My Experience with Covid-19
...and updated mental models for the Delta variant.
While putting the finishing touches on my last piece analyzing Covid vaccination, I became sick with Covid. While I technically had a mild infection, I would not want it again, and for me, it was definitely more than a cold or flu. The Delta variant is about four times more deadly than a bad flu, and I’d say that tracked with my experience. I’ve had the flu two or three times in my life and this was definitely 3-4x as bad as those experiences. I was sicker than I’ve ever been with any other infection.
My sickness began with mild congestion and malaise, followed quickly by a massive headache and loss of smell, which we experience as about 90% of what we call taste. I could taste sour, salty, sweet, etc, but all of the depth of flavors were completely gone (a friend of mine sent me an interesting paper that says the loss of smell may be a defensive mechanism of the immune system, as the olfactory nerves cross the brain-blood barrier and could be a vector for brain infection, so the body simply kills them temporarily to protect the brain).
For the first three to four days, I felt pretty good besides these annoying initial symptoms. I continued working from home energetically, taking phone calls and virtual meetings, just with a nap in the afternoon. Sometime the following week, however, it became difficult to breathe, it was hard to get up suddenly without dizziness, and a continuous moderate cough emerged. At first, I refused to take ibuprofen out of the belief that the natural fever would help against the virus. But as my lungs became more and more inflamed, ibuprofen seemed like a better bet and eventually became necessary to reduce inflammation such that I avoided low blood oxygen and hospitalization. A new study showing better outcomes with early use of ibuprofen seems to back up my experience. I also took baby aspirin to reduce my risk of blood clots, which seem to be the main fatal risk for mild cases not requiring oxygen or ventilation.
In the worst of it, the hardest part of my day was getting up in the mornings after my blood levels of ibuprofen had depleted overnight. I was fortunate that laying on my stomach, which is how I normally sleep, stopped me from coughing and made breathing easier. But to leave my stomach, get up, and walk around in the morning now seemed like an overwhelmingly difficult task. My absolute lowest, scariest experience with Covid happened one of these mornings when I had delayed getting up 30-40 minutes, knowing it would be difficult. Finally, I had to make my way to the restroom. In that process, I became extremely light-headed and had to quickly lay on the bathroom floor to recover for a minute, before erratically stumbling back to bed and the certainty of adequate oxygen laying on my stomach. I was scared I had maybe stroked or something, so I grabbed the pulse oximeter, and for the first time during Covid, I saw it in the danger zone of around 90%. After this episode, I remained in bed on my stomach for over an hour recovering, waiting for the ibuprofen to kick in so I could actually start my day.
Recovery was slower and more frustrating than I expected. My symptoms began on July 28, and it was only this past Friday (August 27) that I finally had a weights workout that felt more or less normal compared to before Covid. In terms of strength, the experience probably set me back three months. My sense of smell started coming back in the second week, and has now almost fully recovered. Bitter flavors took the longest to normalize. At first, alcohol, wine, chocolate, and especially coffee tasted pretty bad. Now, everything tastes normal except for coffee, which still seems to be missing some of the flavor notes I enjoyed previously. I do find my sense of smell tends to fade during a meal, so my nose is probably still recovering.
In my previous post, I mentioned one thing I failed to account for in deciding whether to get the vaccine was the lost productivity of a mild Covid case. All in all, I lost probably three weeks in the prime of my life that I will never get back, and my to-do list just grew as I was out. So if you’re in a similar situation - too much stuff to get done and not enough time - getting the vaccine for the potential time savings from recovery alone (even from a milder, shorter infection) is a big benefit.
Not to be too dramatic about it, but this was the first sickness I’ve ever had where it felt like it was possible I could die. This did not result in any kind of deep spiritual experience because I was so sick I didn’t really have the energy to think about it. A life lesson I took away from this is that any end-of-life unfinished business, whether spiritual or practical, is unlikely to be resolved once someone becomes sick with a life threatening illness. We sometimes fear sudden, accidental death because it would prevent us from doing this sort of planning or settling accounts, but I’m not sure many people in the process of dying have the luxury of making final decisions, amends, or arrangements with their full mental and emotional faculties. Better to live every day like we will die, and plan practically for it well before death arrives.
In summary, Covid was much worse than I expected for someone of my age and fitness level. That statement may surprise some people who have known me in the past, but I spent a significant part of my late 20’s and 30’s fixing bad habits and building a base of fitness. I have a BMI of 23.7, exercise strenuously with both resistance and aerobic activities, and take a fistful of supplements every day (zinc, Vitamin D, you name it) and I increased my supplements during infection. I even took ivermectin (human pills, not horse paste) towards the middle of my infection when it got worse. None of that helped my mild case actually feel mild.
Someone close to me asked if I felt foolish for not vaccinating before this. I said I don’t think so because I was one of the first people I knew who was infected during the Delta wave. My original analysis based on the original Covid data indicated the vaccine was a toss-up for me; I have consistently recommended vaccination for people over 60 or with comorbidities. Something big has changed with the Delta variant (see details below). Unlike in previous waves, there are many more middle-aged people adjacent to my social circles dying and many more young people needing hospitalization. One local church in my mid-sized city recently performed four Covid funerals in a week, three for men in their 50’s. So while I don’t think I was foolish then, I would probably consider myself foolish now for avoiding it after having seen the full effects of Delta in our local community. Providence was kind to me in allowing me to surviving Delta with seemingly no lasting effects beyond natural immunity.
So what’s going on with the Delta variant and how have my mental models changed with new information? Here’s a quick update on how I’m thinking about it:
The Delta variant appears to be about twice as deadly as the original virus. This, and Delta’s contagiousness, pretty much blows up my previous risk estimation model. With Delta, even under absurdly conservative assumptions about vaccine safety, the reward to risk trade is statistically worth it for nearly everyone to vaccinate. The one exception might be for teenagers or early 20’s people in the top 5% of fitness among their peers.
The vaccines are less effective at preventing Delta infections, but about equally effective in preventing hospitalizations and death. The original studies showed the vaccines at about 90% efficacy, whereas with Delta there is only a 60% reduction in infection, but still a 90% reduction in hospitalizations and deaths.
Local county data backs this up. A friend recently analyzed data reported by Jefferson County, Texas in our local area. As of last week, 42% of Jefferson County was vaccinated, but only 6.2% of hospitalizations were among the vaccinated, which is even more significant when you consider that the vaccinated tend to be older, more vulnerable people. Also last week, there were 65 people on ventilators in Jefferson County due to Covid, zero of which were vaccinated. So the vaccine appears to offer a 90% reduction in the risk of hospitalization, and perhaps an even greater reduction in the risk of being put on a ventilator, i.e. potential death or serious lifelong disability.
If we look at any reasonably large county-level data, we see similar patterns. It seems unlikely a conspiracy could be coordinated among so many disparate, indepedent reporting authorities to cook these numbers.
If Delta is twice as deadly, why does it seem to be ten to twenty times worse than last year, killing more relatively healthy, younger people? First, most of those who were most vulnerable in the first wave, the elderly, have either died, recovered, or been vaccinated. The Delta variant also spreads faster, now approaching smallpox in contagiousness. The original virus was only somewhat more transmissable than a common cold. So while, yes, more people are dying as a percentage, most of the perception I believe comes from the higher transmissibility of the Delta variant. An enormous number of people have been infected over the past month, driving most of the increase in deaths.
With the original virus, it wasn’t an irrational strategy to rely on one’s good health as a backstop and just hope not to get infected before herd immunity was reached. This seemed like a reasonable approach in April or May. Why take the small risk of the vaccine if the virus was about to burn out anyway? Delta has changed the viability of such a strategy enormously. Because it infects vaccinated people who can spread it, the threshold we are going to need to have viable herd immunity is now pushed way up into the 90+% range. Hope is no longer a strategy. The question, and anyone so far uninfected probably has a small window to decide, is whether to catch it with the benefit of the vaccine or not.
The Covid vaccines do appear to be one of the most dangerous vaccines in history. It’s also true they are way safer than risking catching the Delta variant unvaccinated. If public health authorities would acknowledge that, but also emphasize that they are safer than catching Covid, they might have more credibility with convincing the public to get vaccinated.
I think one error I was making in my previous thinking about the vaccine was assuming that the risk of the vaccine and the risk of Covid infection were completely independent, like the odds of winning the lottery versus getting hit by lightning: one has nothing to do with the other. This doesn’t make sense, though, when we consider that the active ingredient of the vaccine is the spike protein. Pro and anti vax people agree that the spike protein induced by the vaccine is likely the cause of any legitimate post-vaccine side effects. So here’s a rather obvious consequence of that: if most Covid deaths are due to cytokine storms overreacting to the spike protein, wouldn’t we expect someone who has a really bad reaction to the relatively low levels of spike protein in the vaccine to also have a massive and dangerous reaction to the much higher levels of spike protein experienced during Covid infection? And since vaccine side effects are more manageable and predictable than Covid infection, wouldn’t it make sense, if someone had the bad luck to be overly sensitive to the spike protein, to prefer to have this reaction to the controlled, dosed spike protein in the vaccine rather than the uncontrollable levels induced by the virus? Especially since avoiding infection entirely is now almost impossible with the Delta variant?
Is there good news? With Delta spreading so quickly and thoroughly in the population, I am hopeful we will reach something like herd immunity after this wave. Because immunity, whether natural or vaccinated, is not perfect with this virus, it will not disappear entirely but may reach some sort of endemic status, like the flu. It will always be with us, but at manageable levels going forward. Immunity should also improve with each subsequent infection. As people survive it multiple times, symptoms should become milder and milder.
I am open to the idea, backed up by some studies, that natural immunity is better than vaccine immunity. This may be true, and I certainly hope it is true having had the virus. On the other hand, some studies show higher levels of antibodies in the vaccinated. Whether natural immunity is better is not relevant to the question since getting natural immunity requires surviving the virus. If it kills you, it doesn’t really matter whether natural immunity is better or not. The question is whether the benefits of vaccination exceed the risk before you become infected.
So now that I’ve survived Covid, will I get vaccinated? My plan is to assume I have immunity for 3-6 months. After that, I plan to get vaccinated unless new information changes my mind. I definitely do not want to risk having Covid again. Blood clots appear to be the most significant unmanageable side effect, so I’ll plan to again take baby aspirin a couple of days before and two weeks after receiving the vaccine.
