[version_five]

> Severe Illness: Individuals who have SpO2 <94% on room air at sea level, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mm Hg, respiratory frequency >30 breaths/min, or lung infiltrates >50%.

Isn't the point that levels below severe are not generally fatal and don't require hospitalization. Nobody thinks it's good to get sick, but it generally ceases to be a threat to public health with vaccination.

[gibba999]

The million dollar questions include:

- Long COVID post-vaccine. >10% of people have brain damage visible on MRIs, including mild cases.

- Future mutations. People have been overly optimistic for 15 months now, and believed bad things couldn't happen. They do. There's no reason to believe Delta or Gamma are the end, or anywhere close.

[inter_netuser]

brain damage after vaccine, or "mild" disease in vaccinated people?

can you point to that MRI imaging? curious to see.

[gibba999]

This is the major one:

https://www.medrxiv.org/content/10.1101/2021.06.11.21258690v...

This one scared me since it was a large, relatively unbiased sample, with before-and-after imaging. It also showed brain damage even in mild cases of COVID19 in >10% of cases.

There are a lot of supporting smaller-scale studies too, replicating the same general result. E.g.

https://www.khou.com/article/news/health/coronavirus/covid-1... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066611/

If you Google, you'll find dozens of other small-scale studies.

[timr]

> This one scared me since it was a large, relatively unbiased sample, with before-and-after imaging. It also showed brain damage even in mild cases of COVID19 in >10% of cases.

It shows no such thing. It's an analysis of MRIs where the authors infer loss of gray matter in specific regions of the brain. This is in no way "brain damage", and representing it this way is leaping to wild conclusions.

Lest you not believe me, here is a randomized controlled trial, showing that "excessive online video gaming" reduces orbitofrontal gray matter:

https://pubmed.ncbi.nlm.nih.gov/29057579/

(...so your Mom was right: gaming is turning your brain to mush!)

Here is a review that shows that similar losses in gray matter are associated with anxiety and sleep loss (two problems that I'm sure didn't affect anyone in 2020):

https://pubmed.ncbi.nlm.nih.gov/29244642/

Similarly: "Profound and reproducible patterns of reduced regional gray matter characterize major depressive disorder"

https://pubmed.ncbi.nlm.nih.gov/31341158/

Just for fun: here's a paper that shows that "tooth loss was a causal factor for volume reduction in brain areas related to memory, learning and cognition"

https://pubmed.ncbi.nlm.nih.gov/29475808/

(bonus points: can you spot the missing correlate?)

The fact is, you can find research literature associating "loss of gray matter" with pretty much anything. And if a reliable trend does exist across this literature, it seems to be that gray matter changes are often seen in...wait for it: depressed people and the aged.

But I'm sure that Covid has done nothing to depress people or affect the aged, so we can probably safely ignore that little detail.

[gibba999]

I think a lot of this comes down to replication, effect size, and sample size.

Yes, there are studies which show virtually everything, but in this case, we have:

- >10% of mild cases reporting long COVID brain fog (without MRIs)

- Visible correlations on MRIs with large n (cited study)

- Lots of small-scale studies / looking at specific cases

- Some understanding of a relevant mechanism-of-action (see: olfactory loss)

Together, that's about as strong evidence as you'd expect after 15 months. We have effect, we have correlation, we have case studies, and we understand why it's plausible.

The big question is whether it strikes vaccinated mild / asymptomatic cases. We don't know. There are a lot of cases like this.

[timr]

> >10% of mild cases reporting long COVID brain fog (without MRIs)

"Brain fog" is not a diagnosis. It has no definition. It has no test. Literally anyone could say they have it, and not be wrong.

It also overlaps substantially with "fatigue"...which we all know comes along with a lot of other common issues. Such as depression.

> Visible correlations on MRIs with large n (cited study)

The size of n doesn't matter if the thing you're reporting is not a meaningful metric. Here, we have a paper that has gone on a fishing expedition for a quasi-subjective metric with unknown levels of noise, which is widely "shown" to be associated with many common and uncommon issues across the research literature.

This is a low-quality data set. But yes, it is a larger low-quality data set.

> Lots of small-scale studies / looking at specific cases

Collections of anecdotes are not data.

> Some understanding of a relevant mechanism-of-action (see: olfactory loss)

...for a single symptom (loss of smell). But no, we don't know why that happens, and to the extent we do, the current best hypothesis has nothing to do with neurons, but rather, the scaffolding around those neurons.

> Together, that's about as strong evidence as you'd expect after 15 months.

Nonsense. We've been debating this "long covid" for more than a year now. There are apparently many sufferers. We could have easily conducted randomized, longitudinal, controlled trials. We have not.

The total evidence for "long covid" continues to be anecdotes and self-reported "symptoms", of indeterminate duration, amongst populations that are mostly self-selected for having "long covid". I believe that we'll eventually find out that some of these things are real, but right now, this is just hysteria.

[ianlevesque]

Denial is quite a river these days. Where else are you going to get a brain imaging study with before and after data on thousands of people? If that's not persuasive and concerning to you I don't think anything will be.

[native_samples]

Why should a "study" in the abstract automatically be persuasive and concerning? Scientists get paid to publish studies, so the literature is full of nonsensical studies that show correlations between anything and everything. User timr just explained to you why this specific study cannot be used to conclude anything, but you're saying he's the one in denial?

[timr]

> Where else are you going to get a brain imaging study with before and after data on thousands of people?

Why does the size of the study matter so much if the endpoint of the study is absurd, the gathering process was a fishing expedition, and the whole thing is subject to confirmation bias?

Even if you believe that these researchers are finding real signals in these MRI scans (which I don't automatically grant; even they admit that some of the "pathologies" they've identified aren't significant, and they didn't pre-declare the endpoints anyway, so you can't rely on conventional statistical significance thresholds), the fact that they know the outcome for each subject hopelessly poisons the data.

> Denial is quite a river these days.

People have a habit of inventing fictions they believe wholeheartedly in order to ignore a truth they cannot accept.

[elcomet]

> bonus points: can you spot the missing correlate?)

Concussions ?

[marton78]

Poverty, drug use, poor life choices.

[timr]

I was thinking of all of the lifestyle factors that might make one susceptible to tooth loss for >10 years prior to the study (this was a selection criteria for the participants): lack of education, nutrition, medical care, etc. The paper never controls for why these people lost their teeth.

(To be fair to the researchers of this paper, they do discuss some of this, but they focus on a causal relationship between tooth loss and the other factors. They never really consider that the relationship between these factors and tooth loss could be reversed.)

[eloff]

I couldn't find where it talks about vaccinated patients in the study you linked.

It's not surprising that covid19 can cause brain damage (and heart damage, and death) to unvaccinated people.

[gibba999]

That was listed under "The million dollar questions include"

I'm now realizing formatting / phrasing was unclear.

1. >10% of mild / asymptomatic cases have brain damage.

2. The million dollar question is whether this includes vaccinated cases. Vaccines reduce hospitalizations and deaths by far more than they do mild and asymptomatic cases.

[eloff]

Ah, now I see what you mean. That is worrying. I hope that the rate of mild cases in vaccinated people is lower than the article would lead one to believe. I also hope the protection given is enough to avoid that kind of brain damage.

[wesleywt]

The article says nothing about vaccinated people.

[peytn]

That first pre-print is wild. 8 pages of methods for 8 pages of results (incl. figures). Quite a "pipeline."

[Tepix]

Interesting!

[dopylitty]

That may be but it’s not a particularly useful definition on an individual level.

If I’m sick in bed for two weeks I can’t work or take care of my family so those mild symptoms very much would be a danger, not to mention the dangers from long COVID which hasn’t been ruled out in vaccinated folks and the dangers of exposing people who can’t be vaccinated.

[spoonjim]

It’s very useful on the individual level. All that sounds bad but not as bad as dying.

[ianai]

There could still be Lewy bodies (dementia) for all I know.

[lugged]

Sure if you don't think permanent social distancing and mask wearing is not a problem.

The severity of mild covid is still potentially long lasting and I'm willing to guess elderly aren't going to handle it well.

Letting covid become endemic could reduce our life expecty considerably.

[version_five]

> Sure if you don't think permanent social distancing and mask wearing is not a problem.

I'm confused by this comment. I do think they are a problem, that's why I am encouraged by a vaccine that reduces covid to something that is not life threatening and that we can stop freaking out about.

[throwawayboise]

It always was that for the vast majority of people.

[audiometry]

3mn Indian souls would disagree

[55555]

That's a terrible loss, practically a genocide, but to be fair the parent said "the vast majority of people" and there's 1.4 billion people in India. In India, 151,000 people die every year just from car accidents, and ~4 million die each year from heart disease.

[kadoban]

Isn't covid already endemic?

[lugged]

Some claim it can still be irradicated. But those people get banned on YouTube for saying bad words so you probably won't believe me.

[kadoban]

Do they say how? Doesn't seem like it even makes sense anymore. I'm going to guess based on your youtube wording that their answer is not vaccines?

[RalfWausE]

"Do they say how?"

I am relatively certain this is the reason they are banned from youtube... i have seen a (now removed) video from a crank on youtube who suggested saturation bombing of high incidence areas might be the solution...

[rolleiflex]

I chuckled at this. Reminds me of https://xkcd.com/1217/

[lugged]

Vaccines + ivermectin. The numbers seem to work but only if you accept the Mexico City study. Or the numbers coming out of India.

[bsdetector]

Bret Weinstein has been citing studies he claims show that ivermectin reduces spread such that even close family members are unlikely to be infected from a person with covid.

edit: curious how hn readers feel they will be able to correct misguided beliefs if they don't even know what those beliefs are.

[Izkata]

It's also how India got their insane case rate two months ago under control.

[pas]

> permanent social distancing and mask wearing is not a problem.

It's a problem, but we can manage it better than overflowing morgues. Frequent tests, rapid antigen testing (let's say at the entrance of restaurants, clubs, festivals), encouraging people who feel ill to stay the fuck away from others, and so on.

[kumarvvr]

Whoa, I sometimes get SpO2 around 91 - 94 and I chalk it up to calibration error on cheap SpO2 devices (The ones that clip on to the hand, cost about 20 USD). Have been tested twice per employer requirements and was never positive though.

[rolleiflex]

The cheap SPO2 devices are calibrated on fair skin. If you have a darker complexion there is a known measurement error. If you are at 91% and feeling fine you are probably fine. Your body has a better SPO2 sensor than anything man-made.

[kumarvvr]

Damn, I am brown and I guess I have to take that as a 3 - 5% error?

[rolleiflex]

That is correct. See here: https://pubmed.ncbi.nlm.nih.gov/18048893/