worms in your spaghetti

Examine forms of misinformation and disinformation

Join us in our COVID-19 fact-checking column as we analyze the data (aka spaghetti), pull out the misinformation (aka "Worms") and focus in on the good information (the meatballs--or juicy veggies, depending on your preferences). Make sure to leave room for the Cannoli-- a sweet ending-- to any (worm-free) meal! 

Our Worms Collection: 

(1) WHO Continues To Ignore Long COVID Catastrophe 

November 2022: The WHO's misuse of the death rate metric as a tool for assessing the pandemic, the continued silence on long covid despite significant research, and the ignoring of scientific consensus on how to end the pandemic as a public health threat. 

(2) INCREASES IN DISEASE PREVALENCE AND SEVERITY A LIKELY RESULT OF COVID-19 AND LONG COVID. THE “IMMUNITY DEBT” HYPOTHESIS IS UNFOUNDED. 

February 2023/ Updated May 2023: The inaccuracy of the "immunity debt" hypothesis and the silence on COVID-virus-caused immune system damage when assessing the cause for the huge surge in RSV cases and severity the past few seasons. 

(3) The US Call to End the Public Health Emergency in May 2023 Means Individuals and Policy-Makers Must Take More Actions to Prevent Transmission, Not Fewer

March 2023/ Updated on 5-23-23: The premature ending of COVID-19 protections and safeguards by the US and other governments and the resulting worsened surveillance, greater divide in treatment access, more stress on the healthcare system, and overall negative impact on infection prevention strategies has left an increased responsibility on the individual to use COVID precautions to protect health.

Is COVID-19 Still considered Dangerous?

Yes! It is dangerous in both its initial infection phase as well as its long-term phase.

COVID-19 risks move well past the acute infection-- the term for the initial "sick" phase that now is resulting in less deaths and hospitalizations than earlier in the pandemic, but still is killing over 1,000 Americans each week, since August 26th 2023 continuing through to now in Spring 2024. The COVID-19 death rate is at least 4 times higher than influenza.

However, it isn't hospitalization and death in the acute infection that is our most likely concern (even though it IS a concern, as more than half of the US population is considered higher risk for severe outcome). Yet, there is a much larger chance that this will affect our long-term health in serious often chronic and disabling ways, and those risks pertains to ALL people, whether one is considered higher risk in the acute infection phase of the disease or not. 

For instance, prior COVID-19 infection more than doubles heart attack and stroke risks for up to a year after infection. A 2021 Lancet study showing heart attack risks 3-8 times higher, and strokes caused by blood clots 3-6 times higher, the weeks after COVID infection. Increased risks persist for at least a year after COVID-19 infection for all ages.

And, although long COVID is often called mysterious, we know A LOT about HOW and WHY this happens, and we have plenty of PROOF.

For instance, one reason scientists believe COVID-19 causes stroke and heart attack risks to skyrocket is that COVID-19 infections trigger an exaggerated inflammatory response (which can happen even in formerly healthy people) that makes blood clots more likely. A 2023 study in Nature Cardiovascular Research shows the virus may infect coronary arteries, causing plaque buildup to become inflamed and break off, which can then lead to a heart attack. A 2022 study confirmed stroke risks were heightened in younger and healthier people, including those with seemingly mild acute infections. So, you might think you got off easy initially in an infection, only to have these serious problems surface a few weeks or months later. 

The health effects happen in four different time windows after SARS-CoV-2 infection: 0–30 days (namely the acute phase), 31–90 days, 91–180 days and 181–365+ days (these last three comprise the post-acute phase). For example, this image from a study on the cardiac effects of COVID-19 shows heart effects at different phases in vaccinated and unvaccinated individuals, highlighting the reduction of some types of effects in different phases by vaccination status.

Long COVID heart attack and stroke risks are far worse than "long flu". Even though they are learning more that flu can cause inflammation that increases heart and stroke risks, research shows that SARS-CoV-2 virus does so at rates more than 7 times higher than after the flu.

And the long-term effects of COVID-19 infection can move well beyond heart attack and stroke risks. COVID-19 infection can cause cascading effects leading to gastrointestinal problems, multi-organ impairment, abnormalities of blood vessels and coagulation, mitochondrial cell dysfunction, functional impairment and fatigue, muscle abnormalities, development of allergic diseases and asthma, immune dysregulation, detrimental neurological impacts (including brain cell fusion, depression, and cognitive impacts), as well as many other health effects.

Long COVID can be divided into (sometimes overlapping) subtypes, based on its cause and/or the parts of the body it affects, which may help with identifying long COVID, and/or possibly developing treatments down the road. But right now, there are no approved treatments or cures for long COVID. However, the more research that comes out, the more hope and relief we can give to the millions already suffering from this disease. Using precautions now, whether you have long COVID or not, shows you care, that you prioritize health, and that you believe actions need to be taken. There are many causes that will need to be addressed, so be wary of anything that seems to be a biomarker or cure-all for every type of long-COVID effect. Pay attention to the subtype and it may assist if you are seeking treatments. 

There are many recent discoveries and theories about how COVID-19 infections cause long COVID symptoms, including a recent study showing that COVID-19 infection may trigger a person's body to make certain enzymes that cause some of the inflammatory symptoms of long COVID and manifest into a variety of long-term health conditions. There is hope that treatments might be developed to counter this particular brand of long COVID in the future.

There are other possible causes for long COVID supported in research as well. A 2023 study concludes that persistent SARS-CoV-2 viral antigens (COVID virus that stays in the body long after the acute infection), reactivation of latent viruses (meaning viruses that are common but dormant in our bodies, such as the Epstein-Barr virus, will become activated and cause problems) and chronic inflammation may all contribute to long COVID. This adds to a plethora of research that shows that the SARS-CoV-2 virus can linger in the body and can cause cascading effects throughout that manifest as long COVID.

Researchers in a 2024 study found major differences in differences groups with associated causes, including

• distinct protein profiles in GI and cognitive groups with associations between Epstein–Barr virus reactivation and neurological symptoms, autoantibodies and GI symptoms relative to other forms of LC49,53. Brain–gut axis disturbance (SCG3) in the GI group, which occurs in many autoimmune diseases54.

• signatures suggestive of neuroinflammation (C1QA) in the cognitive group, consistent with findings of brain abnormalities on magnetic resonance imaging after COVID-19 hospitalization55, as well as findings of microglial activation in mice after COVID-19 (ref. 56).

• Proinflammatory signatures dominated in the cardiorespiratory group. Lung-specific inflammation was suggested by the association between PCDH1 (an airway epithelial adhesion molecule35) and cardiorespiratory symptoms.

• Fatigue and anxiety/depression groups and were consistent with those seen in non-COVID depression, suggesting shared mechanisms57 , including associations between markers of myeloid inflammation enhancing immunopathology58 and causing fatigue.

In February 2024, researchers in Dublin, Ireland published a study in Nature Neuroscience that found that

• "sustained systemic inflammation and persistent localized blood–brain barrier (BBB) dysfunction is a key feature of long COVID-associated brain fog."

• They found evidence of blood vessel inflammation and blood clotting issues resulting in microbleeds in the brain. 

• They also identified inflammatory biomarkers suggesting immunological dysfunction.

• They had imaging showing the resulting structural brain damages in regions involved in "brain fog"--an umbrella term for the fatigue, memory, and cognitive problems described by many with long COVID.

• They found some of the brain abnormalities to be similar to patients suffering from neurological diseases including epilepsy, traumatic brain injury, and schizophrenia, and other biomarkers similar to those implicated in the pathogenesis of chronic fatigue syndrome, a condition with clinical similarities to long COVID.

• The researchers found no difference in age in this study, again affirming that long COVID is happening to people of all different ages. 

• Information on biomarkers may help those who are suffering from long COVID to identify it, find support for it (i.e. disability support), and hopefully will aid in developing treatments in the future. 

Long COVID is NOT Rare

Importantly, LONG COVID IS NOT RARE-- it is common. It has affected millions of people and can cause a wide range of serious complications including disability and death.

The effects of long COVID have and are continuing to show up showing up in steep increases in disability rates in the workforce since 2020, as can be seen in the image below: 

A 2022 Brookings Report shows that long COVID is keeping over 4 million people out of work so far. This impact is not set up to lessen any time soon, due to the continued spread of COVID-19 ad the worsening effect of infections and reinfections on the body.  

Long COVID continues to be serious and prevalent. According to a 2023 Nature article, “long Covid incidence is estimated at 10–30% of non-hospitalized cases, 50–70% of hospitalized cases and 10–12% of vaccinated cases  …Symptoms can last for years, and particularly in cases of new-onset ME/CFS and dysautonomia are expected to be lifelong. With significant proportions of individuals with long COVID unable to return to work, the scale of newly disabled individuals is contributing to labour shortages. There are currently no validated effective treatments.”

A 2021 systematic review found more than half of COVID-19 infections resulted in long COVID six months after recovery. A 2023 Nature immunological review concluded “The oncoming burden of long COVID faced by patients, health-care providers, governments and economies is so large as to be unfathomable, which is possibly why minimal high-level planning is currently allocated to it. If 10% of acute infections lead to persistent symptoms, it could be predicted that ~400 million individuals globally are in need of support for long COVID.”

A 2023 Scientific American article stated “the most common, persistent, and disabling symptoms of long COVID are neurological”, later quoting a physician saying, “I now think of COVID as a neurological disease as much as I think of it as a pulmonary disease, and that's definitely true in long COVID.” Although formal guidance on how to record long COVID on death certificates was not released until 2023, CDC data from early 2024 has shown thousands of deaths of US citizens from long COVID.

The only way to prevent long COVID is to prevent COVID-19 infection. In reality, we should not be only using the short-term infection risks to gauge COVID-19's danger, but instead talk about the different types of dangers during each phase and inform people to be on the lookout.

But what if I'm vaccinated!?

Although there has been a lot of public health messaging pushing vaccines as the solution to COVID-19, vaccines alone cannot slow down the evolution of the SARS-CoV-2 virus and they fall short as a solution to COVID-19 risks due to their inability to prevent COVID-19 infection and transmission (vaccinated people can still get infected with COVID-19 and spread it to others). Furthermore, their effectiveness wanes significantly over time and by variant (this preprint shows progressive loss of neutralization observed across newer variants, irrespective of vaccine doses, and notes that the updated XBB.1.5 booster significantly increased titers against newer variants but not against JN.1 (JN.1 is the most prevalent variant in the US currently as of March 2024). And what do vaccines do for long COVID risks? A landmark 2022 study shows only a modest risk-reduction of 15% for long COVID amongst vaccinated individuals.  They have benefits, and reduce some risks, but the answer to the problems we face lies in actually preventing transmission, and that is something vaccines are not currently able to do on their own.

It is also important to note that preventing transmission is not only important to lower YOUR own health risks, but it is also important for lowering the risks to OTHER PEOPLE. As stated earlier, a person's vaccination does not stop them from transmitting COVID-19 to others.  So, even if you think that your risks are low enough and that you are OK in taking higher risks without protections like masking-- this decision affects OTHERS too, others who may not want to take those risks in lieu of masking. Others who may face even higher risks due to health, age, socioeconomic reasons, or because they do not have vaccine protection.

For instance, some people cannot get vaccinated (such as those with certain allergic reactions or other contraindications). Some will not get vaccinated (such as those with medical mistrust (often due to very real former medical trauma that has affected their ability to trust medial professionals and has caused many people to be psychologically resistant), or those who are concerned about risks of developing conditions, which although rare can happen, or who are afraid of having adverse reactions to the vaccines. Others feel they do not need to get vaccinated because they think COVID-19 and long COVID doesn't affect healthy or young people due to the poor public health messaging that has occurred over years, and the lack of visibility of those who are using precautions. The overwhelming research showing COVID-19 does have high risks to health is not being adequately communicated to the public at this time. And then, some who get vaccinated do not gain protection from it due to having immunosuppression from other conditions or medications. Finally, there are those who are not staying up to date with vaccinations. The percent of the US population reporting receipt of the updated 2023-24 COVID-19 vaccine is only 13.7%. 

We are all interconnected, and no one can run the world on their own. We need to take a united stance. The fact is, the long-term effects from COVID-19 affect all demographics and health statuses, including young, formerly healthy people, and vaccinated people. It important for us all to use tools to prevent COVID-19 infection, and that means masking and cleaning the air.

If It Hasn't Gotten Me By Now, Doesn't That Mean I'm In the Clear?

If you haven't had any long-term effects after your first infection, and/or if your first infection was not severe, it does not mean you will not in your second, third, or fourth. Most people suffering from long COVID had mild initial infections. Because long COVID symptoms often do not appear until months after infection, many fail to connect their long COVID symptoms to their initial COVID infection-- which may have even been asymptomatic. Research shows that asymptomatic infections are both transmissible to others AND that they can result in long COVID. A 2021 study showed one-fifth of asymptomatic cases end up developing long-lasting symptoms.

There is not long-term immunity to COVID-19, and reinfections with new variants are common whether you are vaccinated or not. Any infection-gained immunity is short-lived. A recent Lancet study shows that reinfections are actually more likely AFTER prior Omicron infection (not less). And there is a growing body of research on long-term COVID-caused immune damage that refutes the ill-formed "immunity debt" hypothesis that has spread rampantly in the media and caused some people to fear using the tools that can protect them.

Importantly, the chance of poor health outcomes increases with every reinfection, as can be seen in this groundbreaking 2022 Nature study, summarized in the image below.  

Long COVID is NOT a thing of the past. Research is showing that it is still causing population-wide problems across the globe. March 2024 data shows that long COVID cases are surging in the US. A 2023 study on long COVID among Canadians showed that: "on those who reported ever experiencing long-term symptoms, those who continue to experience these symptoms (58.2%) outnumber those who have reported them resolved (41.8%).

As of June 2023, an estimated 2.1 million Canadian adults continued to experience long-term symptoms after a confirmed or suspected COVID-19 infection that could not be explained by anything else. Almost 80% of these adults had been experiencing long-term symptoms for 6 or more months and about half reported no improvement in their symptoms over time. When at their worst, these symptoms often or always limited daily activities for more than 1 in 5 Canadian adults who continued to experience long-term symptoms at the time of the survey. In addition, among adults who experienced long-term symptoms and were employed or attending school, more than 1 in 5 missed work days because of their symptoms."

They also showed increasing risks with each reinfection, as can be seen in the image below:

Long COVID can be serious and debilitating, often reported to impact life worse than cancer and other diseases. Intense fatigue and "brain fog" (a term some say is too mild and should be referred to as brain damage) from long-COVID was rated worse than those recovering from stroke, and similar to that of Parkinson's disease. Recovery remains rare. It affects all ages and demographics. Kids have been shown to be much more susceptible to Omicron infections than prior variants, with resulting damage to their lungs, immune systems, increased risk for diabetes, and systematic review showing a 1 in 5 chance of children getting long COVID. A Lancet study found the long COVID risks to be between 20-30% in children. 

What are we supposed to do then?

Why, wear a mask, of course! (We are the Maskers Comic after all!) And it is the easiest thing anyone can do to help get things back in track-- when you go around others households, wear a respirator mask, like an N95, KF94, KN95, or better. 

We are firm believers in using methods to prevent infection in the first place, because preventing COVID-19 infection protects against the acute effects of the disease, prevents further transmission to others, and prevents long COVID. It will help us in both the short-term and long-term to reduce transmissions both in our personal health, the health of others around us, and it will advance our fight against COVID-19 by reducing infections and slowing down its evolution, making the vaccines and treatments we do have more effective for longer periods of time.  

One-way masking on its own is not enough

Respirators, like N95 masks, along with cleaning the air, are non-invasive ways to filter out the SARS-CoV-2 virus from the air, making it much more difficult for it to infect you. And yes, we can filter out the virus. We have plenty of studies on the efficacy of N95 masks in filtering our aerosols and many industries use them from firefighters fighting wildfire smoke to people spraying pesticides, to carpenters using power saws to cut wood. They can capture tiny particles INCLUDING those that the virus travels on. 

Wearing a respirator mask as opposed to a surgical mask makes a huge difference. In a real world study on the efficacy of respirator masks in a COVID ward, when surgical masks were replaced with FFP3 (N95) respirators for nurses on a COVID-19 ward, infection risk declined by 52%-100%.

A pre-COVID study showed respirator masks significantly reduced infections with airborne pathogens, also showing continuous use of respirators to be more effective than intermittent use.

A 2021 report published in Science concludes face masks effectively limit the probability of SARS CoV-2 transmission, while also acknowledging that mask efficacy depends on airborne viral load, adequate fit and filtration, and other protections used. Many of us are not wearing fit-tested N95s and sometimes may have gaps, leaks, or times where we take the mask off for various reasons. For this reason, having more people masking, reducing the number of infectious people in a space, adding enhanced filtration of the air, reducing the density of people in a space and increasing personal space between people, and decreasing time in higher risk situations all should be added as well. Masks work better at lower viral densities. A 2022 study published in the Journal of Infectious Diseases found that fit-tested N95 mask combined with a portable HEPA filtration system offers the best protection against viral particles in the air.

In the image below from Sanford Health, you can visualize how the risks of COVID-19 infection and transmission decrease with more people masking. When the non-infected person is the only one wearing a mask, the chance for infection is still high.

A 2021 PNAS study found that when

• only the non-infected person wears a surgical face mask, with an infectious person speaking at a distance of six feet, the risk for infection reaches 90% after 30 minutes.

• With only the non-infected person wearing an N95 respirator mask in the same situation, infection risk remains at approximately 20% after one hour.

• When neither wears a mask the risk of the infectious person transmitting to the non-infected is 90% after only a few minutes.

• However, when both wear a well-fitting N95 mask, infection risk is only 0.4% after an hour. (Note: newer variants are even more infectious than the variants that were around when this study was done, meaning time to infectious dose may be less than these estimates). 

It is really important for us to advocate for others to mask along with us in a space-- ESPECIALLY in spaces we have to spend more than an hour of time in (even 20% is too high of risk for me personally, and that is just for 1 hour of one way masked time, using an estimate with LESS contagious variants than we have currently according to the above study). According to a 2023 study, transmission can happen in as little time as 20 seconds to 4 minutes. A Nature study from December 2023 also showed transmission can happen in as little as a few minutes in normal conditions.

Adding the correct infection prevention strategies makes huge a difference. A 2021 study showed universal masking is significantly better than one-way masking. And research shows adding mask requirements reduces the spread of COVI-19. A 2022 research article found that the mean observed level of mask wearing corresponded to a 19% decrease in the reproduction number (a measurement of how many people each infected person spreads COVID-19 to) , and stated that “the evidence that mass mask wearing reduces transmission implies that mandates (and other mask-promotion policies) may be effective against COVID-19 if and when they improve or increase the use of masks.” Adding increased air filtration also makes a difference. A 2022 study published in the Journal of Infectious Diseases found that fit-tested N95 mask combined with a portable HEPA filtration system offers the best protection against viral particles in the air.

We give more information on these all of these topics in our Multiple Layers: A Step Beyond the Swiss Cheese Model, where we also discuss the importance of clear public health messaging, such as the importance of openly acknowledging and expressing the risks of COVID-19 and long COVID, the need to push for political action, and the need for policies that prioritize public health over short-term economic interests. We also talk about the important responsibility of each individual and organization to develop effective strategies on how to prevent COVID-19 in our homes, schools, workspaces, and communities, and take a look at how to properly use the tools we have to prevent infection.

We all deserve to be given the information and tools we need to keep ourselves and others safe, while also being social. Creating that opportunity is what this website is all about. 

So, in short, is COVID still dangerous? Yes! Yes it is.

fight bad policies by creating good ones

Here are a few of our most recent pieces, developed to combat reduction in protections:

1: "Infection Control Policies Work" Although the short- and long-term risks of COVID range can be chronic, disabling, and deadly, it is important to know there are reasonable policies we can implement now to significantly reduce these risks. Read more here to learn what can be done, and feel free to share this short document (4 pages) with your schools and workplaces.

2: "CDC's 2024 Isolation Policy Change Unsupported; 14 Days Needed", fights back on CDCs reduced isolation time recommendation that appallingly encourages known contagious people to return to work and school; We advocate for a research-backed 14-day minimum isolation with test-out in order to reduce both symptomatic and asymptomatic spread (each makes up approximately half of the total spread of COVID-19). 

3: "Summary of the 2024 Senate Hearing on Long COVID":  COVID-19 is not the flu, and it poses much higher risks in both its acute infection state as well as in its long-term risks (often referred to as long-COVID or Post Acute Sequelae of COVID (PASC). Read more about the urgent long COVID problem addressed at the 2024 Senate hearing, and find out why action to increase long COVID awareness and research was given bipartisan support by senators. 

We have the knowledge and tools to fight back against poor policies and systems that do not benefit anyone, and we can create change for the better through clear, effective policies! Read more below, in "Clear Public Health Messaging Using Multiple Layers: A Step Beyond the Swiss Cheese Model", presented at the 2023 World Health Network Clean Indoor Air Expo, and which includes a comprehensive supportive document on what the layers of protection are and how they interact. 

In other words, if you have done things to enhance ventilation and filtration to 6 Air Changes per Hour (ACH), such as adding HEPA purifiers and/or CR-Boxes (see section below to learn how many/what type your space needs to achieve a certain ACH), then it will take them 69 minutes to flush out that space from a person  from another household, particularly if they are not wearing a respirator mask. Note: you cannot base this on whether or not they have symptoms, since asymptomatic spread is common. 

If you get 12 air changes per hour (ACH) , it will take 35 minutes to flush out that space. During that time, you should remain masked. Even if the other person was masked, it is still a good idea to wear your mask during that flush out period, since our masks are typically not fit tested, and people can be imperfect when wearing them. This is especially true if it is not a respirator mask (ie if it is a surgical mask it will have much greater leakage due to looser fit and poorer filtration of the mask material).

If you need to take a quick sip or a drink, you can use either a sip straw mask insert like the one in the section above, or go outside. Sometimes I myself will tell people they can do it, but to be very quick about it (studies show it take a few minutes to inhale enough virus to become infected), and that I don't recommend doing this when other people are also taking a sip at the same time. The virus has gotten more contagious and evolved ways to more efficiently attach to cell receptors, so it's best to make it quick if you need to take off the mask for whatever reason. 

Note:  Purification and Ventilation should be done in indoor environments ALONG WITH masking, and it is NOT a replacement for masking. Masking helps prevent short-range transmission from closer exposures, something that ventilation and filtration cannot do. Ventilation and filtration lower the amount of covid-19 particles that might linger in a room, and reduce chances of those particles building up in a room and getting into any gaps in masks over time. 

Total CADR, or Clean Air Delivery Rate, is a measure you need know for your customized space to achieve the 6-12 ACH, or Air Changes Per Hour, that are commonly recommended to reduce COVID-19 Risks. 

Note:  Purification and Ventilation should be done in indoor environments ALONG WITH masking, and it is NOT a replacement for masking. Cleaning the air makes masking more effective, especially over longer periods of time.