The U.S. has recently taken a sharp turn toward “living with,” rather than trying to avoid, COVID-19. According to the U.S. Centers for Disease Control and Prevention, masks should not be worn indoors in any part of the United States. Many vaccine and mask requirements have also been repealed in COVID-sensitive areas. A March poll from Axios/Ipsos found that 66% believed COVID-19 poses no or little risk.
It’s hard to blame people for relaxing a bit. Most people are well vaccinated. A COVID-19 case is unlikely to cause serious disease. But some experts say that the risk of Long COVID—the name for symptoms that last months or even more than a year after a COVID-19 case—is real enough that it should worry both vaccinated and unvaccinated people.
The risk of long COVID can be both debilitating, and it is relatively uncommon. It’s also too soon to say whether Omicron infections will lead to more or fewer Long COVID cases than previous variants, says Dr. Michael Lin, an infectious disease specialist at Rush Medical College in Chicago.
“The short answer is, at this time, we don’t know enough” to give concrete advice about how Long COVID should fit into risk calculations, Lin says.
Which person is more likely to receive Long COVID?
Long COVID is not a single patient profile. An estimated 10% to 30% of people who get COVID-19 develop some degree of lasting symptoms, though vaccination significantly reduces an individual’s odds. People of all ages are affected by the disease, regardless of their COVID-19 severity. While women seem to be at greater risk than other genders, a large number of those affected are female. Long-haulers (also known as those with Long COVID) are often active, healthy, and well before becoming sick. Others had preexisting medical conditions.
Nobody knows what triggers some people’s symptoms. Recent studies have explored potential risk factors—from asthma and Type 2 diabetes diagnoses to quirks of the immune system—but that research is still progressing.
Long COVID: How can you reduce your risk?
Long COVID can be seen in both unvaccinated as well as vaccinated patients. But getting vaccinated is one of the best known ways to reduce your risk—aside from never getting infected at all, of course.
A recent study from researchers at the U.K.’s Office for National Statistics found that adults who got infected after two doses of a COVID-19 vaccine were about 40% less likely to later report symptoms of Long COVID than unvaccinated people who got infected. About 9.5% of people who had been vaccinated and 15% of those without vaccination reported experiencing symptoms within 12 weeks of infection. Other studies—most of them small—have reached similar estimates.
“You’re much less likely to get Long COVID if you’re fully vaccinated,” says Dr. Wes Ely, a professor at the Vanderbilt University School of Medicine who researches Long COVID, “but the risk does not go to zero by any means.”
Linda Loxley is a long-hauler aged 55 who lives in Rhode Island. She contracted COVID-19 while she was undergoing her second vaccination. After avoiding the virus for all of 2020—despite working at a senior center where she was likely to be exposed—and getting her first vaccine dose, “I thought I was safe,” Loxley says.
COVID-19 instead left her with severe headaches and debilitating fatigue. She also suffered from nerve pain and cognitive dysfunction. The severity of her symptoms led to her having to quit her job. After a year, there has been no significant improvement in her health.
Loxley believes that long-haulers’ experiences should serve as a warning to COVID-19. “This is real,” she says. “We caught this virus, and we can’t get rid of it.”
Do I need to worry too much about Long COVID
When anyone can get Long COVID and vaccination is a good—but not flawless—way to cut risk, it’s virtually impossible for anyone to accurately calculate their odds of developing the condition.
Robyn WILSON, an Ohio State University professor in decision analysis and risk management, said that certainty is what humans seek. “We want [the chances of something to be] zero or 100. Anything in between, often our perceptions or calculations will be biased” depending on personal risk tolerance, circumstances, or experience with the threat in question, she says. For example, someone whose spouse suffers from Long COVID might overestimate the likelihood of getting it, whereas someone who doesn’t know anyone with the condition might discount it too much.
Even experts are split on how heavily Long COVID should factor into an individual’s risk calculation.
“It’s reasonable to still mostly focus on the acute symptoms and hospitalization and death as being the primary motivators to avoid COVID,” Lin says, because so little is known about Long COVID.
But Ely says people shouldn’t forget about Long COVID either. “Anybody who is healthy and wants to remain healthy and live a normal lifestyle is going to have to be aware” that Long COVID is a possibility and act accordingly, such as by wearing an N95, KN95, or other protective mask in public indoor settings, he says.
Wilson states there’s still so much to discover and that each person must determine how Long COVID might affect their behavior. One person might decide the mental-health benefits of going back to “normal” make any related risks worth it, while someone else might decide peace of mind makes continued caution worthwhile. Wilson states that neither is necessarily right or wrong, provided they don’t intentionally endanger others or make those around them uncomfortable.
When accurate risk calculations aren’t possible, “you have to rely back on mental shortcuts” that allow you to make difficult choices, she says. Throughout the pandemic, Wilson has deferred to CDC guidance whenever she has to make a decision—which, these days, means she feels pretty comfortable easing up on precautions.
“I still encourage people to look to the experts for what is appropriate,” she says. “But if you at a personal level aren’t comfortable with that uncertainty…do whatever you’ve got to do.”
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