Updated 2023/09/22

1. The CDC and WHO, when dealing with live samples, consider SARS-CoV-2 a biosafety level 3 pathogen — the same level as measles and tuberculosis (CDC, 2020; WHO, 2020)

2. SARS-CoV-2 is airborne (Nature, 2022)

   1. The EPA states: "Transmission of COVID-19 from inhalation of virus in the air can occur at distances greater than six feet. Particles from an infected person can move throughout an entire room or indoor space. The particles can also linger in the air after a person has left the room — they can remain airborne for hours in some cases." (EPA as of 2021)

   2. The CDC recommends "at least 5 air changes per hour of clean air in occupied spaces" and published a table of cost considerations for various ventilation and air filtration strategies (CDC as of May, 2023)

3. It can spread without symptoms (Nature: News via archive.today, 2020; JAMA: Infectious Diseases, 2021; CDC, 2022)

4. In some settings it has entered through the eyes (Medical Science Monitor, 2021)

5. The Omicron lineage is more stable on surfaces (Emerging Infectious Diseases, 2022)

6. Between 1 in 3 and over half (56%) of people infected with an Omicron subvariant didn't show symptoms (Vaccines, 2022; JAMA: Infectious Diseases, 2022)

   1. Asymptomatic infections by previous variants have caused silent damage (JAMA: Infectious Diseases, 2020; Pathogens, 2021)

      1. 52% of the people who remained asymptomatic after being infected on the Diamond Princess cruise ship in 2020 still experienced lung abnormalities that were visible on a CT scan (Lancet: Infectious Diseases, 2020)
   2. A preprint found that vascular damage and red blood cell turnover occurred in patients without symptoms (bioRxiv, 2023)
7. The FDA recommends repeat testing following a negative at-home/rapid antigen test result — even without symptoms — to reduce the risk of a false negative result (FDA as of November, 2022)

   1. At-home/rapid antigen tests that rely on nasal swabs have been prone to false negatives early in infection (Microbiology Spectrum via Caltech, 2023)

      

8. Vaccines have helped prevent severe acute outcomes, including death (Current Pharmaceutical Design, 2022)

   1. Vaccines have been far safer than infection (Lancet: Infectious Diseases, 2022; Nature, 2023)

   2. The WHO determined that the risk of vaccine antibody escape for variant XBB.1.16 is "moderate, due to a similar immune evasion profile as XBB.1.5, the current dominant variant globally" (WHO as of April, 2023)

9. SARS-CoV-2 can establish asymptomatic persistence (Nature Immunology, 2023: "Factors that differentiate SARS-CoV-2 persistence in PASC from persistence in asymptomatic individuals should be explored.")

   1. There is no evidence to date that the immune system is capable of fully clearing SARS-CoV-2 from the body. One study demonstrated asymptomatic persistence and "clearance" after vaccination, though their definition of clearance was when the patient stopped shedding detectable amounts, which doesn't mean the virus isn't persisting in other locations (Nature: Signal Transduction and Targeted Therapy, 2023)

10. “Mild” covid (NIH, 2023: "any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhea, loss of taste and smell") has caused:

    1. Immune dysfunction & dysregulation (Journal of Clinical Investigation, 2021; Nature: Signal Transduction and Targeted Therapy, 2021; PLOS Pathogens, 2021; Nature Immunology, 2022; Immunity, 2023)

       1. The immune system is not analogous to a muscle that needs to be used to be kept in shape, and there is no material benefit to any amount of viral infections (Financial Times via archive.today, 2022)

       2. "Sweden made global headlines for its decision to combat the spread of the virus with mostly non-coercive measures while the rest of Europe went into varying degrees of lockdown" (The Local, 2021). The Public Health Agency of Sweden reported for the week of May 8-21, 2023, that "people under the age of 18 without underlying disease or condition have been very seriously ill with complications such as myocarditis or encephalitis" (Folkhälsomyndigheten, 2023)

       3. A preprint found that "even remote, clinically mild SARS-CoV-2 infection could have long-term consequences on tissue-based immune homeostasis," notably chronic T cell activation for at least 2 years (medRxiv, 2023)

       4. "Throughout the pandemic, scientific evidence has mounted that even mild COVID infections may be doing something to our immune systems, as well as our collective immunity" (Memorial Sloan Kettering Cancer Center Library, 2023)

    2. Capillary clotting (Biochemical Journal, 2022)

    3. Arterial stiffness (Journal of Clinical Medicine, 2023)

    4. Chronic pro-inflammatory gene expression (Genome Medicine, 2023)

    5. Accelerated biological aging (International Journal of Molecular Sciences, 2021; Nature Communications, 2022)

    6. Damage to:

       1. The nervous system, brain, & blood-brain barrier (Nature Medicine, 2022; Journal of Neuroinflammation, 2022; Nature: Signal Transduction and Targeted Therapy, 2022; Neuroscience and Biobehavioral Reviews, 2023; Neurology, 2023; Nature: Cell Death Discovery, 2023; Journal of Neuroinflammation, 2023; Journal of Magnetic Resonance Imaging, 2023 [unvaccinated cohort])

          1. The vagus nerve (PLOS One, 2023)

       2. The heart (Journal of Virology, 2022; Circulation Research, 2023)

       3. The kidneys (Nature Reviews Nephrology, 2021)

       4. The inner ear (Nature: Communications Medicine, 2021)

       5. Mechanisms that play a crucial role in preventing cancer (Biochimie, 2023)

    7. Cumulative damage upon reinfection (Nature Medicine, 2022)

    8. An increased risk of:

       1. Heart disease and stroke (Nature Medicine, 2022)

       2. Diabetes, including pediatric (CDC, 2022; JAMA, 2022; Lancet: Diabetes and Endocrinology, 2022; JAMA: Infectious Diseases, 2023)

       3. Serious health complications and premature death (JAMA: Health Forum, 2023)

          

11. Between August 1, 2021 and July 31, 2022, "among children and young people aged 0 to 19 years in the US, COVID-19 ranked eighth among all causes of deaths, fifth in disease-related causes of deaths, and first in deaths caused by infectious or respiratory diseases," accounting for 1 in 50 deaths in this age group (JAMA: Public Health, 2023)

12. Out of 40 studies worldwide that assessed "the prevalence of any symptom" among 12,424 children and adolescents, as of December 11th, 2022, 15% suffered at least 1 symptom at least 1 year after infection (Journal of Infection and Public Health, 2023)

13. Out of 31 studies worldwide (including preprints) that assessed "more than 20 persistent symptoms and clinical features" among 15,000 children and adolescents, as of December 2022, 16% suffered at least 1 symptom at least 3 months after infection (Pediatrics, 2023)

14. The rate of long covid symptoms at 6 months among a vaccinated, post-Omicron subcohort of adults (median age 47) with 1 infection was 16%, while the rate for individuals with more than 1 infection was 21% (JAMA, 2023)

15. Between October 2019 and October 2022, 70.4% of household transmissions in the US were sourced back to children (JAMA, 2023)

16. As of August 2022, according to medical billing records from Japan, the reinfection rate for the Omicron lineage has been 3.7 months, or about 3 times a year (Kyodo News, 2023)

17. Australia reported an excess mortality rate of 6% for the first three months of 2023 (Actuaries Institute, 2023)

18. The US Department of Health and Human Services considers "Long COVID" a disability under the ADA (HHS as of July, 2021)

19. The CDC is no longer tracking reported cases, focusing instead on hospitalizations and deaths (CDC as of May, 2023)

    1. In September 2022, the number of reported cases were a quarter of what they were at their peak the winter before. The director of the Institute for Health Metrics and Evaluation estimated that only 4% to 5% of infections were being reported, because many of the infections uncovered through at-home tests either weren't reported to public health departments, or weren't detected at all (NBC News, 2022)

20. Among outpatients in the US between December 30, 2020 and January 28, 2022, treatment with metformin — a drug used to treat type 2 diabetes — reduced the incidence of long COVID by ~41% in a decentralized, randomized, quadruple-blind, parallel-group, phase 3 trial (Lancet: Infectious Diseases, 2023)