Since the initial wave of the omicron variant receded and inflation replaced Covid-19 in the news, the discussion on social and economic reopening has largely been decided in favor of “reopeners”. But the debate over the prudence of reopening and taking off the masks has not gone away. As Covid-19 cases rise again, there is still a part of the population that thinks that too much normality is a public health mistake.
Lately, this group has shifted its focus somewhat from the dangers of death (diminished by vaccination and immunity) to the danger of long-term Covid, the potentially debilitating chronic form of the disease. In a recent essay in The Washington Post, health policy expert Ezekiel Emanuel wrote that a “1 in 33 chance” of developing long-term Covid symptoms — assuming that, for vaccinated people like him, 3 percent of infections become chronic — is enough. so he continues to wear N95 (or PFF2) masks outside of restaurants, trains and planes as much as possible.
As he admits, there is a lot of uncertainty surrounding the picture. As with many issues, there is a notable intellectual clustering effect: people who still approve of pandemic restrictions are more likely to emphasize its dangers, while mask skeptics seem to tend to suspect it is a kind of state hypochondria. ruled by Democrats.
Since vaccines became widely available, I’ve been a pandemic peacemaker, and I happily ripped off my mask when planes no longer required it, which should have prepared me to be skeptical about the long-term Covid. But at the same time, I have extensive knowledge of chronic diseases and their controversies, based on extensive personal experience, which from the beginning has made me a long-time Covid believer: its scope is uncertain, but it is clearly real and often terrifying.
From Emanuel’s perspective, I shouldn’t have these two positions. I have experienced in my own flesh how bad a chronic infection can become. So what am I doing eating out, getting on planes naked, writing this column without a mask in a cafe?
It’s an interesting question, one that inspired me to do some math about a different kind of risk—what my family is at by still living in Connecticut, a hotbed of Lyme disease, my personal, chronic, unwanted visitor.
Estimates of the frequency with which this disease becomes chronic range from 5% to 20% of cases. Let’s say 12% and we’ll have a risk four times that of Emanuel’s estimate for Covid. But luckily, Lyme disease is not airborne, so the risk of becoming infected is much lower. If endemic Covid turns out to look like the flu, the probability of contracting it in a given year could be between 1 in 5 and 1 in 20, while the probability of contracting Lyme is more than 1 in 700.
But… In Connecticut the incidence is at least three times the national average, and there are six people in my house for me to worry about. So the risk of any one of us being infected annually could be close to 1 in 40. Combine that family number — maybe a little statistical cheat, but I definitely care more about my kids than I do about myself — with the probability a little more high for Lyme disease to become chronic and our risks are on the same general level as those of long Covid which Emanuel considers unacceptably high.
That said, we took precautions: we no longer live in the Stephen King-style farmhouse where the supernatural powers of New England have come to work on us; we check our children for ticks; we are very attentive to possible signs of infection. But we also lead a pretty normal life (with hiking, nature, danger), despite my terrible experience.
Maybe this is crazy and we should have moved to Arizona. But the lesson I learned from Lyme is that chronic illness mediated by infections can be so common that to lead any kind of normal life is to put yourself at risk.
For example, new evidence suggests that multiple sclerosis is linked to the extremely common Epstein-Barr virus; US case estimates range from 400,000 to just under 1 million. Likewise, chronic fatigue syndrome can be triggered by viral infections, and estimates of its victims reach 2.5 million.
Start counting the many other chronic diseases that may have some infectious root and you can defend Emanuel’s level of caution based on pre-Covid-19 threats alone. But this is not how human civilization has traditionally dealt with chronic dangers.
We take unusual precautions during unusually deadly outbreaks, but when the dangers linger we look for ways to treat and cure while trying to live life as normally as possible. We certainly don’t look at images of an 18th century courthouse or cafe, when the risks of infectious disease were greater than anything we know, and say, “Why aren’t these people wearing masks? Why are they leaving their homes? “
Chronic disease is a major scourge that the long-term Covid has helped to bring to the fore and requires better diagnosis and better treatment. But doing the math and knowing the danger won’t stop me from showing my face on planes and restaurants or my kids from walking—carefully, I hope—in Connecticut’s parks.
