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Covid Zero Transitions to Covid Everyone


Each week comes with more announcements that, despite doing everything right, I or someone close to me got Covid-19. From celebrities, to congresspeople to vocal zero-Covid advocates, eventually, every single person will get Covid.

Somewhere along the way it became fashionable to claim, often based on weak evidence, that Covid results in permanent brain, heart, or lung damage even if one has a mild or asymptomatic infection. Recently I saw someone claim asymptomatic infection even results in erectile dysfunction.

It is certainly a bold claim that a respiratory virus you have and not feel anything from can result in erectile dysfunction. Of course, anything is possible, but it’s interesting that in the history of respiratory viruses, and all of medicine, no scientists in prior eras were capable of making such a daring claim. 

As we move from zero Covid to everyone Covid, it might be good to take it easy with extremely incredulous claims that asymptomatic Covid infection can lead to all sorts of distant maladies. The scientific burden is very high to take seriously such associations, and is often not met. Mostly due to inadequate controls. 

The other thing we must acknowledge is that even though we can agree it is better to meet Covid after vaccination than before vaccination, we don’t know much about when. Could it be better to meet Covid soon after your last dose rather than when it is merely a distant memory? Breakthrough is inevitable, but when does it provide the most durable immunity, with the least risk?

Being vaccinated and boosted is all that a healthy person can reasonably do to lower their risk of Covid-19. Avoiding social gatherings and wearing masks might delay the inevitable, but then again, it might merely cause inconvenience without achieving these goals.

Recently a randomized trial found that home pulse oximetry use after a covid diagnosis did not improve outcomes. Imagine if we applied this design to all other questions, including whether asymptomatic testing helps.

As zero Covid advocates recover from Covid, we may eventually reach herd sanity. That is when we stop treating mild covid infections like the boogeyman, and realize that living with others means that there are many infections we cannot avoid.

Republished from Substack

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  • Vinay Prasad

    Vinay Prasad MD MPH is a hematologist-oncologist and Associate Professor in the Department of Epidemiology and Biostatistics at the University of California San Francisco. He runs the VKPrasad lab at UCSF, which studies cancer drugs, health policy, clinical trials and better decision making. He is author of over 300 academic articles, and the books Ending Medical Reversal (2015), and Malignant (2020).

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