On Long-COVID and the Paradox of Technology: or, “See, Here I'm Now By Myself, Uh, Talking To Myself.”

I was at the doctor’s office the other day and was struck by a paradox of modern medicine: on the one hand, we have truly miraculous cures that testify to the collective genius of the human species, while on the other hand, this genius is often wielded by people who exhibit all of the shortcomings of our species, like callousness and ignorance. It was a good lesson in the promises and perils of technology.

For the past several months, it turns out that I’ve been suffering from a form of tendinitis. For me, what this meant is that several times a day, whenever it was triggered by certain uses of my thumbs or wrists, I’d experience sudden shooting pain. This pain was the most intense pain I’d ever felt, prompting me to describe it as a “10” on the intake form, and I’d experience it several times a day. Luckily, what made it bearable was that it would end just as suddenly as it began, so that this sharp and shooting pain would last only a fraction of a second, always leaving me with the same thought: I don’t know how others deal with this kind of pain on an extended basis, because I don’t think I could.

At the doctor’s office, I wasn’t expecting much. I figured this would be the first of several appointments, and that maybe after several months I’d start feeling better. But 45 minutes after I arrived, I was receiving steroid shots in my wrists, and was told that not only would the pain cease in a few days, but that these shots also cure the problem in the vast majority of cases. Having for months faced the worst pain I could imagine, a 5 minute procedure promised to relieve the pain and cure the problem.

This experience left me grateful for having been born at this point in time. These types of steroid treatments were only invented in the 1950s, and more generally, the post-war era really has become an era of unprecedented medical advances. And we’re still living in this era. When it comes to more serious problems, cancer continues to kill many, but a cancer diagnosis is not what it was a century ago. It’s not even what it was 30 years ago. And it won’t be what it is now in another 30 or 50 or 100 years. Which raises the flipside of my gratitude for being born when I was: resenting not being born in 100 years, when whatever currently incurable malady eventually gets me has an over-the-counter cure. But such is modern life.

However, the contradiction that caught my attention didn’t have to do with the rate of technological change, but with something much simpler: the complete lack of masks at the doctor’s office. The doctor I saw wasn’t even located in a private practice or small clinic, but in one of the largest hospitals in New York City, and it seemed like not a single person was wearing a mask. And this wasn’t only true for the patients visiting the hospital or the non-medical staff, but for nurses and doctors too, including the two doctors who treated me.

In general, I’m struck by the lack of masking, but in a hospital setting, it’s even more striking. It’s easy for me to see why hospital management would want to ease mask requirements, because the overwhelming thrust of employers has been to minimize any and all COVID precautions in favor of “business as usual.” So, I was expecting that the hospital might not be enforcing a mask mandate, because hospital administration has a lot of say in determining these policies. But I was a little surprised that neither of my doctors had chosen to wear a mask.

In the public discussion, I understand that there is no perceived need to mask. However, I’m convinced that the lack of masks at least partially owes itself to a general ignorance about the ongoing nature of the pandemic. Our media and our politicians have done us a terrible disservice, misinforming us and keeping the true nature and cost of COVID from us, all the while downplaying its severity. It therefore makes sense that no one masks: why mask if there’s no need?

In my case, I’m hardly an expert on COVID, but I’ve done my best to keep abreast of the medical research on COVID, or to at least keep on top of it enough so that I can make relatively informed decisions about my behavior, such as masking. I won’t belabor the research too much, but, for me, the real issue isn’t the immediate COVID infection but the long-term consequences of it. The latest estimates put incidents of long-COVID at 20% of COVID cases, so that 1 in 5 COVID cases become long-term. And we know that COVID infections cause many people to have cognitive, cardiovascular, and neurological damage, which in many cases is permanent. These effects are also cumulative. So we now live in a world in which we are destined for multiple repeat infections of a disease that with each infection threatens to do permanent damage to the central systems within our bodies. And as the 20% number for long-COVID cases suggests, these disabling events are hardly infrequent.

Medical research on COVID is still at an extremely early stage. It takes a very long time to gather evidence, conduct experiments, determine findings, and finally, to publish. This is only compounded by the fact that when it comes to the long-term and permanent consequences of COVID, decades might be required to fully understand the consequences, because many of the consequences will unfold on that timeline. For instance, thinking of this generation of children who will likely contract COVID handfuls of time before they graduate high school, the real consequences of the cognitive, cardiovascular, and neurological damage won’t be fully known until the end of their lives. It’s only then when we can gather data on how many had heart attacks at a young age due to cardiovascular damage, how many developed early onset Alzheimer’s owing to cognitive damage, or how many developed cases of severe depression or anxiety owing to the cognitive damage. These are just a handful of the possibilities that we are facing, but we’re already seeing some of the effects, such as a spike in heart attacks among young people post-COVID.

Turning to a different example, for most people, Polio was an asymptomatic disease. These people got infected, but they never even knew it. In only about 25% of cases did people experience flu-like symptoms, while it was only in 1 in 200 cases that Polio led to paralysis. Contrasted with COVID, many more people experience a symptomatic case of COVID than they did of Polio. And while it’s still too early to determine the true long-term consequences of COVID, when taking into account the extremely high incident rates of long-COVID and the permanent damage COVID often causes to our cardiovascular, cognitive, and neurological systems, we’re potentially looking at a mass disabling event that makes Polio pale by comparison. We might eventually come to see Polio as a walk in the park.

For this reason, some people have started rebranding Polio as long-Polio. As with COVID, most symptomatic cases of Polio were flu-like, and it was only in a small minority of cases that paralysis occurred. So, what we typically think of as Polio—the kind of disease that led to F.D.R.’s paralysis, for instance—was really the long-term consequences of a very rare fraction of cases.

Our politicians and our media have worked hard to convince us that the real issue isn’t any of the long-term problems caused by COVID, but only the immediate consequences of a symptomatic infection, like hospitalization or death. And these numbers have greatly decreased from the height of the pandemic, largely owing to vaccination. However, as with Polio, the pandemic is hardly over, and really, I’d argue that it’s just beginning. But given the concerted effort to get things backs to normal, we’ve been convinced that the problem of COVID lies in the acute symptomatic phase and not the long-term aftereffects.

Most people don’t have the tools or the access to find medically sound research on COVID. While the research still has a long way to go, the research that has been published is quite disconcerting. However, the mainstream media isn’t reporting any of this information, and the silence is similar from our politicians. Absent an accurate story about COVID, it’s only normal that people will believe what the media and our politicians tell them: COVID is over.

Whenever I’ve had to chance to watch a COVID researcher talk about their findings, these researchers always council masking and other precautions like ventilation. This makes sense: as the people knowledgeable about the true nature of COVID, they would obviously want to take precautions about a virus they know is serious. However, the fact that neither of my doctors were wearing masks (and nor were any other doctors or nurses, for the large part), to me indicates that they’re simply unaware of the research. If they were aware of it, it makes no sense that they would expose themselves to countless patients who might potentially be infected, just as it doesn’t make sense that they would be comfortable potentially exposing their patients either. Perhaps some doctors are that callous, but I don’t think this would explain the almost complete lack of masks among all doctors.

And here’s the real paradox: these two doctors, capable of wielding the height of 20th and 21st century medical technology, capable of curing me from a pain that would have been absolutely debilitating if not for its momentary duration, weren’t actually knowledgeable about other areas of medical research. As with academics such as myself, who are knowledgeable about our own subject areas but not necessarily about anything else, these doctors possess tremendous knowledge about a very specific area, but not necessarily about anything else. So they can cure my wrist in five minutes flat, but they’re subjecting themselves and their patients to repeated and potentially debilitating COVID reinfections.

This paradox seems to be such a fundamental paradox of our modern, technological age that it borders on the banal. We have unleashed technological wonders that make the achievements of prior ages pale by comparison, but the people wielding these technological advances—us—are just as dumb as people ever were. Maybe dumber, because rather than instilling in us a sense of humility, our technological advances have made us more hubristic than ever. Or as the great mathematician Jeff Goldblum once noted: “your scientists were so preoccupied with whether or not they could that they didn’t stop to think if they should.” And now, the virus is loose in the park.