Thread by @bopinion

Before he had Covid-19, Brendan Delaney, the 57-year-old chair of medical informatics and decision making at Imperial College, could cycle 150 miles in a day.

Covid changed that, but not because he had a severe case of the disease trib.al/nMhJr0P

Like many healthy people, he figured his symptoms, a mild fever and a cough, would pass soon enough. Instead, he experienced debilitating aftereffects, such as:

🥱Fatigue
🫁Breathlessness
🌡️Fevers

Seven months later, he is still not back to normal trib.al/nMhJr0P

He can’t imagine getting back on a bike and says that if he pushes himself too hard, he ends up in bed with a fever for a couple of days.

He considers himself lucky that he’s able to work. Many other long Covid sufferers cannot trib.al/nMhJr0P

As a second wave of infections grows, so it follows that the number of long Covid cases is bound to increase.

Although this clearly has implications for public health and the economy, it has been almost nowhere in the broader policy debate trib.al/nMhJr0P

So far, we've focused largely on minimizing deaths and hospitalizations.

But most long Covid patients weren’t hospitalized and didn’t have pre-existing conditions. This should throw some cold water on the idea of herd immunity trib.al/nMhJr0P

As lockdown fatigue set in, more and more people supported the idea of disposing restrictions and allowing immunity to build up among the young while shielding the vulnerable.

Going in this direction would be far more costly than many perhaps realize trib.al/nMhJr0P

“We need to control this virus not because of the risk that Granny may catch it and die, or your uncle may end up in ICU, but because fit, healthy people without any comorbid conditions who are young can end up having their lives wrecked,” Delaney says trib.al/nMhJr0P

We know from experience with other viruses that effects can be long-lasting:

🦠2003 SARS outbreak
🦠Ebola
🦠MERS
🦠Glandular fever (caused by the Epstein-Barr virus)

It’s similar with today’s coronavirus trib.al/nMhJr0P

Conventional medicine doesn’t have a good record on responding to conditions like long Covid.

For years, sufferers of chronic fatigue syndrome, Lyme disease, endometriosis and other conditions often fought lonely battles for attention and medical care trib.al/nMhJr0P

The most reported symptoms of long Covid sound like they could be any number of illnesses:

💤 Extreme fatigue
🫁 Breathlessness
♥️ Heart palpitations
🤢 Gastrointestinal pain
🦴 Joint aches
🧠 Memory and focus issues

The full list is much, much longer trib.al/nMhJr0P

Nailing down exact numbers isn’t easy, but 10% of Covid Symptom Study app users, used by more than 4.3 million U.K. participants, reported symptoms lasting for more than three weeks after infection.

Some 60,000 reported having symptoms three months in trib.al/nMhJr0P

Increasing infection rates have ushered in fierce debates over the relative costs, benefits and ethical considerations of various lockdown measures.

Long Covid may alter that calculus further, depending on the impact on household income and productivity trib.al/nMhJr0P

A 2004 study estimated the impact of chronic fatigue syndrome (similar symptoms to long Covid) said it probably led to:

– A 37% decline in annual household productivity
– A 54% reduction in labor productivity
– An annual lost value of $9.1 billion a year trib.al/nMhJr0P

How the long Covid costs stack up will depend on prevalence, duration and degree of incapacity.

It does seem that symptoms slowly get better, but it’s too early for a tally of long-term effects such as fibrosis of the lungs or compromised immune systems trib.al/nMhJr0P