Since the initial Omicron wave receded and inflation replaced Covid-19 in the headlines, the reopening debate has largely settled in favor of reopening. But the debate about the wisdom of reopening and unmasking has not disappeared. With Covid cases on the rise again, there is still a voiced constituency that sees too much normality as a public health mistake.
Of late, this constituency has shifted its focus somewhat, from the perils of death (reduced by vaccination and immunity) to the peril of long-term Covid, the potentially debilitating chronic form of the disease. In a recent Washington Post essay, health policy expert Ezekiel Emanuel wrote that “a 1 in 33 chance” of long Covid symptoms (assuming for the vaccinated, which he is, about 3 percent of Covid infections become chronic) still enough to keep him in an N95 mask as much as possible, out of covered restaurants and out of trains and planes.
As Emanuel admits, there is a lot of uncertainty surrounding prolonged Covid. As with many issues, there’s also a noticeable intellectual cluster effect: People who still advocate pandemic restraints are more likely to emphasize its dangers, while mask-and-mandate skeptics are more likely to suspect it’s some kind of hypochondria in the blue state.
I’ve been a pandemic dove ever since vaccines became widely available that luckily tore off my mask when planes no longer needed it, which should prepare me for long Covid skepticism. But at the same time, I also have extensive knowledge about chronic diseases and its controversies, based on extensive personal experience, which has made me a long-time Covid believer from the start: its scope is uncertain, but it is clearly real and often terrible.
From Emanuel’s perspective, I shouldn’t have both positions. I have experienced in my own flesh how bad a chronic infection can become: what am I doing eating out, flying with bare faces, writing this column exposed in a coffee shop?
It’s an interesting question, and it inspired me to backtrack on a different kind of risk — the risk my family is taking by still living in Connecticut, a hotbed of Lyme disease, my own unwelcome chronic visitor.
Estimates for how often Lyme disease becomes chronic range from 5 to 20 percent of cases. Call it 12 percent and you get a risk four times higher than Emanuel’s estimate of 3 percent for Covid. But luckily, Lyme disease isn’t airborne, so your risk of getting infected is much lower. If endemic Covid ends up looking like the flu, your chances of getting it in any given year could be between one in five and one in 20, while your chances of getting Lyme are more like one in 700.
However! Here in Connecticut, the incidence is at least three times the national average, and then there are six people in my household to worry about. So the odds of any of us getting infected each year might be close to one in 40. Combine that family figure — a slight statistical spurious error, but I’m certainly more concerned about my kids than I am about myself — with the slightly higher chance that the Lyme disease is becoming chronic, and our risks are in the same overall margin as the long-term Covid risks that Emanuel deems unacceptably high.
That said, we do take precautions: we no longer live in the Stephen King-style ranch where New England’s eldritch forces went to work on us; we check our children for ticks; we are extremely attuned to possible signs of infection. But we also lead a pretty normal life in Connecticut – walks, nature, danger – despite my horrible experience.
Maybe this is crazy and we should have moved to Arizona. But the lesson I’ve learned from my Lyme-acquired knowledge is that infection-caused chronic illness can be so common that living a normal life means exposing yourself to risk.
For example, we have new evidence suggesting that multiple sclerosis is related to the extremely common Epstein-Barr virus; estimates of MS cases in the United States range from 400,000 to just under a million. Likewise, chronic fatigue syndrome can be affected by viral infections; estimates of victims range from 2.5 million. Start adding up the myriad other chronic conditions that may have a contagious root, and you could argue for Emanuel’s caution based only on pre-Covid threats.
But that is not how human civilization has traditionally dealt with chronic dangers. We take unusual precautions during unusually deadly outbreaks, but where the dangers persist, we look for ways to treat and cure, while continuing to try to live our lives as normal as possible. We certainly don’t look back at images of an 18th-century courthouse or coffeehouse, when the risks of infectious disease were greater than we know, and say, ‘Why aren’t these people wearing masks? Why did they ever leave the house?”
Chronic illness is a major scourge, which Covid has long helped bring to light, crying out for better diagnosis and better treatment. But math and knowing the danger won’t stop me from showing my face on airplanes and in restaurants or my kids from walking—carefully, I hope—in Connecticut’s state parks.
