Are There More COVID-19 Questions Than Answers?
How do you feel about the uncertainty surrounding the effectiveness of masks, medications, and mandates to minimize the pandemic that President Biden said is no more?
Much has been written in the last month questioning much of the public health guidance that has been given during the COVID-19 epidemic.
A Cochrane analysis, published in January, 2023 , became a cause célèbre when it concluded
“There is uncertainty about the effects of face masks”
Since the existing evidence was so weak the authors (lead by Tom Jefferson) wrote:
There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs
Scientists and doctors who had concluded that non-pharmacological interventions were a waste of time were delighted. Authorities and doctors who believed in masks and NPIs were aghast.
Seemingly vindicating the pro NPI team, earlier this month, in a very unusual move, Karla Soares-Weiser, Editor-in-Chief of the Cochrane Library published the statement below:
Is “Masks don’t work” an oversimplification of “we looked at the data, it sucks” therefore “there is uncertainty about the effects of masks.” You, Mr. John Q. Public, will have to tell me if this subtle change in Plain Language resonates with you.
Given the use of the word uncertain in the original, it is not clear to me how rewriting the Plain Language Summary will help anything but I do know that Tom Jefferson, the lead author of the study, is now writing for the conservative (and fiercely anti-NPI) Brownstone Institute and has become a hero of the anti-NPI crew and a bête noire for the pro-NPI crew.
I’m interested in surveying how TSC readers feel about these things. Please take a minute to answer these few questions which will help me gauge where my audience stands on both pharmacologic and non-pharmacologic approaches to the COVID-19 pandemic and/or whether they would rather have me write about cardiovascular disease, age forestallment, diet, and music.
To me the Covid wars of rhetoric are eerily similar to the dietary rhetoric wars. Typically the truth requires listening carefully to the valid points of sensible, principled, and (often) credentialed scientists, finding trustworthy voices in the middle and navigating a course between the two extremes.
Is There A Pandemic of Long COVID?
There’s been much fanfare regarding observational studies showing an increased risk of cardiovascular disease and death persisting for 18 months after Covid. Should we fear Long Cardiac Covid? I will write a post soon on the question of post-COVID cardiac risk as I consider it in my “wheelhouse“ and it is relevant to almost all my patients.
Finally, some papers suggest an immense persistent toll on all organ systems from COVID-19. Eric Topol co-authored a paper entitled “Long COVID: major findings, mechanisms and recommendations on January 13, 2023 in Nature Medicine. Two months later the article is one of the most accessed, tweeted, blogged and quoted articles of all time.
According to this narrative summary of long COVID evidence, “The incidence is estimated at 10–30% of non-hospitalized cases, 50–70% of hospitalized cases and 10–12% of vaccinated cases. Long COVID is associated with all ages and acute phase disease severities, with the highest percentage of diagnoses between the ages of 36 and 50 years, and most long COVID cases are in non-hospitalized patients with a mild acute illness.”
Clearly, long Covid is an important topic but there are so many questions about the entity that the article correctly concludes that “current diagnostic and treatment options are insufficient, and clinical trials must be prioritized that address leading hypotheses.”
Both long COVID and cardiac risk post-COVID bear on the question of how much time and energy we should spend on avoiding getting infected with COVID-19.
Feel free to embellish, elaborate, or castigate in the comments.
Plainly Yours,
-ACP
I have seen articles discuss that the calcium deposition in the intima of arteries resembles what happens in bone. Perhaps there are cells in the intima that resemble the osteoclasts that perform the function of laying down new bone.
"on holiday" suggests you are in UK?
Indeed