Personal Sidebar: Long COVID
This isn't going into the book, at least not in the current manuscript, but an uptick in reported COVID infections in the wake of the discovery of the NB.1.8.1 strain has pulled me into at least one argument about the long-term effects of COVID infection and the proper response to handling the experience of living in a COVID world. So I'll just put my personal position on all of this here, and then I can just give people the link and /ignore them from then on.
It's important to understand that while COVID-19 and its various variants presents as a pulmonary infection, that's actually not the body attack vector that is the most concern. The actual danger of COVID that mostly gets overlooked by the general public is how the attack on the ACE2 receptors (the method by which the virus inserts itself into cells) means that the actual damage done is mostly in the vascular system. By causing variations in the thickness of arterial walls, COVID causes both bleeding from tears and blockage of bloodflow through clots and obstructions. It also means that it's relatively easy for COVID to cause damage and inflammation in spinal and cranial bloodflow systems.
COVID presents as a respiratory disease, but it's actually a cardiovascular disease. The single biggest problem with COVID is that it prevents oxygen from getting to the places it needs to go when it needs to go there. This is why exercising with COVID is so dangerous: your body's demand for oxygen is restricted, which very literally kills parts of your body – and, most importantly, brain tissue. It's why trying to do work (especially creative work) is so dangerous; thinking requires energy, energy requires oxygen, and if there's no oxygen the brain dies.
The brain is tricky. There are huge chunks of how the brain works that we have absolutely no understanding of. But as a general rule, gross damage of certain parts of the brain are recoverable; but fine damage of most parts of the brain are irrecoverable. So the method by which COVID attacks the brain isn't something people usually get better from.
The cognitive effect of COVID infection is both significant and hard to quantify. It's only been five years since we started seeing COVID infections (and their post-infection effects). But for me, the effects of what's being called Long COVID are significant and debilitating. I was sick with COVID for six weeks before I returned to work and to my life as normal. But I've never recovered to 100% of the function I had before I got sick. I have very little capacity for sustained physical work, which makes things like "chores" and "exercise" extremely difficult. But from my perspective the much larger problem is the cognitive decline after being sick. Memory, recall, and language facility are all impacted. Aphasia is much more pronounced, and general cognitive tests (e.g. crossword puzzles, math puzzles, and the like) result in significantly lower scores post-infection. Productivity recovery – the ability to bounce back from sustained intellectual work – is more than doubled.
It hasn't been long enough for studies to determine the quantitative effect of COVID via study. We probably won't know how bad COVID was for at least a generation. But my personal, anecdotal experience is that it was debilitating to the point of disabling me, and I don't know that I'll ever recover from it. So I have a very specific and strong position on what we should do about COVID and why.