A huge point missing from the 'cumulative risk' discussion is that it's not just about the cumulative risk of developing long-COVID population-wide, but also what happens to the quality of life of those who have long COVID with subsequent infections. Or does no one care?
The limited research we have so far shows that this group is at high risk of worsening with each infection- significantly affecting their quality of life. Something not measured in cumulative risk studies- because those studies only measure new LC among those who don't have it
Given the high levels of prevalent long COVID in every single country (as shown by the ONS survey, the household pulse survey and others), shouldn't we also care about what repeated infection are doing to this very large population?
Ultimately it's about quality of life at population level- and if millions of people are experiencing worsening quality of life - along with many others developing LC anew - with each infection - that should be considered too.
Studies and discourse need to go beyond simply talking about cumulative risk of developing long COVID, but also what quality of life is like population-wide (including for those with LC) with repeated infections.
After all, even if the risk of developing new LC post-reinfection was zero (it's not- according to the ONS - it's near 3%)- if you still had 40-50% of a cohort of 2 million people with LC worsening with re-infection, that'd still be a pretty big impact at population level.
Developing long COVID shouldn't just be the end outcome when people are excluded from these cohorts. We need to actively study the impact of re-infection among people with long COVID, and not exclude them in evaluation of cumulative impacts.
I think it's very likely that risks of long COVID are non-independent (i.e. correlated). Those who develop worsening after 1 infection are at much higher risk of developing worsening with subsequent ones. Excluding them massively underestimates population level impacts.
What we then end up measuring is survivorship bias rather than impact at population level, which is what we should be measuring. Not to say that people who're at lower risk don't get LC. They do. But there's a subgroup at much higher risk of worsening with each infection.
Let's not exclude them. Their experiences, lives matter. And they're a huge group at population level.
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