Dr. Al-Aly to room of unmasked Senators: Long COVID comes from COVID

Advocates were thrilled when the HELP Committee announced a hearing on Long COVID. But why is basic prevention being ignored?

Last week, the US Senate Committee on HELP (Health, Education, Labor & Pensions) announced a hearing on Long COVID. The reaction among patients and advocates was instant, loud, and joyous; finally, the government would acknowledge the worsening crisis. Finally, elected officials were saying the words “Long COVID.” (Joe Biden, for the record, still has never said nor tweeted the words Long COVID; tens of millions are now suffering with it thanks to his mass infection-normalizing policies). Finally, an institution admits the disease is real.

The bar, as you can tell, is not high.

My emotions as I watched the hearing were mixed. Senator Sanders’ opening statements were fantastic; he acknowledged that Congress had “not done enough,” promised to do what he could to help, and also made critically important statements about the risks of Long COVID, correctly stating:

Each reinfection increases the risk of developing Long COVID. If you are under the impression that once you’ve gotten COVID you never need to worry about it again, you are mistaken.

This simple piece of information has the potential to be world-changing were it widely understood and incorporated into public health guidance. Taken together, the facts that Long COVID is a serious, debilitating illness, that many people do not recover, that it is common, that risks compound- not decrease- with continued reinfections- any logical person will understand that the only reasonable approach to COVID is a serious, institutional mitigation strategy.

Our collective approach to a virus that carries a high risk of long-term and even disabling illness cannot be to reinfect every person with it 1-2 times a year. No society, no economy, can bear the illness burden, disruption, and cascading consequences of population-level worsening health. This should be obvious, the ground floor of understanding the COVID/Long COVID crisis.

We’ve already begun to see the society-level outcomes of normalizing constant reinfection with COVID. We’ve got record student absences. Reintroduction of child labor as industries struggle to stay staffed. Immune dysregulation resulting in massive waves of RSV, deadly outbreaks of Strep A, a surge in fungal infections, and more. High excess deaths and, particularly, high cardiac deaths among young and middle-aged people. Unsustainable pressures on global healthcare systems that, while they existed before COVID, can clearly be seen to drastically accelerate post-COVID in this NHS data.

Senator Sanders, however, did not wear a mask during his opening statement. The other Senators, including doctors, including Senator Markey who stated “22-38% of people who get COVID will get Long COVID” and Senator Marshall who described a “close loved one” badly struggling with Long COVID, did not wear masks.

Senator Sanders did put on a mask when he was done speaking, which I was pleased to see. But the irrationality, the rejection of basic science and the promotion of poor public health inherent in removing a mask to speak is both incredibly damaging as well as discrediting if you’d like to be a champion of the cause. Millions are desperate to be able to point to progressive role models like Senator Sanders when they chose to wear a mask to protect their health. The refusal to mask by prominent progressives is a major contributor to the continued stigmatization of masks in leftist spaces.

Having a Long COVID crisis hearing in a room where COVID mitigations are absent is like having an AIDS crisis hearing and trying not to mention HIV prevention. It’s unserious if you’re not going to address the root cause.

Fortunately, tireless Long COVID researcher Dr. Ziyad Al-Aly appeared in the second half of the hearing in a blue suit and well-fitting brown mask, perfectly willing to talk about the elephant in the room. “There is no Long COVID if you never get COVID,” he pointed out, going on to discuss the importance of air quality upgrades. While pushing for mitigation measures, he made the memorable and evocative comparison:

We proof buildings for earthquakes that happen once every 50 or 100 years. We invest millions. Why can't we do the same thing to make sure that our buildings are proofed against natural hazards like airborne pathogens?

Hearing these words before a Commitee of U.S. Senators was thrilling. I’m very hopeful that this discussion is the first of many, that the electeds in the room and their teams will begin to do the economic math on massive illness reduction via engineering.

The assembled Senators were empathetic and attentive as they listened to patients express their pain and researchers describe their findings. But the message sent by the lack of masks and COVID mitigation in the room is an inability to understand- or unwillingness to acknowledge- that the Long COVID crisis represents the utter failure of Presidents Trump and Biden’s shared COVID approach. Long COVID isn’t a mysterious curse from the Gods or an unknowable affliction of fate; it’s the result of a COVID infection. Last week, we hit the peak of the second largest COVID wave of the entire pandemic, with nearly 1.5 million infections per day. That is, conservatively, 150,000 new Long COVID patients. Daily.

Patients who, as was so thoroughly demonstrated at the HELP hearing, will be left without treatment, will be disbelieved by doctors who’ve absorbed years of “COVID is the flu now” propaganda, and will in some cases become housebound, bedbound, and unable to work.

Patients who need not have joined the ranks of those who’ve already been harmed, if they’d been properly informed that a single COVID infection can ruin your life, but simple mitigations can drastically decrease your risk of catching it.

To think you can address a public health crisis of this scale while putting out zero messaging on prevention, while refusing to model basic mitigations, while holding fast to the failed “just ignore it” strategy, is entirely unserious. Letting COVID rip despite knowing it will inevitably ruin the lives of many who contract it (including children who cannot possibly consent to their forcible infections), is indefensible and sadly completely unnecessary. When our leaders talk about “having the tools,” to handle COVID, they are technically correct. They have simply made these tools unavailable, expensive, and unmentionable through privatization and misinformation.

Entering year five of life with COVID, we could have a properly educated population that has not been politically radicalized against masks or pumped full of propaganda about how they don’t work. We could have fully upgraded indoor air quality with MERV-13 filters, HEPAs and CO2 monitoring. We could have normalized and distributed accurate COVID tests and staying home when sick. Instead, every single policy change coming from the Biden White House and CDC has been to encourage folks to pretend COVID has gone away, to ignore it, to contract it, to spread it, and to get back to work.

Most Long COVID patients are well aware that another infection could further disable or even kill them. As they await treatment, what would the HELP Committee advise the tens of millions of people who cannot afford another COVID infection to do? When 1 in 30 or 1 in 20 people have active COVID infections, and have been told they no longer need to try not to spread it? When basic public health interventions have been portrayed as crazy, weird, stupid, annoying, impossible and rude?

Yesterday, as a roomful of Senators contemplated the packed house of masked advocates in front of them (an overflow room also filled up), California announced that it would reduce its COVID isolation period to a single day. This obvious concession to capitalism over human lives will do nothing to address the globally worsening staff shortages, but instead hasten long-term staffing crises in every public-facing industry as more and more are disabled.

Today, Long COVID trended on twitter with over 30,000 tweets discussing the hearing, the illness, the implications, and the future.

Tomorrow, the ranks of Long COVID patients will rise yet again. And the day after that, and the day after that.

Until our political leaders and public health bodies understand and acknowledge that our collective health is being slowly drained by continual COVID reinfections, the Long COVID crisis is here to stay.