Within the context of the heightened tensions between Russia and the U.S., Russia, on 1st February 2022, through its foreign minister Sergei Lavrov invokes an article of a 1999 agreement (Reuters, 1 February 2022). What is is this agreement and which article does Lavrov use?
Download the 1999 OSCE Istanbul Document here or access to it on the OSCE website
The 1999 agreement is actually the OSCE 1999 Istanbul Document. It resulted from a summit between the leaders of 54 states participating in the Organisation for Security and Cooperation in Europe (OSCE) that took place in Istanbul in November 1999.
The Document notably contains a “Charter for European Security” (pp. 1 to 45), “Done at Istanbul, on 19 November 1999, in the name of”, follows the names and signatures of the countries signatory to the charter (pp.14 to 42).
As shown on the two images below, both the U.S. (p.15) and Russia (p.36) have signed the Charter, besides Canada and many other European and Central Asian States. Ukraine is also a signatory.
U.S. and Russia signatures to the Charter for European Security, done at Istanbul on 19 November 1999
Foreign Minister Lavrov refers to article 8 of the Document, that reads:
“8. Each participating State has an equal right to security. We reaffirm the inherent right of each and every participating State to be free to choose or change its security arrangements, including treaties of alliance, as they evolve. Each State also has the right to neutrality. Each participating State will respect the rights of all others in these regards. They will not strengthen their security at the expense of the security of other States. Within the OSCE no State, group of States or organization can have any pre-eminent responsibility for maintaining peace and stability in the OSCE area or can consider any part of the OSCE area as its sphere of influence.“
Art. 8, Charter for European Security in 1999 OSCE Istanbul Document p.3 [my emphasis].
From Russia’s point of view, any enlargement of NATO eastward is in contradiction with this article. Actions with possible security implications for Russia in a country such as Ukraine, also a signatory to the Charter, similarly are, too, in contradiction with Article 8.
However, from Ukraine’s point of view, the annexion of Crimea by Russia, may also be seen as being in contradiction to Article 8. And there, Russia may in turn argue it answered to the initial absence of respect to its security in 2013 and 2014 (see Crisis in Ukraine) that similarly contradicted Article 8.
Interestingly, in an early analysis of the Charter for NATO, the point invoked by Lavrov in Article 8 is not considered (see Victor-Yves Ghebali, “The OSCEs Istanbul Charter for European Security“, NATO Review, July 2000). This absence may show how much sometimes our focus on one aspect may make us blind to other aspects. This may also show some inability (intended or not) to consider how much NATO may be felt as threatening by others. This incapacity to consider others’ point of view was very much also at the heart of the 2013-2014 Ukraine crisis. This most probably remains true today.
On 21 January 2022, Alterre Bourgogne Franche-Comté organises its yearly conference Alterre Day on the theme:
Unsustainable! Which solutions for a better and desirable world? VISIO CONFÉRENCE – 21 JANVIER 2022
Don’t miss Alterre day
Book your day (conference in French) to follow the speakers who will demonstrate that there is a need to enlighten public and private choices, to develop knowledge, to change our habits for a possible, viable, acceptable, desirable future.
The Red Team Analysis Society is honoured to contribute to this day by bringing the geopolitical angle (see detailed programme below), which is so often forgotten, but, thanks to Alterre BFC, not this time.
Practical details
The event will be broadcast live via YouTube and Facebook, and in replay. Three sequences on the programme from 9.15am to 12.30pm, then 2.30pm to 4pm.
➡️ Register (official registration with Alterre) 👉 Download the program (pdf) on Alterre website, or read below (incl. English version).
9.15 – 10.45: Sustainability versus unsustainability, what are we talking about?
This first sequence questions the notion of “sustainability”, in its different meanings – ecological, economic, social, democratic – in order to better define the possible futures.
Dr Natacha Gondran is a professor of environmental assessment at the École des Mines de Saint-Étienne, where she is the “sustainable development and societal responsibility” delegate, and a member of the “Environment, city, society” joint research unit (University of Lyon – CNRS). With Aurélien Boutaud, she is the author of L’Empreinte écologique (La Découverte, 2009, republished in paperback in 2018) and Limites planétaires (La Découverte, 2020). She is a specialist in the “absolute evaluation of sustainability”. She will present the various biogeochemical processes that threaten the planet’s equilibrium and the limits that must not be exceeded without generating irreparable consequences (the “ecological tipping point”).
Dr Hélène Lavoix, doctor in political science from SOAS, University of London and holder of a master’s degree in international politics from the same university, founded and chairs The Red Team Analysis Society, a think tank, consultancy and training firm specialising in strategic foresight and international security. She is interested in all phenomena that create uncertainty and often threats at the political and geopolitical level. This includes issues destabilising the planet, from the Covid pandemic to climate change, from religious radicalisation to the rise of artificial intelligence. During her speech, she will explain the geopolitical issues related to the overcoming of planetary boundaries, from the competition for access to resources to the increasing instability of the world, not forgetting the emergence of new areas of geopolitical competition, as with the example of the deep sea.
11:00 – 12:30: What avenues for a desirable model?
Now that we have established the facts and the issues at stake, what avenues are being explored to invent the world of tomorrow, based on a sustainable and desirable model?
Véronique Varlin, Associate Director of the Observatoire Société et Consommation (ObSoCo) and member of the Scientific Council of the Ecole de la Banque Postale, has worked for twenty years in strategic consulting in communication agencies. Her talk will allow us to delve into the imaginations of the French and to explore their potential adherence to three utopian systems (ecological, security, techno-liberal) in order to try to draw a vision of a sustainable and desirable future.
Vincent Liegey, engineer, essayist and lecturer specialising in degrowth, is the coordinator of the social cooperative Cargonomia (distribution of local organic food products by cargo bikes) and is the author of Décroissance, fake or not (Tania Édition, 2021). After reminding us that infinite growth is nonsense in a finite world, he will invite us to consider a future world based on values different from those of today: open relocation, conviviality or autonomy. Only a paradigm shift will allow us to emancipate ourselves from the growth society, which is fundamentally unsustainable from an environmental point of view but, above all, increasingly morbid from a human point of view.
2.30 – 4 pm: Towards a sustainable economic system
The shift of humanity towards a sustainable and desirable model implies a profound reform of our economic functioning. But can the world of business operate ‘differently’? And if so, with what tools, based on what concepts, with what engine?
Aurélien Oosterlinck is coordinator of the Ecological Accounting Chair (AgroParisTech, Paris Dauphine and Reims Champagne-Ardenne universities). He is interested in the way in which accounting integrates ecological issues, even though accounting, which is the tool used to manage companies, has ignored this issue until now. However, the development of an “ecological accounting” is indeed a necessity to build a sustainable model.
Sylvain Breuzard, founder and president of Norsys, a company with a mission in the digital world, chairs the board of directors of Greenpeace and, in 2021, authored La permaentreprise: un modèle viable pour un futur vivable, inspired by permaculture (Eyrolles). The “perma-company” builds its raison d’être and its development on four inseparable ethical principles: caring for humans, preserving the planet, setting limits, sharing fairly. It is sober in its consumption of resources and seeks solutions in cooperation with other stakeholders. A demanding development model that leads the way.
A movie and a thought experiment in strategic foresight
The 2021 “Dune” movie by Denis Villeneuve is a deep reflexion about the future of political and strategic power (Denis Villeneuve, Dune, 2021). This movie explores the deep connections between the source and exercise of strategic power and the state of the environment. It is both a faithful and creative adaptation of the first part of the Frank Herbert’s classic science fiction novel (Frank Herbert, Dune, 1965).
Formally, the story follows the adventures of young Paul Atreides, heir to the Duke of Caladan planet. The galactic emperor offers the governance of the planet Arrakis to his father, the Duke of Atreides.
Arrakis, also known as Dune, is an arid, desert planet, where the “Spice” is produced. It is the most important product in the universe because it allows space navigators to follow the folds of space. As such, it is a basic condition for inter-planetary exchanges, and is the material basis of the imperium.
The “regime change” implied by the arrival of the House of Atreides on Dune triggers a conflict with the Harkonnen family. That House provided the former governors and exploiters of the planet, while it is the historical bitter foe of the Atreides. The feud that follows the new appointment by the Emperor ends with the slaughter of the house Atreides. It forces the young Paul to join the “Fremen”, the indigenous people that live in the sand desert.
Power and environment
As it happens, the whole movie hinges about the way the exercise of power is rooted in the determinisms of natural environments (James C. Scott, Against the Grain, A Deep History of the Earliest States, 2017). For example, the Atreides government strives to master the “desert power”, while being originally a “sea power” government (“Sea Power”, Encyclopedia Britannica). Strategically adapting to these determinisms is a life and death issue for political authorities.
This transition from water abundance to extreme scarcity supports an important reflexion about depletion and power. So, “Dune” is about the “great depletion” of everything, especially of water and biodiversity. The film illustrates how depletion follows climate change as well as the forms of power that emerge from depletion.
Thinking the future of geopolitics on a warming planet
It follows that this movie is not “simply” Hollywood entertainment. It is also a massive “thought experiment” in communication of strategic foresight and early warning about the future of geopolitics. As such, it is exemplary of the way Hollywood continually absorbs the emerging issues of the U.S political and national security debate (Valantin, Hollywood, the Pentagon and Washington…, 2005). The “strategic warning dimension” of this movie is about the risks of political and military maladaptation to climate change and their scenarization.
In this case, the notion of communication of “strategic foresight and early warning” reveals the depth of its function. It installs the spectator as a witness of what could be the fate of humankind when, in a few months, its most basic life conditions are being taken into a spiral of fatal degradation, while unable to adapt.
The Great Shift
Power and its “natural environments”
“Dune” explores the way the Atreides governance shifts from peaceful seapower to “desert power” for war. At the beginning of the movie, the Atreides family rules upon planet Caladan.
It is a very humid planet with a vast ocean. The Atreides rules it through “sea power”. However, the transplantation of the Atreides on Dune forces them to change and to try to master “desert power”.
The movie depicts this ecological, political and strategic transition from a water cycle regime to another.
Climate and strategic transitions
Indeed, it shows the destabilization of a powerful government by a rapid “turnover” of the ecological conditions in which it is embedded. The passage from the water rich Caladan planet to the arid Dune planet allegorises the climate and political violent changes that numerous countries and their government are already undergoing.
Thus, it resonates with the current consequences of the shifting climate and water cycle on Earth. For example, a recent study establishes that the southern Siberian climate shifts rapidly into a new regime (N. Kharlamova et al.,“Present Climate Development in the Southern Siberia: a 55 year observations record”, IOP Conferences Series: Earth and Environmental Science, 2019).
This new regime accompanies the aridization of the steppe-parkland area and of the mosaic of birch-forests, while the summer season is dryer than 55 years ago. Those climate and ecological conditions are shifting very rapidly, while turning a normally humid region into one prone to mega fires.
As it happens, during the 2021 summer, Russia had to face once again historic megafires in Northern and southern Siberia. In the south-east of Nizhny Novgorod, in the depths of the deep Russian forest, a huge battle against the fire took place near the secret city of Rasov (“Russian army helicopters join battle against Siberian wildfires”, Reuters, 14 July 2021).
Starting during the Soviet Union era, Rasov has been the city where Soviet then Russian weapons nuclear were developed. Containing the huge wildfire there was thus of strategic importance, hence the use of civil security and military forces (“Russian planes seed clouds as raging wildfires near power plant”, Reuters, July 19, 2021).
From a “Burning World” to an “Arid World”
This example reveals how, on a (very) rapidly warming planet, some extreme weather events such as megafires are multiplying and expanding in a region where, in summer, the climate used to be mild and humid.
In other words, Siberia integrates the planetary archipelago of places where, each summer, there are surges of tsunamis of fire. Those emerge in North America, Russia, Africa, South Asia, and Europe. Each year, they break former records and spread wider, while becoming much more intense.
These fires define the parts of the world that are going to become a place apart, i.e the “Burning World” (Jean-Michel Valantin, “Adapting to the Burning World”, The Red Team Analysis Society, November 9, 2020). These mega wildfires are already pushing modern emergency services to the limits of their response capabilities (Ed Struzik, “The Age of Megafires: The World Hits a Climate Tipping Point”, Yale 360, September 17, 2020).
This means that the governance of the Drying and Burning world turns into a new political regime. In this “New World” a singular continuity between civil and military capabilities establishes itself.
This happens in order to manage the suit of “improbable” crises that becomes the new reality. Following this line of thought one may say that “Dune” exemplifies what happens during the the “post-Burning world”. That is to say when humanity settles into the “Arid World”.
However, “Dune” also raises the question of the real ability of government to adapt if bioclimatic conditions shift rapidly and radically. In the case of the Atreides family in spite of their awareness, the change from one planet to another is so rapid that it lethally weakens them.
Maladaptation as a strategic weakness
Indeed its members lack the time necessary to adapt to their new bioclimatic conditions and to turn it into a source of power. That is when their worst enemies, the blood thirsty and revengeful family Harkonnen defeats them through a sneak attack.
The Atreides are all slaughtered with the exception of the young heir Paul and his mother. They seek refuge in the desert. There, they will learn the ways and means of desert power with the “Fremen”, the indigenous nomadic warrior people.
Desert power rules
The movie lays down the basics of “desert power” for the spectator. In order to turn the desert into a base and a means of strategic power, it is necessary to understand it as a dominant and hostile environment.
Indeed, the defining features of the desert are the fundamental danger of aridity, and the impracticability of an infinite landscape of sand, dunes and rocks.
The presence of hostile semi-nomadic tribes and of giant sand-adapted predators (the “worms”) exacerbates those features. Thus, the desert puts de facto “under siege” the modern cities from where “migrant elites” try to rule.
Cities under siege
So, the movie shows how the urban world may poorly fare in regions where climate is quickly aridizing the environment. In the meantime, cities become literal strategic trap because of their exposition to “desert power”.
In other terms, while nowadays urban development is a massive driver of the “Great acceleration” of the current planetary change, cities are the main losers of the “desert power” emergence (J.R McNeil, Peter Engelke, The Great Acceleration, An Environmental History of The Anthropocene since 1945, Belknap Press, 2016).
So, “Dune” literally shows how desert power derives from the perspective of the strategic actors looking at the cities from the desert. Desert power comes from the ability to “follow the sand”, thus being semi-nomadic and able to live with very limited resources, especially water.
This tightly controlled sobriety confers a tremendous advantage upon those dependent on urban infrastructures and on complex technologies. Indeed, the latter have to carry the expensive and ponderous resources to project themselves in the desert. Thus, “desert power” is also the ability to develop long duration strategies in a world of very limited resources.
In other words, the movie, as well as the novel, proposes a scenario regarding possible ways for a polity to gain the strategic high ground in an arid world. This strategic approach entails self-discipline, hard sobriety and endurance in a time of rapidly changing climate and depleting resources.
Controlling Spice and depletion power
Finally, the ultimate strategic advantage of “desert power” is the weaponization of resources depletion and the threat to use it. Indeed, “Dune” is the only planet in the known universe where the desert sandworms produce “The Spice”.
This singular product allows space pilots to find their way through the “folds” of space. Thus, without spice, the galactic empire disappears. Each and every planet would be left to its own resources, cut off from the routes of the interstellar commonwealth.
From a “Dune” point of view, controlling the Spice is the same thing as dominating the Empire. However, Spice production is inherently a segment of the planetary ecology. So, organizing a shortage, or even the final depletion of the Spice through the ecological destruction of the planet is an extreme form of “desert power”.
In this acceptance, “desert power” becomes “depletion power” and the most formidable tool for deterrence and domination.
Weaponizing depletion
From this perspective, it is possible to change the depletion of basic resources by “channeling” it. In this regard, the movie is a thought experiment about the evolution of contemporary strategies based upon the weaponization of resource depletion.
It is the case, for example, of the “dam wars” waged by Turkey upon Syria and Iraq. Turkey is the upstream country of the Euphrates and Tigris rivers, which cross downstream Syria and Iraq. Those rivers, that define antique “Mesopotamia”, are the main sources of surface water in a largely water poor region.
Thus, the Turkish political authorities master the water cycle as a form of political power and influence. It is especially true of the water management of the Euphrates and Tigris rivers. One must keep in mind the vital role of these rivers. They are going through a region where access to their water is a vital necessity for entire countries.
Channeling aridisation
In the 1960s, the Turkish political authorities developed a strategic framework for the water management and development of southern Anatolia. This project is known as the Southeast Anatolia Project, or “Guneydogu Anadolu Projesi” (GAP). It was first thought about by Ataturk, founder of the Turkish Republic, during the twenties (“History of the South Eastern Anatolia project”, South Eastern Anatolia Project Administration, March 31, 2006).
This roadmap, central to the political thinking of the successive governments, has led to the construction of 14 dams on the Euphrates River. Throughout the years, the construction of eight dams on the Tigris River has been completing the roadmap. (Joost Jongerden, “Dams and Politics in Turkey: Utilizing Water, Developing Conflicts“, Middle East Policy Council, 2010).
Channeling water wars
This immense water project is used for the development of electricity production and for agricultural irrigation (South Eastern Anatolia Project Administration, ibid). In the meantime, Turkey uses its control of the upstream water. This has often led to very high levels of tensions with Syria and Iraq. It was also the case with the different Kurdish factions.
It was especially the case in 1975 and 1990, when water tensions almost led to open war between the downstream countries and the upstream country, because of the drastic decrease of the Euphrates flow during the building of a dam (Michael Klare, Resource Wars, 2002).
Furthermore, these infrastructures and their control are a tool in the long-standing conflict between Turkey and the Kurds. They literally “weaponize” rivers. This weaponization derives from control and reduction flow of water.
Since 1975, the reductions of the water flows of downstream Syria and Iraq may be respectively of 40% and 80%. (Connor Dilleen, “Turkey’s dam-building could create new Middle-East conflict”, The Maritime Executive, November 6, 2019). In other words, Turkey channels a “long depletion” to its neighbours. Thus, they impact the economic development and life conditions of the downstream regions and countries (Klare, ibid).
Since the U.S invasion of Iraq in 2003, and the start of the Syrian war in Syria, Turkey has been using its dams to lower the water flows of both those countries.
The Turkish water management is both a highly political tool of development and a strategic weapon. As it happens, it is also used to develop South Anatolia, a poor area with an important Kurdish population.
In other words, the Turkish authorities now have a real knowledge in wielding and using “(water) depletion power”. It has become a massive tool of international influence. As the whole Middle East is rapidly aridizing, the Turkish depletion power is all the more efficient.
For example, during the historic drought of the 2021 summer, the Turkish-backed Syrian national army (SNA) built three dams on the Kabhour river. By doing, so, they cut the water for the Kurdish downstream communities, while those were already hammered by the drought. As it happens, the Turkish military offensive in Syria accompanies the this “water depletion” offensive.
This weaponization of water depletion literally appears as a small scale and very precise use of “depletion power”. This development of a new environmental strategic management is the core of the “desert power” that the movie explores.
As it happens, “Dune-part I” allegorizes the political and strategic tendencies that are currently emerging on our warming and depleting planet. It is a thought experience that warns us about the way climate change drives an international redistribution of power between the countries that will be able to adapt… and the others.
This brief article is an updated warning about the threat created by the Omicron variant. It is assessed with 15, 22 and 23 December 2021 information. It concerns a series of indications related to the risks of hospitalisation, to vaccination and to incubation period for the Omicron variant.
Since the Omicron variant was identified, early studies are carried out as quickly as possible to allow us understanding the threat better and thus improving our answers.
This warning follows up on the previous one, issued on 18 December, and completes and updates it.
The early assessments that have been recently published and we use here are:
Other studies are to be expected. Monitoring must of course continue.
Collectively, the very high infectious power of Omicron continues making it a very serious threat to societies.
At individual level, the situation, compared with the Delta variant, may be slightly less dangerous, notably for vaccinated people and only as far as hospitalisations are concerned. Yet, the bad news regarding the booster dose also introduces some new concern. Reduced incubation period and the danger of not understanding how tests function must also be taken into account, especially before Christmas and New Year.
The two assessments on hospitalisation risks are for the UK, however, considering past waves, they are indications of what could happen elsewhere in the world. We should, however, consider notably previous immunity acquired within the population before applying British findings to other countries.
It should be stressed, furthermore, that these assessments are made on a small number of cases, thus a host of factors could lead to changes. Also, we still do not have any assessment of lethality. We do not know either – and cannot know – about both possible complications created by Omicron after the primary disease nor about the risks involved in terms of Long COVID. Cautiousness thus must remain the norm.
In a nutshell, the British findings are as follows:
Reduced rate of hospitalisation compared with Delta variant
Average estimates
“… the risk of hospital admission for an identified case with Omicron is reduced compared to a case of Delta… An individual with Omicron is estimated to be between 31 and 45% less likely to attend [Accident and Emergency] A&E compared to Delta, and 50 to 70% less likely to be admitted to hospital.”.
Imperial College London estimates are less optimistic, but still encouraging. Always comparing with Delta,
The estimates suggest that Omicron cases have, on average, a 20-25%reduced risk of any hospitalisation and an approximately 40-45% reduced risk of a hospitalisation resulting in a stay of one or more nights.
Report 50, Imperial College London, 22 December 2021
The length of stay in hospital also appears to be reduced, however, data are insufficient for any thorough assessment (ICL).
But how dangerous was and still is Delta?
According to the Scottish study,
“Risk of COVID-19 hospital admission was approximately doubled in those with the Delta VOC when compared to the Alpha VOC, with risk of admission particularly increased in those with five or more relevant comorbidities.”
Thus, if we have around 50% less risk of hospitalisation with Omicron than with Delta, which itself had a risk of hospitalisation that doubled (actually 1.85) compared with Alpha, we are back to a rate of hospitalisation similar to what we had with the Alpha variant. This means the third wave (see Towards a Covid-19 Fifth Wave), but we then need to look at immunity, both natural and related to vaccination. As a reminder there was hardly any vaccination for the third wave.
Previous immunity and Omicron hospitalisations
Imperial College London gives us a more detailed picture of hospitalisation rates for Omicron.
People with no previously acquired immunity
If you have not been vaccinated, nor been previously infected with the SRAS-CoV-2, the prospects are slightly better than with Delta, but not that much:
0-30% reduced risk of any hospitalisation [compared with Delta]
Report 50, Imperial College London, 22 December 2021
People with existing immunity
“… the estimated reduction in risk of hospitalisation due to previous infection is… around 55-70% reduction“.
Report 50, Imperial College London, 22 December 2021
Vaccination and Omicron
The (relatively) Good
The efficacy of the booster dose is confirmed by the studies.
“Vaccine efficacy analysis continues to show lower effectiveness for symptomatic Omicron disease. There is evidence that protection against symptomatic disease wanes after the second dose of vaccine, and then improves after the booster…. There are insufficient severe cases of Omicron as yet to analyse vaccine effectiveness against hospitalisation, but this is more likely to be sustained, particularly after a booster.”
There is however bad news that is broken out by the UK Health Security Agency and that confirms or explains Israel decision to recommend a 4th booster shot:
“…the latest data suggests this extra protection starts to wane more rapidly, being about 15 to 25% lower from 10 weeks after the booster dose.”
Thus, after a booster dose, one needs to wait 2 weeks before to be protected against Omicron, and this protection will start diminishing at an unknown rate 10 weeks after the shot, i.e. 2,5 months. As a whole, the booster dose only offers a full protection for 2 months.
The Intriguing
“Intriguingly” to use ICL words, and although researchers caution about not relying too much on these findings, it would seem that a two course vaccination with Astrazeneca protects better from infection with Omicron than a two course vaccination with Pfizer or Moderna.
“Hazard ratios for hospital attendance with Omicron for PF/MD are similar to those seen for Delta in those vaccination categories, while Omicron hazard ratios are generally lower than for Delta for the AZ vaccination categories. Given the limited samples sizes to date, we caution about over-interpreting these trends, but they are compatible with previous findings…”
Report 50, Imperial College London, 22 December 2021
Some elements on Omicron and incubation period
Incubation is the delay between the moment when an individual is infected and the time when s/he will show symptom – and most of the time become infectious thus dangerous to others.
With the initial strain of the SARS-CoV2, the picture was slightly more complex as people could become contagious before becoming symptomatic (see Dynamics of contagion and the COVID-19 Second Wave). In the very few studies we found on Delta, Omicron and incubation, there is no mention of this factor. Indeed, for example the Nov 2021 study on Delta specifies that
The incubation period was defined as the number of days between the single contact and the onset of symptoms.
The story of the Norwegian 2021 Christmas party cluster is worth narrating in full, as it highlights perfectly well the risks that not understanding tests and incubation entail
“The company Christmas party held on 26 November 2021 and that one of the attendees had returned from South Africa on 24 November 2021…. The closed event was held in a separate room (ca 145 m2) in a restaurant in Oslo from 18:00 to 22:30, after which the venue was opened to the public from 22:30 to 03:00. A pre-party had been arranged for the Christmas party attendees at a separate venue, after which they were transported by private buses to the restaurant. Although there were no restrictions in place for events at the time in Norway, all attendees of the party were reported to be fully vaccinated and had been asked by the organiser to perform a rapid antigen self-test….”
On 1st December the attendee having been in South Africa tested positive. Out of the 117 people attending the Christmas party, 110 accepted to be surveyed. Out of the 110 attendees, by 13 December, 66 were confirmed cases and 15 probable cases. Hence, the attack rate of Omicron was estimated to be 81/110 = 78%. The average age of the attendees was 38 years old.
Thus, to summarise, 117 people think they are very careful and all healthy, and, as a result gather happily at an event. Then, reality strikes, 81 of them are finally infected with Omicron within three weeks.
On the bright side, none of these people needed hospitalisation by 13 December 2021. Of course, this does not mean that they did not then lead to chains of contamination that triggered hospitalisation. This does not mean either that all similar contaminations would never imply hospitalisation.
Tests only protect others … when they are positive
What does the above story highlights?
Tests only protect others … when they are positive. If you test positive, then you know you are infectious and can contaminate others. Thus you isolate, and start caring about yourself. It is absolutely critical to use tests to identify and then limit contamination as early as possible.
However, if you test is negative, then this only means that at the time of testing you were not infectious. But you can very well be in one hour, two hours or six or whenever until the end of the longest possible incubation period. Ideally, if you want to be really sure and really protect others, you would need to permanently test yourself. The device we would need would be more akin to heart monitoring than to COVID tests.
Omicron and incubation
Omicron possible incubation period
Out of Norway’s study, we have first elements regarding the incubation for Omicron.
The incubation period for symptomatic cases ranged from 0 to 8 days with a median of 3 days (interquartile range: 3−4).
The incubation period for Delta was estimated to be 4,3 days and for prior variants (original, Alpha, Beta, etc.) to be 5 days.
Finally, we found that the mean incubation period was shorter for Delta compared to non-Delta infections (4.3 and 5.0 days, respectively)…. We calculated the incubation period to be shorter for Delta (mean (SD) = 4.3 (2.4) days; median (IQR)= 4 (3-5)), compared to non-Delta infections (mean (SD) = 5.0 (2.4) days; median (IQR)= 5 (3-7)) (P < 0.001). Among non-Delta infections, the mean (SD) incubation time was 5.0 (2.3) days for Alpha, median (IQR)= 5 (3-7); 5.1 (2.7) for Beta/Gamma median (IQR)= 5 (3-7); and 5.1 (2.5) for non-VOC median (IQR)= 5 (3-7).
As the time for incubation is reduced, then it is much more difficult to stop contamination. Indeed, the human process that have been implemented will likely be slower than the spread of the infection.
The good news may be that if the longest length of the incubation period is confirmed to remain at 8 days and if there are no outliers, then possible quarantines can also be shortened. This is probably what we see happening, for example in England and probably in France. However, note that the scientific data upon which to ground this decision are still very sparse. The necessity to keep the various flows of a country going are also a major consideration in the decision regarding length of isolation period.
At the individual level, as long as there is no certainty regarding the length of the incubation period, even if you are authorised to end your isolation period, it would be safer for your loved ones and in general for people you will meet, if you were wearing a N95/FFP2 face mask and anyway reducing as much as possible contacts.
This brief article is a warning assessed over 15 to 18 December 2021 about the very serious, indeed “major, imminent threat” created by the Omicron variant (Neil Ferguson in Emily Head, Dr Sabine L. van Elsland, “Omicron largely evades immunity from past infection or two vaccine doses“, ICL News, 17 December 2021).
Since the Omicron variant was identified, we have been waiting for further assessments regarding this variant of concern (VoC).
Two such early assessments have been recently published:
European Centre for Disease Prevention and Control, Assessment of the further emergence and potential impact of the SARS-CoV-2 Omicron variant of concern in the context of ongoing transmission of the Delta variant of concern in the EU/EEA, 18th update – 15 December 2021. ECDC: Stockholm; 2021.
Neil Ferguson, Azra Ghani, et al., “Report 49 – Growth, population distribution and immune escape of Omicron in England”, Imperial College London, 17 December 2021 – with a Summary by Emily Head, Dr Sabine L. van Elsland, “Omicron largely evades immunity …“, Ibid,).
Other studies are to be expected, however the probability of the situation being imminently very serious is high enough to deliver a warning. Monitoring must of course continue.
Summarised current findings
Imperial College London assessments are for the UK, however, considering past waves, they are excellent indications of what could happen elsewhere in the world.
In a nutshell, Imperial College London findings are as follows:
The very high infectious power of Omicron is confirmed
“The proportion of Omicron among all COVID cases was doubling every 2 days up to December 11th… Reproduction number (R) of Omicron was above 3 over the period studied”.
Summary News, Imperial College London 17 Dec 2021.
Younger people seem to be more vulnerable than with previous variants
“The distribution of Omicron by age, region and ethnicity currently differs markedly from Delta, with 18–29-year-olds… having significantly higher rates of infection with Omicron relative to Delta. … the researchers note that given its immune evasion, the age distribution of Omicron infection in the coming weeks may continue to differ from that of Delta.”
“Risk of reinfection with the Omicron variant is 5.4 times greater than that of the Delta variant… protection against reinfection by Omicron afforded by past infection may be as low as 19%.”
Summary News, Imperial College London 17 Dec 2021.
Vaccination induced immunity strongly or mildly degraded
Vaccination (initial full scheme/two doses) does not offer protection, while the third dose/booster protects less than with the Delta variant.
“Depending on the estimates used for vaccine effectiveness against symptomatic infection from the Delta variant, this translates into vaccine effectiveness estimates against symptomatic Omicron infection of between 0% and 20% after two doses, and between 55% and 80% after a booster dose.”
Summary News, Imperial College London 17 Dec 2021.
Note, that as a result of these, the very idea of herd immunity disappears or must be revised, as we warned on 27 January 2021 (see COVID-19 Vaccinations, Hope or Mirage?).
Severity
It may be too early to completely assess the severity of the variant, however, so far, severity does not appear to have been lowered compared with Delta:
The study finds no evidence of Omicron having lower severity than Delta,
Summary News, Imperial College London 17 Dec 2021.
ECDC warning assessment
Therefore this study reinforces the alerts of the ECDC, very briefly summarised as:
“…We therefore assess the probability of further spread of the Omicron variant in the EU/EEA as VERY HIGH” .
“…We therefore assess the impact of the spread of the Omicron VOC as VERY HIGH.
“…the overall level of risk to public health associated with the further emergence and spread of the SARS-CoV-2 Omicron VOC in the EU/EEA is assessed as VERY HIGH.“
ECDC 18th Update
Responses and recommendations
Recommandations are full vaccination plus booster/third dose plus full non pharmaceutical interventions (NPI: “use of face masks, reduced contacts between groups of individuals in social or work settings, teleworking, expanded testing and strong contact tracing”- ECDC, and also disinfection of hands and possibly materials etc.).
“Rapid reintroduction and strengthening of NPIs is necessary”
“Vaccination remains a key component of the multi-layered approach needed to reduce the impact of the Omicron VOC, while also addressing the ongoing circulation of the Delta VOC.”
ECDC 18th Update
The ECDC stops shorts of highlighting the possible need for renewed lockdown, and prefers to stress the importance of testing and contact tracing, isolation, increase in health capacities and genomic surveillance.
Long COVID could be the next battle we have to fight and win in our struggle against the COVID-19 pandemic.
Thus, in this article, we seek to assess Long COVID in the framework of the fifth wave of the COVID-19 pandemic. This will also give us possible indications regarding how Long COVID could develop in the future, beyond the current wave. Our aim is to obtain an idea of the current and coming impact of long COVID. This early assessment will, in turn, contribute to the development of responses and strategies to answer this aspect of the pandemic, which has been so far rather ignored.
First, we explain our methodology. Doing so, we uncover some incoherence among the few serious available data on long COVID. We suggest ways to overcome them for our purpose, strategic foresight and early warning. Then we present the result of our evaluation as three short scenarios for Long COVID and the fifth wave: “Coming back to our senses“, “Optimism“, and “The price of ignorance“.
The first article of this series on Long COVID reviews current knowledge up to end of November 2021 (Helene Lavoix, “Long COVID and the Fifth Wave – The Hidden Pandemic“, The Red Team Analysis Society, 22 November 2021). It lays the foundation for our understanding of the disease. We also use when needed what was established in our other articles on the fifth wave of the pandemic (Helene Lavoix, “The Fifth Wave of the COVID-19 Pandemic and Lethality“, 9 November 2021, and “Towards a Covid-19 Fifth Wave“, 27 October 2021, The Red Team Analysis Society).
Estimating Long COVID for the fifth wave
Objective and limitations
Objective
As highlighted in the introduction, our objective is to get an idea of the current and coming impact of Long COVID.
We need a global estimate of people experiencing Long COVID each day. We also need to know how many of these people, each day, can carry out or not their activities. Furthermore, as our aim is foresight and strategy for preparedness and response, we need to be able to make forecasts, however tentative. Therefore, we use what has so far been understood of Long COVID, that appears to depend notably on infections, and thus we consider the factors favouring or constraining the pandemic in terms of contagion (see “Towards a Covid-19 Fifth Wave“).
With these estimates, we should start being able to envision collective global impacts.
Limitations
Considering the high level of uncertainty and the numerous approximations and estimates upon which we have to rely, what we shall get are mainly possible rough trends and indications (for an explanation of what are “indications”, see our seminal “Horizon Scanning and Monitoring for Warning: Definition and Practice“, The Red Team Analysis Society, revised ed., 2019).
Moreover, a major approximation that we carry out is to apply rates specific to the UK to the whole world. However, as the UK survey is the only national and historical data on Long COVID available, we do not have much choice. As explained below, we shall also, here, encounter a major problem, incoherence in data.
Hopefully, as countries start taking Long COVID into account, better assessments will become possible.
Methodology
Estimated daily cases of Long COVID
Bearing in mind the limitations faced, we apply Chen Chen et al. (Ibid.) global pooled prevalence rate, 43%, on world daily cases of infection. This gives us an estimated daily number of Long COVID.
For the past, we use real statistical data of daily cases of infection or more precisely daily COVID-19 tested positive cases, an approximative indication for the number of infection (Our World in Data using COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University). Note that even for past data, figures change every day, as corrections to datasets are made. Sometimes, important number of cases of infections are added a posteriori, more than one month later. This adds again another measure of uncertainty.
For the future, using our article “Towards a Covid-19 Fifth Wave“, we make three hypotheses or scenarios for the possible shape of the wave of daily global infections, as detailed below at the start of each scenario.
For all of these scenarios, we consider that the prevalence of Long COVID linked to the Omicron variant is the same as what we was observed with previous variants (WHO, “Classification of Omicron (B.1.1.529): SARS-CoV-2 Variant of Concern” – 26 November 2021). We must, however, underline that this is an unknown. The Omicron variant could lead to more, less, none or far more cases of Long COVID. The intensity and various characteristics of Long COVID resulting from Omicron – or other future Variants of Concern (VoC) – could also change. The new symptoms could only be a couple of weeks of tiredness, or on the other end of the spectrum a far more severe Long COVID. This should be monitored. Even with monitoring, it will take months and even potentially years before we start having an idea of the impact of variant Omicron or other VoC on Long COVID.
Daily number of Long COVID according to length of Long COVID
The next step was meant to be, initially, relatively simple to realise. It would prove far more difficult to handle than planned.
Finding the rates of Long COVID according to duration
The idea, originally, was to “simply” apply the proportion of Long COVID according to duration to the estimated daily number of people that would experience Long COVID and that we had obtained with the previous step.
The proportion of long COVID per length of illness was to be given by the historical monthly datasets of the United Kingdom Office for National Statistics (UK ONS – Tables 1 – Estimates of the prevalence of self-reported long COVID and associated activity limitation, using UK Coronavirus (COVID-19) Infection Survey data- Monthly datasets). The evolution of that rate, since March 2021, is shown on the graph below, which depicts the evolution of Long COVID throughout time in the UK.
Duration of Long COVID since first (suspected) coronavirus infection (Source: UK ONS – Tables 1 – Estimates of the prevalence of self-reported long COVID and associated activity limitation, using UK Coronavirus (COVID-19) Infection Survey data.- Monthly datasets )
For example, on a given month, the lightest brown segment represents new cases of long COVID as a new wave starts, waxes then wanes. The following month, part of these new cases have moved to the next category (Long COVID lasting between 12 and 26 weeks) and thus are depicted as a segment of a slightly darker brown. The new “entrance” in a segment joins the Long COVID cases of previous months still in this category, while some Long COVID cases end and other Long COVID cases move to the next category (26 to 39 weeks). Thus, each month, Long COVID cases move from one column to the next, going each time one category up.
However, we could not just take the percentage resulting directly from the monthly British tables. Indeed the number of cases and the proportions for one month concern all these people who experiment Long COVID for a given month (or for the period under investigation). However, as explained in the previous paragraph, each segment, in fact, links to a different period of time as far as the triggering event, infection, is concerned. For example, the 31 October 2021 result concerns people who were infected after 1 November 2020 (Long COVID lasting more than 52 weeks), and people who were infected between 8 November 2020 and 31 January 2021 for these Long COVID lasting between 39 and 52 weeks, and people who were infected at other periods for each other segment.
As we want to be able to move forward in our assessment, starting from the infections, we cannot take the British tables directly. We have first to recreate tables according to the time of infection and then to deduce a tentative rate for each length of Long COVID we shall then apply to our daily number of Long COVID.
Uncovering problematic incoherence
• Long COVID lasting more than one year: when the number of Long COVID exceeds the number of detected positive cases
We started with the longest Long COVID, the real estimates of UK long COVID that last over 52 weeks. These Long COVID correspond to people who were infected, knowingly or not, at least 52 weeks before the survey. Thus, for example, people declaring a Long COVID that lasted more than 52 weeks on 6 March 2021 had to be infected before 7 March 2020, i.e. at the very beginning of the pandemic.
However, when we compiled the different statistics, we found a surprising result. If we use the UK historical series for Long COVID, as well as the reported official statistics for COVID positive cases, we see, as shown on the curves below, that until August 2021, the number of Long COVID that lasted more than one year (the brown curve) is superior to the cumulated number of people that had tested positive to COVID (the yellow curve). We thus have more people with long COVID than people who were detected as infected. This incoherence continues up until August 2021.
Comparing declared long COVID longer than 52 weeks, infections and estimated long COVID prevalence (Sources: in text)
This statistical incoherence may stem from erroneous declarations (people badly estimated the start of their infection) and from largely unreported cases of infections, as people were infected, noticed it or not, did not report it and nonetheless developed long COVID. These two reasons are not mutually exclusive. We may, in any case, infer that a large part of asymptomatic cases were unreported and that they nonetheless developed long COVID.
With time, as more tests were done and as people probably became used to report their long COVID, biases were reduced. Yet, we remain with an enormous number of long COVID lasting more than 52 weeks, even for the last two monthly reports.
Furthermore, in the light of the British survey, the prevalence found by Chen Chen et al. (43%) cannot work for Long COVID lasting for more than a year. Indeed Chen Chen et al. (ibid) only looked at “prevalence for 30, 60, 90, and 120 days after index date”, i.e. 4 to 17,2 weeks. Thus, three and a half segments of the British survey are not included in Chen Chen et al. meta review. We can still, tentatively use Chen Chen et al. global pooled rate of prevalence, but only out of absence of alternative. In that case – a 43% prevalence for long COVID – the last UK figures would mean that all declared Long COVID will last for more than 52 weeks. Could this be true? It would be imperative to know.
• Potential meaning and consequences
If the numbers given by the British survey are representative, then we could have different explanations allowing to overcome the apparent incoherence.
The British figures could mean that a very large number of people infected with the SARS-CoV2 never completely recover, even if initially they do not feel any symptoms. This is the worst case scenario, because as infections spread, then cases of Long COVID of more than one year would also strongly increase.
Alternatively, the figures could also mean that those people who had a very long Long COVID initially were the most fragile, or the most predisposed to get Long COVID, and thus that their Long COVID lasted longer. With time, as infections rise, these people who are susceptible to get a very long Long COVID could become proportionally less numerous. In that case, the rate for a duration superior to 52 weeks will continue to fall, and maybe stabilise.
Actually, fundamentally, we do not know.
In this light, the British approach makes sense. By looking at the proportion of Long COVID compared to the overall UK population, the UK statisticians overcome the obstacle of detection of asymptomatic cases, as well as the challenge of variations in tests’ policies. However, they also make it difficult, if not impossible to anticipate. Thus, they have good indications to manage the present, but they cannot prepare for the future.
• Ways forward to handle this case in the framework of strategic foresight and early warning
In terms of foresight, this means it will truly be very difficult to estimate how many people could develop a Long COVID of more than 52 weeks in the future, starting from the identified number of infections.
As we want to be able to anticipate, considering the dearth of data, we can make the hypothesis that the final result for the last experimental statistics given by the UK (31 October 2021) is somewhat representative, despite biases probably remaining. This could be, in terms of rates, a kind of worst case scenario.
To give an idea of the immense uncertainty we face, we present below two curves, showing two estimates for Long COVID superior to 52 weeks (the brown dotted line): the first estimate was done with the UK statistics for 2 October 2021 and the second with the statistics for 31 October 2021.
Wild differences: two estimates for the number of long COVID longer than 52 weeks from 2 October and 31 October 2021 statistics of UK ONS survey (Sources: in text)
As is obvious from these two curves, the results are varying wildly as we go, for end of May 2022, from more than 3,75 million of Long COVID lasting for more than a year to around 1,5 million.
If we make a similar calculation for each of the minimal duration for Long COVID as resulting from the British survey, we see that the curves all vary as shown on the figures below. The Long COVID curves follow more or less the curve of infections, in a flattened way, but without simple linear consistency of rates. As a result, it is difficult to discern simple trends, and our knowledge is so far too limited to create a more coherent model. Much research still needs to be done.
Declared long COVID per length of long COVID, and corresponding infections and estimated long COVID prevalence (from UK ONS statistics for 31 October 2021)
In such difficult cases for anticipation, notably as far as the long COVID cases superior to 52 weeks are concerned considering the potential numbers involved, we need to use scenarios added to early warning and to adjust scenarios as knowledge increases.
Here, we shall only focus on one scenario. We shall consider that the Long COVID rates per duration of Long COVID all correspond to the recalculated rates for the 31 October 2021 UK survey (latest data available at the time of writing).
These rates will be applied to the global daily rate of Long COVID (even though we know that the meta review by Chen Chen et al. does not cover 3,5 segments), for each of the corresponding length of Long COVID. For Long COVID longer than 52 weeks we shall conservatively consider that the length of the illness is only these 52 weeks. Again, this is a major approximation. Here also, scenarios would be needed to consider various lengths of this type of Long COVID that could be, for example, 1 year (this scenario), 2 years, or for ever (a HIV type of scenario).
Once more, we want to stress that, even for the scenario selected here, the result will, obviously, only be roughly indicative.
All these steps being done, we now have a rough indication of people suffering of Long COVID daily in the world.
Severity of long COVID
Finally, we need to know the impact of Long COVID on daily activities. In other words, each day, we want to roughly estimate how many people with Long COVID will be completely unable to carry out their activities, will be somehow limited in their activity and will not be limited at all.
Always using the UK ONS monthly survey, as far as the limitation of activity is concerned, rates vary little over months, as shown in the graph below. We shall take the latest rates, i.e. those for 31 October 2021, for our assessment. This time we can be slightly more confident in our assessment, apart from the fact that we apply British conditions to the whole world, when, most probably, the rates vary immensely according to countries.
Estimated number of people living in private households with self-reported long COVID by subsequent activity limitation (Source: UK ONS – Tables 9 – Estimates of the prevalence of self-reported long COVID and associated activity limitation, using UK Coronavirus (COVID-19) Infection Survey data.- Monthly datasets )
Three Scenarios for Long COVID and the Fifth Wave
Resulting from our model*, we now have a rough daily number of people suffering from Long COVID estimated globally up until end of February 2022, furthermore sorted according to activity limitation. Using our earlier work on contagion (“Towards a Covid-19 Fifth Wave“), we created three scenarios to envision three possible shape for the fifth wave.**
We present these results first side by side to allow for comparison, then one scenario after the other. We detail more the narratives for scenario 2 and 3 than for scenario 1.
Estimates of number of people suffering of long COVID each day in the world until the end of the fifth wave of the COVID-19 pandemic: 3 scenarios (be careful the scale changes according to scenario).
What we see, first, is that Long COVID hardly follows waves. Rather, the waves can be observed but are transformed into ondulations towards higher numbers of daily Long COVID. Only the second scenario seems to show a stabilisation at a very high level. The last scenario would lead us towards a staggering 140 millions people suffering of Long COVID each day.
Similarly a relatively large and slowly rising share of the world population is limited in its daily activity, either slightly or a lot, a share that accelerates in the third scenario.
Scenario 1: Coming back to our senses
The first scenario considers that the global fifth wave of infection will follow a pattern similar to the second wave.
Borders have been more reopened than for the third and fourth wave, and non-pharmaceutical interventions as well as cautiousness have also been relaxed, considering notably an erroneous understanding of current vaccination and willingness to go back to a pre-pandemic world. Nonetheless, as infections rise, measures are reintroduced. The new Omicron variant is finally found as being highly infectious, as suspected initially; the “increased risk of reinfection” is also confirmed with time (WHO, “Classification of Omicron (B.1.1.529): SARS-CoV-2 Variant of Concern” – 26 November 2021; Juliet R.C. Pulliam et al., “Increased risk of SARS-CoV-2 reinfection associated with emergence of the Omicron variant in South Africa“, medRxiv [not yet peer-reviewed], 2 Dec 2021, 2021.11.11.21266068; doi).
The pattern of the fifth wave thus “looks” like the second wave, at a slightly higher level because of temporary complacency and because of the Omicron variant.
Scenario 1: Coming back to our senses – Estimates of number of people suffering of long COVID each day in the world until the end of the fifth wave of the COVID-19 pandemic
Daily, towards the end of December 2021, 110 million people in the world suffer of Long COVID. It is especially hard for those 21 million people and their families who cannot at all assume their daily activities.
The costs on individuals, families, companies, sectors and countries that started appearing previously do not relent. On the contrary, they go on and increase.
Scenario 2: Optimism
This is the most optimistic scenario. The pattern of the fifth wave looks like the pattern of the fourth wave.
The factors that could lead to this scenario would be vaccination that become more widespread worldwide while it reduces somehow infection. We also have a very positive impact on infections of the third dose or booster dose in those countries that had so far largely driven infections and lethality (Tal Patalon et al., “Odds of Testing Positive for SARS-CoV-2 Following Receipt of 3 vs 2 Doses of the BNT162b2 mRNA Vaccine“, JAMA Intern Med. Published online November 30, 2021, doi:10.1001/jamainternmed.2021.7382). Finally, the Omicron variant, despite being very infectious, has led to reinstate more reason and common sense in various policies and behaviour. As a result, we are in a situation that is more similar to what was done during the fourth wave.
The fifth wave in scenario 2 looks very much like the fourth. It is only very slightly stronger to account for the Omicron variant.
Scenario 2: Optimism – Estimates of number of people suffering of long COVID each day in the world until the end of the fifth wave of the COVID-19 pandemic
Daily, towards the end of December 2021, the number of people in the world who suffer of Long COVID seems to stabilise and even to become very slightly lower around 107 million cases. This number remains enormous, but, at least, it does not increase anymore. Life remains especially hard for those 20 million people and their families, who cannot at all assume their daily activities.
The costs on individuals, families, companies, sectors and countries that started appearing previously go on. However, the stabilisation, even at a high level allows for a modicum of adaptation. True enough, those sectors that have been disrupted will not really be able to go back immediately to what they were before the pandemic, but the alternative solutions that were imagined could be sufficient. Of course, this means that these solutions will have to last at least a couple of months more.
Scenario 3: The price of ignorance
This scenario is probably the most worrying. The pattern of the fifth wave for the infections would look like the first wave: global infections would rise to reach a new and higher plateau.
This scenario is grounded in a change of priorities, with the primary concern, worldwide, given to the return of an economic system similar or as similar as possible to what existed before the pandemic. Vaccination strongly lowers the number of severe forms of COVID-19 necessitating hospitalisation, as well as mortality. Thus, those cases of COVID-19 that remain, despite the daily load of deaths and sufferings, are deemed as acceptable for the sake of conserving the existing socio-politico-economic system. In most countries, policies and behaviour aim thus, as much as possible, to ignore the still continuing pandemic. Thus, infections rise, but do not trigger the type of responses that would be necessary to stop global contagion.
The arrival of the Omicron variant, past a few first weeks of return to caution, does not change policies and behaviour. Under pressure from the UN bodies and various actors, hinderance to travels and the few closure of borders that had been temporarily reinstated are abandoned. This is done even before we can assess with certainty the severity of the forms of COVID-19 triggered by the Omicron variant and definitely before any link or absence thereof to Long COVID can be made and understood. This is done even though the strong infectious power of the Omicron variant is confirmed.
As a result, the fifth wave looks like the first, but at a much higher level. In our timeframe (four months), it does not stop rising. Probably, it would continue going up and up until new more adequate policies are designed, or until the SARS-CoV-2 and the COVID-19 disappear or become benign.
Scenario 3: The price of ignorance – Estimates of number of people suffering of long COVID each day in the world until the end of the fifth wave of the COVID-19 pandemic
The number of people in the world who, daily, suffer of long COVID seems to never stop rising. It does increase less steeply than infections, but it reaches new heights every day, up to almost 140 million cases at the end of February 2022. Life remains especially hard for those 26 million people and their families who cannot at all assume their daily activities.
The costs on individuals, families, companies, sectors and countries that started appearing previously continue to rise. The disruptions that were partly stemming from Long COVID intensify. As Long COVID is not monitored and has been rising without awareness and care, disruptions erupt haphazardly and pile up. Production, logistics, services are hit and new solutions must be found. Cascading effects cannot always be stopped. On the contrary, domino effects increase as more and more people become prey to Long Covid.
Consommation also takes a toll. Indeed, people struggling and suffering, as well as their families, not only have less disposable income but also revise their priorities and are less encline to consume (e.g. Patrick W. Watson “The “Long COVID” Economy“, Forbes, 14 June 2021 using a commentary by David R. Kotok, “M2 Velocity, Fed & Years Life Lost (YLL)“, Cumberland Advisors, 27 April 2021).
China, which now fully benefits from its insistence on a zero COVID policy, is almost free, relatively, of the dire effects of long COVID (e.g. Helene Lavoix, “How China Could Win the War against the Covid-19 Pandemic“, The Red Team Analysis Society, 18 January 2021). Those countries like Australia or New Zealand who also kept their borders closed for a long time reap benefit of their cautious policy.
In the harsh context of great-power struggle and competition that is taking place internationally, China, unburdened by Long COVID, enjoys a very large relative advantage, directly and indirectly as it can showcase its foresight and acumen. On the other hand, Europe and the U.S. now must carry the ever increasing weight of Long COVID. At worst and on the long run, if Europe and the U.S. do not act and thus if they continue letting infections spread and Long COVID rule, China will have won the international contest simply by default of its adversaries.
Conclusion
Despite the many uncertainties and limitations highlighted, it is clear that the real impact of the COVID-19 pandemic definitely and imperatively must take into account Long COVID. The more the world in general, a country in particular, faces infections, the higher its burden in terms of sufferings, economic and financial cost, and disruptions. For countries, to these already immense burdens we must add loss of power, absolute and relative.
Further research would be needed to estimate more finely possible impacts, including through comparisons with previous pandemics. How resilient are the various systems within which we live, when confronted to this kind of grinding weight?
Long COVID is fundamentally disruptive, including because of the dearth of data and the absence of understanding we face. Data must be gathered, knowledge must be accumulated, treatments must be found and, waiting for these, solutions must be imagined. Policies considering Long COVID must be designed and implemented.
The price to pay to live with the COVID-19 without considering Long COVID may well be far too high to pay.
**Considering the dearth of knowledge and data on long COVID, the number of estimates and approximations, without forgetting the incoherence uncovered, we do not give probabilities for each of these scenarios, which are, at this stage, merely indications aiming at framing the issue.
In our precedent article, we saw that current conflicts are integrating climate related tensions. This process is literally transforming certain conflicts into “proto-climate wars” (Jean-Michel Valantin, “What are Climate Wars ?”, The Red Team Analysis Society, 2 November 2021). This transformation follows the way the chain of consequences of climate change influences the definition of the goals of war.
The same process most probably applies to internal tensions. Hence, we have to wonder if the interactions between climate change and domestic tension may lead to civil wars?
Civil war
In order to answer this question, we have to define what is a civil war. We propose to define it as a war that happens within the borders of a given country, between different but domestic armed parties fighting the state (Encyclopedia Britannica).
According to Max Weber, a state is the “legitimate monopoly of violence” (“Politics as vocation“, 1919). So, a civil war both signals its weakness and worsens it. However, this weakening may very well turn a civil war into a “disagregation war”, when and where the opposite parties keep on fighting, while war becomes its own finality (Harald Welzer, Climate wars: what people will be killed for in the 21st century, 2012).
Thus, a civil war implies a profound breaking down of the social, institutional and political order. As it happens, in certain areas and periods, climate change is already exerting effects on societies analogous to those of civil war.
So, we shall use the start of the Syrian war as a case study. First, we shall see how and why there was such social vulnerability in the face of the 2006-2011 long drought.
Then, we shall see how climate change and political tensions interacted in the Middle East and Syria during the Arab spring and the start of Syrian civil war in 2011.
Finally, we shall study how this led to the weakening of the Syrian State as a monopoly of violence.
First contact
Syria’s fragility
There are several studies about the links between climate change and the Syrian civil war. Several researchers identify the way the historic long drought of 2006-2010 destroyed the Syrian rural fabric (Werrell and Femia, The Arab Spring and Climate Change, 2013).
It led to a massive rural exodus of poor and destitute populations in badly prepared and managed cities. In this context, the ultra-rapid development of urban inequalities did create a vast reservoir of disaffiliated young people. Those were to become the first reservoirs of the insurgencies.
Building vulnerabilities
However, the very lack of resiliency of this semi-arid country, even in the face of a historical drought, is surprising. As it happens, the reasons for this vulnerability to drought takes root in the agricultural policy of the Assad regime since the 1990s (Aden W. Hassan et alii, “The impact of food and agricultural policies on groundwater use in Syria”, Journal of Hydrology, 29 March 2014).
At that time, the regime forcibly developed cotton cultivation for export to the international market. Cotton cultivation is very water intensive. So, the number of wells doubled between 1998 and 2006, thus overexploiting the quite limited Syrian water supply (Asan, ibid).
So, Syria was already suffering from an acute lack of water when the 2006 long drought started. Faced with this disaster, the Syrian state and its political authorities were basically impotent.
This crisis was even more profound that it took place in the larger climate-politics nexus of the 2011 Arab Springs.
The Arab Spring climate-bread-political nexus
The whole “Arab spring” process took place in the context of a general increase of commodity prices started a few years before. The impact on wheat was especially notable, particularly in 2007-2008, when, as corn and rice, wheat saw its price increasing by 100% (Michael Klare, “Entering a Resource-Shock World“, TomDispatch, April 21, 2013).
Consequently, food and, in particular, bread, the most important element (besides water) of the biological and social daily life for dozens of millions of poor Arab families and people in a dozen countries, cost more. This means: too much.
The world cereal market was under pressure because of three convergent factors. Those were a brutal spike of oil prices, a diversion from food to biofuel crops and financial speculation on commodities. It started an “epidemic” of food riots all around the third world (Michael Klare, “A Planet at the Brink“, TomDispatch, February 24, 2009).
Things grew even worse in 2010-2011, because of a series of extreme climate events on major areas of cereal production. There were giant droughts in Russia and China, and immense flooding in Australia. Russia decided immediately to withdraw what was left of its crops from the world market. Price spikes were the immediate market answer (Klare, 2013).
Thus, the bread prices heightened the Syrian social tensions, that were already embedded in the consequences of climate change.
Oil and Financial shock
However, in the same timeline as the drought, the Syrian oil output decreased dramatically because of geological depletion. The subsequent financial loss deprived the Syrian political authorities of their capabilities to answer the basic needs of the rapidly expanding very poor cities (Mathieu Auzanneau, Pétrole, Le Déclin est Proche, Le Seuil, 2021).
The state, the Syrian civil war and geophysics
In order to apprehend the central role that the “state of the Syrian state” plays in this crisis, we have to remember that, according to major political thinkers such as Thomas Hobbes (The Leviathan, 1651), Max Weber (Politics as Vocation, 1919) and Norbert Elias (The Civilizing process, vol.II, State Formation and Civilization, 1982), the state concentrates the monopoly of legitimate violence and a great capital of legitimacy, i.e. the right to rule as recognised by the population protected by the state.
In other terms, the legitimacy of the state is deeply rooted in its capacity to forbid other actors the use of violence. When the State is efficient, it is thus able to protect people from the violence of invasion, civil war, disaster or widespread crime (Norbert Elias, ibid).
Agriculture as a climate change attractor
So, in 2011, the Syrian State faces the interactions between unsustainable agriculture, extreme drought and oil depletion. Sadly, it is unable to protect the Syrian people and social cohesion. The Assad regime is unable to manage this crisis (Jason Burke, The New Threat, The Past, Present and Future of Islamic Militancy, 2017).
It is in this context that, in 2011, different insurgencies emerge during the “Arab Spring”. As in Tunisia and Egypt, those movements contest both the living conditions as well as the legitimacy of the political authorities. As soon as July 2011, the Assad governed state starts to fight them.
In other words, if there is no direct and immediate causality between the Syrian civil war and climate change, there are deep connections between the economic and social vulnerabilities and the profound and sustainable shock that the long drought inflicts on the country. Those conditions are profoundly destabilising and weaken the authority and capabilities of the state.
The result is a set of volatile social, economic and political conditions that fuel contestation while destabilising and delegitimising institutions ((Acemoglu and Robinson, Why nations fail, 2012).
As it happens, these geophysical and social interactions have to be understood as an integrated process. Indeed, in an arid country, in order to remain sustainable, the uses of water for agricultural, human, and urban needs are basically dependent on the limited availability specific to this resource.
However, the water cycle is basically embedded within the dynamics of the climate (AssessmentJohann Rockstrom and al., “Planetary boundaries: Exploring the safe operating space for humanity”, Ecology and Society, 2009). Consequently, the uses of water literally attract the dynamics of climate change inside the very fabric of the Syrian society.
So, it appears that climate change may very well inter-plays with the fabric of national and domestic tensions leading to a civil war. This means that this process may emerge in other countries when similar dynamics appear.
Thus, it is not specific to Syria or other “non-western” countries. So, we may wonder if this lethal combination could emerge in a great power ?
Featured image: The Euphrates River flows through Lake Assad in Syria in this photograph from the International Space Station as it orbited 263 miles above. NASA, 22 April 2021. Public Domain.
Strategic foresight and early warning are grounded in the idea of preventing surprise and more specifically strategic surprise. However, if we move away from the general idea of “strategic surprise” and try to be specific, i.e. if we try to apply the concept to a specific threat or issue we try to anticipate, then the exercise becomes remarkably difficult.
President Franklin Delano Roosevelt delivers his “Day of Infamy” speech to Congress on December 8, 1941, after Pearl Harbour surprise attack – Public Domain
The “surprise” part of the concept is relatively easily understood and envisioned. When we imagine a threat or danger occurring, we can identify and explain easily the many reasons why this event could happen unexpectedly and find us unprepared. However, understanding, assessing, and estimating these incriminated causes, then remedying them, is more complex. This is indeed the raison d’être of strategic foresight and warning and risk management, and the topic of many studies.
The strategic dimension, for its part, is more elusive and far less intuitive. For example, if you were asked to specify in one or two sentences the strategic-level impacts of the use of nano-drones for hostile action, or of the global exponential increase of long COVID, or of the global or regional shrinking of the pollinators’ population and had to answer the question immediately, would you be able to do it? This is actually a very difficult exercise.
D-day allied assault routes, from Center for Military History, US Army, Public domain, from Wikimedia Commons.
Try to carry out this exercise for any issue or problem that matters to you. Can you do it very quickly? Was it easier? Probably, if you have already thought about the question and researched it, if it is one of your area of specialisation and expertise, then the chances are that you will be able to answer easily. Yet are you really sure you are truly addressing the strategic dimension of the question? Or are you merely thinking – and wrongly so – that strategy is about the long term?
If the issue is about a threat that is obviously strategic, such as a war between Iran and Israel, or between China and the U.S., then it is easier to answer the question.
Yet, even in those cases, some strategic implications can easily be forgotten. But what would be your answer and how easily could you give it if the danger or the threat imagined relates to an entirely new area, as is most likely to happen if you try anticipating and getting ready for the future. How difficult would you find the endeavour if the danger of concern does not belong obviously to the more classical geo-strategic realm, for example an aspect of a pandemic? Would you even think about looking at the strategic aspect of the potential surprise?
This article focuses on the strategic component of the idea of strategic surprise. It underlines some of the major challenges that make it difficult to answer the “strategic-level impact question” and suggest practical ways forward (summarised in the conclusion). The aim of this article is modest and only hopes to contribute to facilitate debates on strategic impact and significance. Those debates will remain, and are necessary to obtain the best possible strategies.
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Thanks: I am very grateful to all those, throughout workshops, who have made this article possible, through rich and enlightening discussions, as well as with their comments and suggestions.
Bibliographic References
Balasevicius, T., Major, ‘Adapting Military Organizations to Meet Future Shock,’ Canadian Army Journal Vol. 12.2 (Summer 2009) 8-24.
Barfield, Ashley, John Bergstrom and Susana Ferreira, “An Economic Valuation of Pollination Services in Georgia,” Selected Paper prepared for presentation at the Southern Agricultural Economics Association Annual Meeting, Birmingham, AL, February 4-7, 2012.
Greene, Brian W., “Rethinking Strategic Surprise: Defence Planning Under “Bounded Uncertainty,” Technical Memorandum DRDC CORA TM 2010-186, August 2010.
Lee Wai Keong, Christopher, CPT, “Strategic Surprise,” Journal of the Singapore Armed Forces, Journal V24 N3 (Jul – Sep 1998).
Luttwak, Edward N., Strategy: The Logic of War and Peace, (Cambridge, MA: Harvard University Press, 2001 2nd edition), p. 4, cited by Crocker, “Thirteen Reflections,” p.2.
Yarger, Harry Richard, “The Strategic Appraisal: The Key To Effective Strategy,” In U. S. Army War College Guide To National Security Issues, Volume I: Theory Of War And Strategy, 5th Edition, J. Boone Bartholomees, Jr. Editor, Strategic Studies Institute Book, United States Army War College, June 2012.
Yarger, Harry Richard, “Toward A Theory Of Strategy: Art Lykke And The U.S. Army War College Strategy Model,” In U. S. Army War College Guide To National Security Issues, Volume I: Theory Of War And Strategy, 5th Edition, J. Boone Bartholomees, Jr. Editor, Strategic Studies Institute Book, United States Army War College, June 2012.
Featured image: USS California slowly sinking, USS Shaw burning – Pearl Harbor, 7 December 1941. By U.S. Navy [Public domain], via Wikimedia Commons – recolorised.
More than 110 million people have experienced or still suffer from Long COVID since the start of the pandemic (Chen Chen et al., full references and detail of calculation below). This is the number that follows from the findings of a study systematically reviewing the research done on Long COVID until August 2021 and published on 16 November 2021 (Ibid).
This staggering figure highlights that the condition known as “Long COVID” must be taken into account if we are to fully understand what it means to “live with the COVID-19”. More particularly, to estimate the multiple impacts of the fifth wave of the COVID-19 pandemic, we need to integrate Long COVID and its effects. Long COVID could well be, and this increasingly so, a key aspect of the pandemic, even though it has rarely been accounted for initially.
Thus, in this article in two parts, we focus on Long COVID. The first part reviews current knowledge. We try to comprehend in which way this aspect of the pandemic may impact security, understood in the broadest meaning of the word. We thus look first at what is Long COVID, its many names, its definitions, the number of people experiencing it, who is at risk in terms of age notably, how long Long COVID lasts and its intensity. We then turn to the vaccines and Long COVID. Finally, we start highlighting possible impacts, at individual and collective level. With the next part, we shall seek to assess more specifically Long COVID in the framework of the fifth wave.
We looked at the potential global lethality of the fifth wave with the previous article, after having focused on contagion and the shape the fifth wave could take, globally.
What is “Long COVID”?
Introduction to Long COVID
“Long COVID” is also known as “Post-Acute Sequelae of COVID-19 (PASC)”, “Chronic COVID-19”, “post-COVID condition”, and “Long Haul COVID-19”.
Long COVID means that, after having been infected with the SARS-CoV-2, one suffers for an indeterminate length of time, from three to nine months according to the WHO, or more according to the United Kingdom Office for National Statistics (see below), of some symptoms, among the 200 symptoms that have been identified (WHO Science conversation, “Post COVID-19 condition“, 30 July 2021).
The WHO suggests, for its part, the following definition:
“Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis.“
Long Covid does not include COVID-19 complications, defined as “any secondary disease that manifests after the acute phase of a COVID-19 infection. Multisystem Inflammatory Syndrome in Children (MIS-C), Chronic Kidney Disease (CKD), myocarditis/pericarditis, Chronic Fatigue Syndrome (CFS) or myalgic encephalomyelitis, and Kawasaki disease are complications known to be associated with COVID-19” (Chen Chen et al., “Global Prevalence of Post-Acute Sequelae of COVID-19 (PASC) or Long COVID: A Meta-Analysis and Systematic Review“, MedRxiv [not yet peer-reviewed], 16 November 2021, doi: https://doi.org/10.1101/2021.11.15.21266377).
According to Chen Chen et al.’s findings, globally, we can estimate that 43% of all COVID-19 tested positive cases develop long-COVID. Prevalence is worse for people who are hospitalised and reaches, in that case, 57%.
This is far from the “approximately 10–20% of COVID-19 patients” suggested by the WHO in its report grounded in a Delphi survey (WHO, “A clinical case definition of post COVID-19 condition by a Delphi consensus”).
Among others, this shows, once more, the danger of using the Delphi method, as Theodore Gordon highlighted (“The Delphi Method”, The Millennium Project: Futures Research Methodology,Version 3.0, Ed. Jerome C. Glenn). Incidentally, these dangers are repeatedly ignored. The methodology continues being promoted without users seeking to remedy problems. It is thus used again and again, most often without caution by many actors, including within governments.
The low prevalence selected by the WHO survey also shows, once more, that the WHO is first and foremost an international political body, thus an arena for diplomatic and normative struggles. Furthermore as an institution, the WHO also has its own agenda (see Helene Lavoix, The Coronavirus COVID-19 Epidemic Outbreak is Not Only about a New Virus, The Red Team Analysis Society, 12 February 2020). Hence, the WHO definitions and recommendations must always be seen and understood in their context.
Following Chen Chen et al., on 22 November 2021, this means that 110,5 million people have suffered or still suffer, globally, from Long COVID since the start of the pandemic (estimates of infection: 257,015 million on 22 November 2021, Reuters). This number rises every minute.
Always according to Chen Chen et al., the prevalence of long COVID varies according to regions with 49% for Asia, 44% for Europe, and 30% for North America.
These results are still estimates as studies differ widely in their designs, regarding for example the type of patients studied, when the research was done, or the type and length of symptoms considered. For example, Chen Chen et al. highlight that for global prevalence, “Estimates ranged widely from 0.09 to 0.81” (Ibid.). Furthermore, to have a better grasp of the prevalence, we would need to be able to consider evolution and changes according to variants.
Unfortunately, long COVID cases are hardly monitored throughout the world, a situation that should change if we want to address it properly. This monitoring is more than necessary considering the staggering amount of people concerned, the sufferings the disease entails and the various direct and indirect impacts of long-COVID, as we shall see below.
So far, we do not know exactly why someone develops long COVID. Indeed, the disease is not yet understood (e.g. WHO Science conversation, “Post COVID-19 condition“, 30 July 2021). Nonetheless, we start having some potential knowledge about the condition, that must still be considered very cautiously.
According to Chen Chen et al., women tend to be more at risk of long COVID than men: the prevalence in females is of 49% (95% CI: 0.35, 0.63), and in males of 37% (95% CI: 0.24, 0.51) (Ibid: 13). Pre-existing asthma seems also to heighten the risks to experience long COVID (Ibid.). However, as the authors highlight, these conclusions resulted from less than five studies and thus should be considered with caution. Other “pre-existing conditions such as obesity, comorbidity, and hypothyroidism” were also singled out as favouring long COVID (Ibid.), but such findings do not seem to sit well with the very high prevalence.
By the end of 2021, thus almost two years after the start of the pandemic, we are only certain of one thing: if we are infected by the SARS-CoV-2, even if we are asymptomatic, then we can experience Long COVID and the odds this happen are rather high.
Young people and even children increasingly experience Long COVID
Taking the British monitoring as indication, worryingly, long COVID seems to be spreading with time among the younger population. In November 2021 the percentage of the British people aged 17 to 24 years who had long COVID was “comparable to people aged 35 to 69 years” (Ibid.).
Furthermore, children also develop Long COVID. The British November 2021 survey highlighted that the percentage of long COVID increased among people aged 12 to 16 years, from 0,89% of the total UK population on 2 September to 1,27% on 2 October 2021 (Ibid, Table 4).
This corresponds to what was found in Israel. According to a mid-September 2021 survey by Israel Health Ministry,
Ongoing symptoms (long-COVID) exist among infected children in the state of Israel: 11.2% of all children experienced some symptoms after recovery, and about 1.8%-4.6% of them, depending on their age, continue to experience long-COVID symptoms after 6 months from the time of acute illness, as of the time of the survey. …
According to the same survey, the older the child, the higher the chance to experience long-COVID. Symptomatic children have a higher chance to develop the illness. Nonetheless, asymptomatic children also develop long-COVID:
“Among teenagers aged 12-18 who developed symptomatic illness, 5.6% experienced long-COVID compared to 3.5% among those who experienced no symptoms when confirmed as coronavirus positive. A similar situation has been observed among other age groups.”
According to Chen Chen et al. Meta-Analysis and Systematic Review (Ibid.), global prevalence of long COVID according to time since “index date”, which is the date for the positive COVID-19 test, but should ideally be the time of infection, evolves as in the following table:
Follow up time after index date (in days)
30
60
90
120
global pooled prevalence of long COVID
36%
24%
29%
51%
Global Prevalence of Long Covid according to time after positive test (from Chen Chen et al.)
Researchers explain the increased rates with time by an overrepresentation of hospitalised patients in studies of reference and drop out of people as they get better, both possibly distorting results.
If we turn to the UK ONS ongoing survey, we have the following figures. In October 2021, 1,2 million people reported they had long COVID (United Kingdom Office for National Statistics; “Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 4 November 2021). Out of these, “426.000 (35%) first had (or suspected they had) COVID-19 at least one year previously“; 204.000 (17%) thought they had COVID 19 between 39 and 52 weeks before (9,75 months and 1 year); 172.000 (14%) thought they had COVID 19 between 26 and 39 weeks (6,5 and 9,75 months) before; 46.000 (4%) thought they had COVID 19 between 12 and 26 weeks before (3 months and 6,5 months), 240.000 (20%) thought they had COVID 19 less than 12 weeks (3 months) before (Ibid).
It is difficult to compare the results of the two studies because the first considers the length of long COVID according to prevalence and the second according to long COVID patients. Furthermore, the first study only covers 120 days, i.e. 17,14 weeks, while the second goes beyond 52 weeks.
Both approaches are nonetheless informative and highlight the long length of time during which people suffer, while their family and society is also impacted.
How many of the people suffering of Long COVID are incapacitated by their symptoms
The symptoms of Long COVID are often incapacitating. Unfortunately, there is so far no treatment against Long COVID because the illness is not yet understood (WHO Science conversation, “Post COVID-19 condition“, 30 July 2021; Long Covid Diagnosis and Treatment by Dr. Seheult of Medcram – 5 June 2021: some data notably on prevalence are outdated).
According to a Swedish study, carried out between 15 April 2020 and 8 May 2020, among health care professionals after mild COVID-19, thus prior to the Alpha and Delta variants, 8 to 15% of people suffering of Long COVID saw their symptoms interfering with their daily lives (Havervall S, Rosell A, Phillipson M, et al., “Symptoms and Functional Impairment Assessed 8 Months After Mild COVID-19 Among Health Care Workers“, JAMA, 2021;325(19): 2015–2016, doi:10.1001/jama.2021.5612).
However, if we consider the ongoing monitoring carried out in the UK, by 4 November 2021, the proportion of people suffering from incapacitating symptoms is much higher:
“Symptoms adversely affected the day-to-day activities of 780,000 people (65% of those with self-reported long COVID), with 233,000 (19%) reporting that their ability to undertake their day-to-day activities had been “limited a lot”.
The variations between the two studies may stem from a host of reasons, the most worrying being an increasingly worse outcome because of variants, as well as, possibly, a repetition of infection creating some type of fragility.
Vaccination and Long COVID
What is the impact, if any, of current vaccination on Long COVID? Here again, we are faced with uncertain knowledge.
A 26 October 2021 study “reviewed data on nearly 20,000 U.S. COVID-19 patients, half of whom had been vaccinated (Maxime Taquet, Quentin Dercon, Paul J Harrison, “Six-month sequelae of post-vaccination SARS-CoV-2 infection: a retrospective cohort study of 10,024 breakthrough infections, medRxiv, [not yet peer-reviewed], 26 October 2021, doi: 2021.10.26.21265508). The researchers looked at “confirmed SARS-CoV-2 infection (recorded between January 1 and August 31, 2021), thus probably including Alpha and Delta variants. Considering the importance of the findings, I quote them at length:
This study… confirm[s] that vaccination protects against death and ICU admission following breakthrough SARS-CoV-2 infection [i.e. infection after vaccination]. … Our study also shows that vaccination against COVID-19 is associated with lower risk of additional outcomes … namely respiratory failure, hypoxaemia, oxygen requirement, hypercoagulopathy or venous thromboembolism, seizures, psychotic disorder, and hair loss. On the other hand, previous vaccination does not appear to be protective against several previously documented outcomes of COVID-19 such as long-COVID features, arrhythmia, joint pain, type 2 diabetes, liver disease, sleep disorders, and mood and anxiety disorders. … The absence of a protective effect against long-COVID features is concerning given the high incidence and burden of these sequelae of COVID-19. … our results highlight that some post-acute outcomes of SARS-CoV-2 (and notably long-COVID presentations) are likely to persist even after successful vaccination of the population, so long as breakthrough infections occur.
Another study has shown contradicting results. The research was realised on self-declaring people in the UK and its results were much more optimistic. It looked also at the impact of vaccination on Long Covid, with data covering variants between 8 December 2020, and 4 July 2021, thus mixing both the Alpha and Delta variants, and suggested that the odds to develop a Long Covid after vaccination was lowered by 50% (Steves, “Long COVID: double vaccination halves risk…; Antonelli M, Penfold RS, Merino J, et al. Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. Lancet Infect Dis. 2021;0(0), doi:10.1016/S1473-3099(21)00460-6).
Taquet et al. address the difference between their results and the UK study on self-declaring patients, highlighting among others that self-declaration may introduce biases. The 26 October study, being done in the U.S., does not include ChAdOx1 nCov-19 (‘Oxford/AstraZeneca’) vaccine, while the second does, as it was realised in the UK (Taquet et al. Ibid.). Further research would be needed, especially considering the positive potential of the ChAdOx1 nCov-19 (‘Oxford/AstraZeneca’) vaccine for Long COVID. However, if we look at the ongoing monitoring of Long COVID done in the UK, we still have significant figures for patients suffering of Long COVID, when the population is largely vaccinated. This would thus tend to suggest that even if the Oxford/AstraZeneca vaccine offers some modicum of protection, it is insufficient regarding the prevalence of long COVID and its intensity.
Another study at 120 days, but not considering the variant Delta, suggests that vaccination improves the condition of Long COVID patients (Viet-Thi Tran et al., “Efficacy of COVID-19 Vaccination on the Symptoms of Patients With Long COVID…“, SSRN/Preprints with The Lancet, 29 Sept 2021). Meanwhile, “the proportion of patients with an unacceptable symptom state” was reduced to 38.9% from 46.4% (Ibid.). Note that 38.9% people “with an unacceptable symptom state”, is still very high indeed.
As a summary, waiting for further research and bearing in mind the precaution principle, it appears wise to contemplate that the current existing vaccines, possibly, hardly have any positive effects on long COVID.
Furthermore, we know first that, considering the current state of knowledge, it is so far infection that triggers long COVID. Second, vaccines seem to have, at best, only a limited positive effect on infections (see Helene Lavoix, “Towards a Covid-19 Fifth Wave“, The Red team Analysis Society, 27 October 2021). Third, whatever protection current vaccines offer in terms of contagion, it is lowered in time as immunity wanes (Ibid). Thus, so far, the only certain means we have to fight and prevent long COVID are non-pharmaceutical interventions (face masks, distance, quarantines, lockdowns etc.).
Individual and collective impacts
Actually, for our purpose, the UK ONS gives us some very interesting data, as it also breaks down the intensity of incapacitation created by Long COVID according to length of illness, as shown in the graph below:
People with long COVID according to activity limitation and length of condition From Table 9: “Estimated number of people living in private households with self-reported long COVID by subsequent activity limitation, UK: four week period ending 2 October 2021”, United Kingdom Office for National Statistics; “Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 4 November 2021
This graph shows possibly also how debilitating long COVID can be as the longer people suffer, the more limited they are in their activities.
The figure of people being severely limited in their day to day activities and having started experiencing symptoms more than 52 weeks ago is substantial. It represents almost one mid-sized city.
In terms of impacts, it should be taken into consideration that one person who experiences a strongly limiting long COVID means that it is the entire family that will be impacted. Indeed, the person limited in her activities must be cared for, while the psychological impact on the family must also be taken into account. If ever the person who is suffering of Long COVID is the care taker and the resource provider, then the consequences are even more dramatic. One person with a partially or severely limiting long COVID thus actually means far more people being directly impacted.
As a result, the graph above highlights that a relatively considerable number of people will be “removed” from society as they will be unable to carry out their work. As the family is also impacted, this will also imply milder but nonetheless most probably perceptible impacts on society stemming from the increased burden and worry on the family.
Notably for small and medium size companies the impact of Long COVID can be disastrous. Indeed, the absence of one person may endanger the very survival of the company. For larger companies, which nonetheless have chosen tight employment policies, the impact of long COVID may also be very serious. Collectively, the severity of the impact will vary according to sectors, and analyses per sector of activity should be made urgently..
For example, it would be very interesting to estimate how much of the current ongoing disruptions of the global supply chain (e.g. Judy Greenwald, “Port logjams exacerbate supply chain risks“, Business Insurance, 1 Novembre 2021) can also be related to long COVID.
As a summary, it is obvious Long COVID is a serious condition, impacting many people and with many and possibly cascading consequences. Next, we shall turn to estimates regarding the future to have a better vision of what long COVID could entail for the fifth wave.
At the end of October 2021, we provided our third intensive training on early warning systems & indicators, part of this year programme on “management of social conflict” of the Ecole Supérieure des Forces de Sécurité Intérieure (ESFSI) of the Home Ministry of Tunisia.
The programme is supported by the European project “Counter-terrorism in Tunisia” via CIVIPOL. The first session took place in August 2020 and the second in March 2021.
It was a 40 hours long intensive training including lectures, tutorials for software and practice around real life issues. It was a fantastic week, as previously. Trainees were very committed, attentive and succeeded in learning new concepts and methodology very quickly and in applying them concretely to their everyday work.
Again, considering the COVID-19 pandemic, we did everything through Zoom, but we are now all used to this framework. It worked perfectly well, thanks to the ESFSI, the great team operating for CIVIPOL in Tunis, and of course, to fantastic trainees!
Trainees hard at work during a practice sessionTutorial for Early Warning: getting ready to practice with yEd graphThe Final Ceremony: I could be present through video but, here this was definitely not as nice as being there!
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