To Mask or Not to Mask: Covid and Long Covid

Not too long ago, the CDC was predicting a catastrophe if citizens did not diligently follow the restrictive mask guidelines in place.  Then just last week it pivoted 180 degrees and claimed that fully vaccinated people could go without a mask in everyday situations, both outdoors and indoors.  The announcement seemed to assume, rather naively, that the unvaccinated would continue to wear masks in public.  It also proclaimed loudly that this decision was based entirely on scientific results.  This action no doubt pleased some who were doubtful about mask efficacy and were quite ready to ditch the things and get back to normal.  But to others, conditioned by over a year of cautious behavior and mask reliance, the move seemed precipitous and suspicious.  Was the CDC unduly influenced by political pressures?  These people will have to decide for themselves what they believe to be the proper course of action. 

The suddenness of the CDC action prompted a pair of doctors to meet and discuss the issue and post their concerns under the title CDC says no masks are needed if vaccinated. But there are plenty of reasons to wear them.  The participants were Dr. Gunisha Kaur, physician and human rights researcher, and Dr. Natalia S. Ivascu, cardiac anesthesiologist and intensivist.  Some of their concerns about relying completely on vaccination were the obvious ones.  Being vaccinated does not fully protect you from acquiring the virus.  There is a finite possibility that you can still become infected and infect others

“Firstly, vaccines do not confer 100 percent immunity; vaccines don’t mean that nobody dies from the targeted illness. Differences in the degree of exposure, individual medical problems and viral transformation into variant viruses all affect how much immunity a vaccine provides.”

“An additional crack in the vaccine armor is that we don’t know how long our post-vaccine antibodies will be adequate to stave off sickness. Similarly, we don’t know if current or future variants will penetrate our vaccine protection.”

“Even vaccinated high-risk patients, such as those who are immunocompromised, may always be in danger. We don’t have a lot of safety data for the Covid-19 vaccines in immunocompromised people, and we don’t know if their weakened immune systems can or will mount a response. So if you won’t wear a mask to protect yourself, do it to protect those around you.” 

These doctors also remind us that there is much about this virus and its multiplying number of variants that is not understood.  

“And while the severity will likely be less when someone develops an infection post-vaccine, the long-term implications of even mild or moderate cases of Covid-19 are unknown…” 

What is not unknown is that long-term conditions exist and are disturbingly common.  There is an official name for these effects: Post-Covid Syndrome (PCS).  The more common term is “long covid.”  Infection seems to mostly start through respiration.  But the virus need not stop at the lungs. It appears to find ways to penetrate most parts of the body and often do its worst damage in regions remote from the lungs.  Long covid appears to consist of enduring symptoms that might have little correlation with the intensity or nature of an initial infection, making it a difficult issue with which to deal.  People who survive an encounter with the virus with no significant symptoms could still suffer from long covid.

The British have been accumulating data from their own experiences with long covid.  Their results were summarized in an article in The Economist titled Post-Covid Syndrome.  It opened with this lede.

“Researchers are closing in on long-covid.  The results are alarming.”

The types of symptoms reported are so numerous that it is difficult to categorize them. 

“There are, indeed, many of them. A survey of almost 3,800 people around the world reported 205. A sufferer typically has several at a time, with the most debilitating usually being one of three: severe breathlessness, fatigue or ‘brain fog’.” 

“Britain’s Office for National Statistics (ONS) estimates that 14% of people who have tested positive for covid-19 have symptoms which subsequently linger for more than three months…In more than 90% of those cases the original symptoms were not severe enough to warrant admission to hospital. According to the ONS, in the four weeks from February 6th nearly half a million people in Britain reported they had had long covid for more than six months—and this will not include any of those infected towards the end of 2020 in the country’s second wave.”

“At the time when the ONS collected those data, at least 1.1% of Britain’s population, including 1.5% of working-age adults, reported symptoms dragging on for three months or longer. Multiply that by the hundreds of millions around the world who have been infected at some point by SARS-COV-2, the virus that causes covid-19, and a public-health catastrophe may be in the making. In the short term, it was only right that effort focused on dealing with the acute disease. Today covid-19’s chronic after-effects also need to be considered.”

The incidence of long covid does not seem to be related to comorbidities which should peak in the elderly. 

The symptoms are significant in intensity with about 80% of sufferers saying the condition has limited the ability to perform their work. 

Long covid is actually a misnomer because what has been observed are illnesses that appeared in the short term.  It will be years before we can assess any long-term effects.

Given this discussion, there seem to be a number of good reasons to continue to wear a mask when out in the general public.  Considerably more scientific knowledge is required before absolute safety can be ensured.  If we do not understand what the virus does to our bodies, it is best, for ourselves and others, to avoid any contact with it at all.  For the immediate future, that means wearing a mask in public.