The long Covid inevitability chain of logic: any flaws?

I’ve been reading about, and thinking over, the comments of those online generally afraid of long Covid casting a shadow over the planet, and this seems to be the chain of logic:

  • Covid will never be eliminated. Even if everyone was vaccinated tomorrow, there would still be breakthrough cases and animal reservoirs.
  • Studies have shown that new strains don’t necessarily protect against previous strains, and that reinfection with even the same strain is possible and common (as, IIRC, is the case with this kind of virus in general)
  • It is much, much easier to get Covid than to avoid it, even with vaccines, except with lifestyle restrictions that 99.9% of people will be unwilling to make.
  • Which means that the majority of human beings are very likely to catch Covid at least once, possibly multiple times, over the course of the next couple of decades as Covid remains in circulation in some strain or another
  • Although long Covid is not inevitable with any given infection, it will happen given enough reinfections.

THEREFORE: long Covid is going to become very common amongst the global population.

Something feels off about this to me, but it seems to make sense. Is there a flaw here? If not, is long Covid disability going to become commonplace? What are the implications if it does?

I’ve been thinking about this a lot, wondering if this is going to become the new hookworm:

Long Covid is not very well known. Covid has only been around for 2.5 years, so there is of course limited knowledge on long term chronic effects. We also don’t know if newer variants have the same Long Covid risks, or the same Long Covid symptoms, at least not to a high degree of certainty, and we have no knowledge about Long Covid effects of future Covid strains.

So I don’t think it’s inevitable that it becomes very common, but I’m certainly not attending any crowded events any time soon. (I’m not hyper-cautious enough to think I’m safe though.)

Long Covid reporting and studies as yet have a lot of problems with self reporting and poorly selected groups to study.

There was a recent article, in the Atlantic I believe, that reported that disability claims have not increased despite Long Covid.

Another report of yes, lower trends of Long Covid with Omicron. I expect that as vaccine and other immunity continues to lessen the impact of Covid (which seems to be happening) that Long Covid will be lessened as well. So I personally don’t see this coming into play.

This seems like the most likely incorrect bit of logic. As people have pointed out, the existing data on long covid are pretty bad. Some studies done in a very old cohort that are unreasonably extrapolated to the population at large. Some studies show that it appears to be largely psychosomatic (reporting of Long Covid symptoms correlated more strongly with people who claim to have had Covid than it is with people who test positive for Covid antibodies)

But let’s assume that it’s a real and (somewhat) rare thing. Even if so, there’s no reason to assume that reinfection carries the same risk of long covid as initial naive-immune-system infection. Both prior infection and vaccines don’t totally protect against infection, but they seem to protect very well against severe outcomes, and they may also protect very well against long-term outcomes.

There is some evidence that the 1889 Russian flu was a previous novel coronavirus pandemic. If so, and if Covid-19 follows the same path, what it turns into is not a disease that causes long-term disability in large fractions of the population, but into a variant of the common cold. Almost everyone gets exposed to it the first time as a small child and very few people ever experience serious adverse affects.

‘Omicron’ hasn’t been circulating long enough to really establish the incidence and duration of post-acute sequelae (colloquially ‘Long Covid’) with comparison to other variants even given how little we understand about the phenomena to begin with. Vaccines do appear to offer significant if not absolute protection against ‘Long Covid’ effects, but as it stands many of the signs and symptoms of Long Covid are pretty subjective. There has long been the thesis that Chronic Fatigue Syndrome, fibromyalgia, many non-specific autoimmune disorders and IgG4-related disease, and other idiopathic inflammatory conditions my be due to or aggravated by viral infections and specifically ‘common’ coronaviruses and influenza viruses that commonly jump between humans and domestic animals. The ‘Long Covid’ effects are particularly evident because of the highly infectious nature and pandemic-level spread of SARS-CoV-2 but this kind of inflammatory and idiopathic effects are not limited to just this virus.


Or it could be that there’s some other, relatively rare, factor involved in Long Covid (beyond just being infected with the coronavirus), and if you don’t have this factor, you’re not going to get Long Covid no matter how many reinfections you experience.

This is sheer speculation on my part, and I have no idea whether there’s any evidence for or against it; but it’s an example of how Long Covid may not be inevitable “given enough reinfections.”

I don’t see any reason to assume that everyone is susceptible to long COVID, any more than any other post-viral syndrome. It happens with the flu, with mono, etc. It’s not unique to COVID-19. It’s just that with so many new infections, people became aware of it.

Plus there’s the issue that we could get the better shots and keep inoculating, thus creating that continued immunity without re-infection.

For instance, a friend of mine came down with a respiratory infection in the spring of 2020. He never got tested for covid, because at the time, covid tests were still fairly hard to come by, and the “treatment” would have been the same either way (isolate for several weeks and wait it out). But given the timing, yeah, it was probably covid.

Even now, he still hasn’t fully recovered from it. But this friend has also had sinus difficulties for most of his life. He finally managed to get the issues “completely” taken care of, a few years before this infection, but maybe he’s just naturally more susceptible to this sort of problem.

That, and as we discussed in a thread a couple weeks ago, long covid is much too broadly defined in these studies. They count “I don’t have the stamina to walk all the way across a parking lot 1 year post-infection” and “it’s been 6 weeks and I still don’t have my sense of smell 100% back” both as long covid, and their level of detriment to your everyday life is wildly different.

Substantially every adult human has had flu. Prior to COVID, some very small percentage of them developed a long-term problem from that flu infection.

In this regard at least, COVID is very likely to be similar. The data to date certainly suggest so. The OP’s chain of reasoning that substantially every adult human will have had COVID eventually (like within a decade or so) is almost certainly true. But there’s zero data-driven reason to conclude that any larger fraction of those people will develop the long-term follow-on problems.

And since substantially every adult catching COVID has already had a flu infection, there’s actually little reason to suggest that “long COVID” will add to the total headcount of people suffering from “Long viral infection”. Especially so for the vaccinated and for folks who’re catching the more recent milder variants rather than the original extra-nasty COVID.

Of course, if SARS-nCOV-2 later mutates into a more dangerous or more vaccine-escaping form we could reset the clock and start generating incremental long viral infection sufferers at an increased rate. But simply due to them having had far worse infections they have a far harder time clearing, while doing more internal damage or triggering more lasting immune system derangement during their illness. Not because COVID is some “super-bug” that has special lingering powers denied to all lesser viruses.

Or at least that’s what the data seems to indicate so far.

And, for that matter, it’s also possible that influenza or rhinovirus or any other virus might evolve into a new, more dangerous, vaccine-evading form. I mean, we’d be better off not adding to that list, but SARS-COV-2 might not be all that large an addition to the list, relatively speaking.

My thoughts exactly. 30 years from now COVID will probably be “just one more damn thing” in the long list of ways Mother Nature tries to screw with us and has since time immemorial.

“Long” covid is far from being understood.

mRNA vaccines are miraculously fast to develop. Will have omicron mRNA vaccines soon, or whatever variant is settled on for the next mRNA. Covid will evolve and mRNA targeted vaccines will follow.