since I'm on the opposite side.

> And if they had been right that it would vanish all by itself, like a flu season

This always seemed rather optimistic. Flu rates are seasonal, and COVID could have been seasonal. But pandemic flus and particularly nasty flu strains also fade away because enough people either get them or get vaccinated that they are usually no longer so significant the following year. COVID lockdowns largely prevented this.

If the vaccines had worked anywhere near as well as an optimistic interpretation of the trials suggested, the lockdowns would probably have looked better in hindsight.

(Which isn’t to say that lockdowns didn’t have some value. If nothing else, they bought time for the vaccines to roll out and they may have contributed to a lot of people getting Omicron instead of earlier strains. It seems like Omicron was a decent amount less nasty.)

It doesn’t boggle my mind. It was explicitly used as a tool of cultural differentiation during an election year.

Masking/not masking became an overt way of signaling tribal association, and it was no accident whatsoever. Predictably, it caused untold numbers of unnecessary deaths.

One takeaway from all this is how willing and fervent people are to signal their group membership, even at the expense of personal life safety.

I wore one as a barrier against airborne particles. I’m sure it’s imperfect at that but also better than nothing. I also wear one when working with power tools that kick up dust that may be harmful to me. I can’t say that I feel particular political allegiance to anyone when I do so.

My feeling is it became politicized because the left saw it as a chance to expose Trump, and the right downplayed it to avoid impacts on Trump's reputation. Like because one side took one stance, the other side inherently had to take a different stance.

The right started out as "Covid is bad, but so is crashing the economy to prevent it", which turned into "Covid isn't that bad, wearing a mask is excessive", which became "The vaccine is more harmful than the disease". The left went from "Causing people to die is worse than any economy hit" -> "You should do everything possible to prevent it" -> "You should wear a mask at all times in public".

I often feel the left would have taken reversed stances if the right had taken the pandemic seriously. If Trump had advocated shutting things down and pushed strongly for vaccines/masks, it seems pretty likely the left would have called this an authoritarian overreach and/or highly questioned the safety of the vaccines.

In short, I think our culture is so highly polarized that as soon as something becomes a major topic, people immediately divide into separate 'sides' on it.

EDIT: follow-up question -- was the pandemic as polarizing in other countries besides the US?

Both parties of capital have handled this pandemic terribly:

https://www.thegauntlet.news/p/how-the-press-manufactured-co...

Doesn't seem to have been as durably polarizing elsewhere, as far as I can tell.

EG: even European countries that were more draconian earlier in the pandemic returned to relative normalcy, with less fear/debate around school reopenings, mandatory testing, mandatory masking, etc, sooner than the US.

In the US, sticky "showy extreme COVID vigilance is my essential identity as a good citizen" or "showy nonchalance is my essential identity as a free person" partisanship lingers.

>it seems pretty likely the left would have called this an authoritarian overreach and/or highly questioned the safety of the vaccines.

Biden, Harris, and Pelosi all said in September 2020 that they won't trust any Trump vaccine. <https://www.newsweek.com/anti-vaccine-covid-trust-skepticism...>

I mean, given what he said about trying bleach in people, I think I'd be a bit skeptical about his vaccines as well.

Me too. Flu is annoying to me but nothing I'd have even really considered a major health threat in general. Covid changed my mind with respect to respiratory disease.

When I finally contracted Covid (I was vaccinated + boosted in alignment with then current CDC guidelines), I ran the range of all the major symptoms like high fever, loss of smell, tachycardia, drop in O2 saturation, etc. Most of the symptoms persisted for several days before I began to recover and the tachycardia and O2 levels bothered me the most. I was actively monitoring my O2 levels and had they dropped much lower I would have gone to the ER as a precautionary measure. Even after the initial recovery, it took almost two more weeks for me to recover my sense of smell.

For me, Covid is no joke and it is absolutely insane to me how basic health precautions like wearing a mask to reduce transmission, isolating, etc have become politicized.

This is why I also think return to office is insane. I'm fully remote thankfully and haven't had covid. But I have seen many getting sick from coworkers because they feel a need to go in even when sick..

The reverse of that argument is that if you work from home, your immune system doesn’t have a chance to learn about the newest bugs and so you’re more vulnerable in the future.

Or if you work from home and never go out to restaurants or do anything that you need to be unmasked and around other people for (or hang out indoors unmasked with anyone who does such things), the social isolation can be pretty bad too. I guess there's no real incentive to run studies about that but I bet they'd show all sorts of ill effects of essentially locking down in perpetuity.

...or you're just fine catching covid outside of work but it's so much worse to catch it in an office

I still go out and about and have a step daughter in high school, so plenty of exposure. I just don't need to sit in a building that likely has insufficient / old hvac/etc. I just consider myself lucky I don't need to sit around a bunch of people for hours on end multiple days a week.

Anecdote: a family member of mine is very COVID cautious and still hasn't had it due to long-term isolation. When he started seeing people a bit, so long as they had tested negative recently, he got sick from someone in my family who had a mild cold. It completely knocked him out, and he said it was one of the top 3 illnesses he could remember (he's a senior citizen). I wondered if the impact it had on him was due to the fact that he hadn't been exposed to anything (no groceries, no offices, no malls) in 3 years.

I'm no where near a germ phobe, but prefer how and when I interact with people. Just last weekend I was at a dinner theater in Ashland.

I think complete isolation could indeed have an impact. Another thing that I think we will see down the road is more super bugs due to the overuse of sanitizer during that period as well.

The immune system and the body is only degraded by infections. Its not like a muscle and immunity debt is a concept introduced in 2021 by the anti vaccine movement. It has no science supporting the concept. Far from it infact we know every infection in our lives does damage and ultimately its a large part of what kills us in time. It was unfortunately a lie that has become mainstream "knowledge", its not medically sound at all.

At the UK inquiry the Chief Medical Officer made the point that pursuing herd immunity via infection is deeply flawed and highly unethical. Given the population has gained little actual immunity to the virus so far and it continues to circulate all year around and has so disabled over 100 million people and killed at least 28 million and every week kills many thousands in the US its not going to stop. Covid is the third biggest killer in the world currently and the death count associated with it due to a massive reduction in testing is unfortunately enormously undercounted especially with the increase in heart attacks and strokes which Covid causes due to its vascular impact.

I wish we had a culture of just basic common sense. If you are ill, do not come into the office. You are not showing dedication, you are showing how inconsiderate and dickish you are.

Recently endured a significant case of post-traveling influenza, I was absolutely useless for 5 days and required a full month to recover fully. The flu is definitely nothing to joke about.

The main problem with this is that half of the infections are asymptomatic. So in the places where immune compromised people go (which is quite a chunk of people about 1 in 50) become really unsafe as they are only getting the benefit of one way masking and people are assaulting those wearing masks. They are being denied access to hospitals and dentists for example as staff refuse to protect them. This has caused an enormous amount of people to be excluded from many public spaces. They are suffering all the consequences of these decisions and being forced into their homes and away from medical care among many other services because people refuse to help.

Covid is going to be an all year around infection that hasn't at any point dropped below 1 in 80 people carrying it, we need to use HEPA filters and UV light to clean the air indoors and adopt masking as a mitigation until we have better vaccines or treatments especially for Long Covid.

>The main problem with this is that half of the infections are asymptomatic.

I've heard it said that current COVID-19 vaccines are counterproductive, because they only reduce symptoms as opposed to increasing one's chances of catching the disease, or reducing one's infectivity. Someone who has been vaccinated and infected is more likely to go to work or school and thus more likely to spread the disease.

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