3 ms·

I now feel much less happy than I did. "Significant increase" could mean anything. A risk ratio of 1.49-1.85 is a huge increase. These conditions are rare but n

by dash2 5y ago

I now feel much less happy than I did. "Significant increase" could mean anything. A risk ratio of 1.49-1.85 is a huge increase. These conditions are rare but not that rare. Now I should be twice as worried about them? Oosh. Will someone at least tell me that Omicron's not so bad?

timr 5y ago
1.5 is a small increase, particularly when the baseline probabilities are small (as they are here). For context, a "big" increase would be something like smoking, where the effect sizes are measured in HR multiples of ten.
- kragen 5y ago
  I think it matters a lot whether we're talking about a relative hazard of 1.5 over a lifetime or, as in this case, over a year. If, year after year, people who suffered covid in 02020 and 02021 continue to have 1½–2× the risk of developing pericarditis or stroke or congestive heart failure or all these other health problems, or if people keep getting covid every year, well, because of the high lifetime base rates of those problems, that would be a bigger health problem than anything since before AIDS, bigger than smoking, maybe bigger than anything since the Black Plague. On the other hand, if, say, 1.8% of people develop ischemic heart disease in the year following covid, while 1.1% of people without covid do, and then in the following years they don't get covid again and the hazard rate declines to the base rate of 1.1% per year or whatever, that's still a significant public health problem, but it's not nearly as big as the people covid killed outright. (Those numbers are from Supplementary Table 3 in https://static-content.springer.com/esm/art%3A10.1038%2Fs41591-022-01689-3/MediaObjects/41591_2022_1689_MOESM1_ESM.pdf https://static-content.springer.com/esm/art%3A10.1038%2Fs415...: "COVID-19 burden" of 18.47 cases of "Ischemic heart disease" at 12 months, and "Contemporary control burden" of 11.19. The other supplementary information is at https://static-content.springer.com/esm/art%3A10.1038%2Fs41591-022-01689-3/MediaObjects/41591_2022_1689_MOESM2_ESM.pdf https://static-content.springer.com/esm/art%3A10.1038%2Fs415... and https://github.com/yxie618/longCVD https://github.com/yxie618/longCVD.) Though I'm no virologist, I don't know of a plausible mechanism by which covid could cause people to get ischemic heart disease, pulmonary embolisms, etc., after 5 or 10 or 20 years of not having covid. More likely, what's happening is that people who haven't fully recovered from covid are getting blood clots, and that's damaging their organs and sometimes killing them, but after a few months they do fully recover and so these problems stop — unless they get covid again. Given that we now have numerous effective vaccines and a few effective palliatives, it seems likely that even though covid has become endemic, people will be able to avoid suffering this level of damage year after year. But I have to admit it's an open question.
  - timr 5y ago
    Yes, if you see the same thing for many years you gain more certainty over the signal, regardless of the strength of the signal. But a small signal is still small, regardless. And it's always incorrect to average together a high-risk group and a low-risk group and claim that everyone is at medium risk. > More likely, what's happening is that people who haven't fully recovered from covid are getting blood clots, and that's damaging their organs and sometimes killing them, but after a few months they do fully recover and so these problems stop — unless they get covid again. That's one hypothesis. Here's another: people (especially older people) deferred medical care throughout 2020 and 2021. They are seeking that medical care now. Undiagnosed heart problems are now being diagnosed. And oh yeah...they got a Covid test somewhere along the way. Often for (wait for it...) hospital admission. I'm not in love with this hypothesis; it's just the first one I thought of. There are actually a ton of plausible reasons why you'd see slightly elevated rates of whatever in a group of older, less-healthy people. Claiming that the virus caused it through a mystery mechanism is a wild leap to conclusions.
wsc981 5y ago
Life's too short to worry about everything and anything. What can you do about it anyway. Pretty much everyone will get COVID at some point and some people will develop heart conditions. You won't be able to prevent getting infected, so you might as well just accept it.

by dash2 5y ago

timr 5y ago

1.5 is a small increase, particularly when the baseline probabilities are small (as they are here). For context, a "big" increase would be something like smoking, where the effect sizes are measured in HR multiples of ten.

kragen 5y ago
I think it matters a lot whether we're talking about a relative hazard of 1.5 over a lifetime or, as in this case, over a year. If, year after year, people who suffered covid in 02020 and 02021 continue to have 1½–2× the risk of developing pericarditis or stroke or congestive heart failure or all these other health problems, or if people keep getting covid every year, well, because of the high lifetime base rates of those problems, that would be a bigger health problem than anything since before AIDS, bigger than smoking, maybe bigger than anything since the Black Plague. On the other hand, if, say, 1.8% of people develop ischemic heart disease in the year following covid, while 1.1% of people without covid do, and then in the following years they don't get covid again and the hazard rate declines to the base rate of 1.1% per year or whatever, that's still a significant public health problem, but it's not nearly as big as the people covid killed outright. (Those numbers are from Supplementary Table 3 in https://static-content.springer.com/esm/art%3A10.1038%2Fs41591-022-01689-3/MediaObjects/41591_2022_1689_MOESM1_ESM.pdf https://static-content.springer.com/esm/art%3A10.1038%2Fs415...: "COVID-19 burden" of 18.47 cases of "Ischemic heart disease" at 12 months, and "Contemporary control burden" of 11.19. The other supplementary information is at https://static-content.springer.com/esm/art%3A10.1038%2Fs41591-022-01689-3/MediaObjects/41591_2022_1689_MOESM2_ESM.pdf https://static-content.springer.com/esm/art%3A10.1038%2Fs415... and https://github.com/yxie618/longCVD https://github.com/yxie618/longCVD.) Though I'm no virologist, I don't know of a plausible mechanism by which covid could cause people to get ischemic heart disease, pulmonary embolisms, etc., after 5 or 10 or 20 years of not having covid. More likely, what's happening is that people who haven't fully recovered from covid are getting blood clots, and that's damaging their organs and sometimes killing them, but after a few months they do fully recover and so these problems stop — unless they get covid again. Given that we now have numerous effective vaccines and a few effective palliatives, it seems likely that even though covid has become endemic, people will be able to avoid suffering this level of damage year after year. But I have to admit it's an open question.
- timr 5y ago
  Yes, if you see the same thing for many years you gain more certainty over the signal, regardless of the strength of the signal. But a small signal is still small, regardless. And it's always incorrect to average together a high-risk group and a low-risk group and claim that everyone is at medium risk. > More likely, what's happening is that people who haven't fully recovered from covid are getting blood clots, and that's damaging their organs and sometimes killing them, but after a few months they do fully recover and so these problems stop — unless they get covid again. That's one hypothesis. Here's another: people (especially older people) deferred medical care throughout 2020 and 2021. They are seeking that medical care now. Undiagnosed heart problems are now being diagnosed. And oh yeah...they got a Covid test somewhere along the way. Often for (wait for it...) hospital admission. I'm not in love with this hypothesis; it's just the first one I thought of. There are actually a ton of plausible reasons why you'd see slightly elevated rates of whatever in a group of older, less-healthy people. Claiming that the virus caused it through a mystery mechanism is a wild leap to conclusions.

wsc981 5y ago

Life's too short to worry about everything and anything. What can you do about it anyway. Pretty much everyone will get COVID at some point and some people will develop heart conditions. You won't be able to prevent getting infected, so you might as well just accept it.