The only good things I can find with these depressing studies and editorials presented in today's NEJM (which I read a day early in print form) are :
1) A lot of potential for bias. In the first study, those people motivated to stay in the survey might have been suffering from long Covid and problems that compelled them to respond. In the second study we are talking about self-reported memory problems via questionnaire (higher scores=more problems reported, therefore the red line on top is worse), and so once again there is the same potential for response bias and recall bias for those people knowing they had Covid. Hard to "blind" that!
2) ACIP/CDC meeting today recommends that those over 65 should get a second XBB monovalent Covid-19 vaccine this spring. Funny timing. The trends Dr. Topol has always highlighted show incremental but ever increasing benefits with staying up to date with vaccines and boosters.
3) Ventilation, respirators/masks in tight situations, and antivirals are still good options on the table.
I'm sticking with my own plan to take antivirals and probably metformin, and agree with Dr. Leana Wen's OpEd in the Washington Post about the pathetic under use of Paxlovid.
The potential for increased risk of Parkinson's disease and dementia years or decades later remains to be seen, but we have early contours emerging, and precedents with influenza... so why not use every tool we have to reduce viral load and the number/severity of infections sustained? The RCT needed to "prove" beyond a reasonable doubt that staying up to date with vaccines, treating infections, and reducing exposures will confirm long term relatively neuroprotective effects will never happen, as it would need to sprawl over decades, really.
Intuition and informed leaps of faith are part of this imperfect art.
