"If you think the COVID pandemic is done and ever-evolving variants pose no significant threat, consider these two realities.
"The first is a recent U.S. study published in the Journal of the American Medical Association. It tracked 150 million workers and their absences in the workplace in the United States since the end of the so-called public health emergency in 2023.
"Its central conclusion: “Health-related absences from work continued to track COVID-19 circulation and were 12.9 per cent higher in the post-pandemic period compared with before the pandemic (140,000 monthly absences).” Absences were highest in occupations with the greatest exposure to the public.
"The study added that continuing circulation of COVID variants has created “a new year-round baseline for work absences” that amounts to adding an additional flu-like season in the workplace.
"Reality No. 2: excess deaths. That’s the level of mortality above what it was before the pandemic. This metric has not returned to normal and remains significantly elevated.
"Just last month Swiss Re, a global insurance firm that analyzes mortality risk by forecasting future life expectancy trends, pegged that number of excess deaths at two per cent above the pre-pandemic annual mortality rate. When you extrapolate that number to North America’s population of 617 million, that works out to be 120,000 unanticipated dead people per year. That’s roughly the equivalent of two fully loaded standard commercial jets crashing and killing everyone aboard every day.
"Last month Neil Sprackling, a CEO with Swiss Re, cited long COVID as a significant factor contributing to that two per cent jump in excess deaths, particularly in people over the age of 65. He also projected that this excess mortality could last until 2030, or longer.
"These two realities underscore a fact that is scarcely mentioned in the media and has become politically unpopular to say. Nearly six years after the arrival of the COVID pandemic, the virus continues to undermine public health, rattle politics and unsettle the economy.
"This state of affairs remains an abiding concern to Yaneer Bar-Yam, a complexity scientist and one of the founders of the World Health Network, a sort of people’s version of the World Health Organization dedicated to protecting health through community action. The U.S. physicist has been studying and fighting the dynamics of pandemics from Ebola to COVID for 15 years.
A complexity scientist’s read on COVID
"At the beginning of the pandemic The Tyee interviewed Bar-Yam regularly because the scientist, who is currently based at MIT, was frequently ahead of the curve. He was one of the first to champion the importance of N95 masks in an airborne pandemic and he was one of the first to warn about the long tail of pandemics.
"Bar-Yam also was one of the first to recognize that vaccines would not end the pandemic, which is one reason why he advocated unsuccessfully to use public health measures to suppress the spread of the virus at the onset. In other words, he recognized and spoke about realities many politicians and public health officials couldn’t.
"So I decided it was time for a revisit. As it turns out, Bar-Yam, who lives in Cambridge, Massachusetts, has much on his mind. He thinks the fallout from repeated COVID infections poses a growing “existential threat” to human health. He is encouraged by the belated recognition of COVID as an airborne disease, including new Canadian standards for masks in health-care settings. And he is deeply worried about new evidence on how children are affected by long COVID.
Cumulative effects of COVID infections
"During our talk the physicist summarized what the science now says about COVID infections, whether they appear mild or severe. Every infection increases the risk for heart attacks, strokes and heart disease; for new-onset diabetes; for cognitive decline and dementia; for deregulating the immune system; and for reactivating viruses like Epstein-Barr or shingles.
"An epidemic of shingles, for example, is now afflicting young Chinese adults who have just recovered from a bout with COVID.
"At the beginning of the pandemic researchers worried about the effects of an acute infection requiring hospitalization. Now the focus has shifted to the long-term impacts of repeated infections and long COVID, says Bar-Yam. Here again the science shows that risks are real and cumulative, particularly among those suffering from long COVID.
“The science is saying our health is progressively deteriorating,” says Bar-Yam.
"Because COVID destabilizes the immune system, researchers are now beginning to see a link between repeat COVID infections and rising cancer rates in young people. One study recently found that a COVID infection can accelerate or increase cancer risk, while another study revealed that a COVID infection substantially heightened the risk of six cancers caused by the sexually transmitted human papillomavirus.
"In this vein Bar-Yam has also co-authored a new peer-reviewed paper in the American Journal of Preventive Medicine Focus that draws some disturbing comparisons between repeated COVID infections and untreated HIV infections, noting each can cause chronic inflammation, immune exhaustion and accelerated biological aging.
"Bar-Yam and fellow researchers are not saying that COVID is the same as HIV-acquired AIDS — the two are vastly different viruses spread in very different ways. But a comparison of the two immune destabilizers helps us see something that public health discourse has largely neglected: “We may be living through a slow-moving immune decline crisis.”
"A recent Brazilian study also noted parallels to HIV and concluded “that SARS-CoV-2 is much more than a respiratory virus — it is a complex immunomodulator that targets central defense cells themselves.”
"As a consequence Bar-Yam doesn’t think COVID should be dismissed or minimized. And he defends his definition of COVID as “an existential threat” with a deliberate choice of words:
“This virus causes system-wide injury that accumulates with each infection: brain damage that undermines decision-making, immune dysregulation leading to infections like Kaposi sarcoma and tuberculosis in lymph nodes — the very signatures of HIV-AIDS now rising again — and cardiac injury with accelerated aging,” explains Bar-Yam.
“‘Brain fog’ is not a metaphor; it is evidence of structural loss,” he adds. “We see it in the research, and we see it around us. I have friends getting sick repeatedly, losing clarity, judgment and capacity. This threatens everything our societies depend on. After just a few years, the decline is visible. A few more, and large parts of the population may be too impaired to function effectively, leaving us without the collective ability to respond.”
"No treatment currently exists for long COVID, which affects millions of Canadians. “But we do have prevention tools: clean indoor air, high-quality respirator masks, testing and smart avoidance of exposure,” explains Bar-Yam. Vaccination won’t stop transmission, but it still helps reduce severe acute disease. “The tools are here. The question is: why we are choosing not to use them?”
"At the moment Bar-Yam is tracking two significant potential responses to the lingering threat posed by COVID. One concerns actions that should flow from the realization that COVID is primarily airborne — a fact once denied by the World Health Organization and dismissed by the U.S. Centers for Disease Control and Prevention. The current scientific consensus not only accepts that clean air saves lives but is belatedly shaping new engineering protocols for schools and hospitals that, with other measures, could eventually help end the pandemic.
"Here in Canada, Bar-Yam notes, the country’s crowded hospitals stopped mandatory masking in 2023, but B.C., Prince Edward Island and New Brunswick have returned to proactive masking. Last summer the Canadian Standards Association, a non-profit organization that sets safety standards for the workplace, proposed significant changes for health-care institutions based on what the science says on aerosols.
"After widespread consultation with health-care workers, it recommended key changes in mask guidance:
"Respirators such as N95 masks need to be worn by health-care workers at all times in health-care facilities. The blue surgical masks known as “splash guards” aren’t good enough for workers to use as respiratory protection. Proper masks should be supplied free of charge in health-care facilities to everyone. And hospitals should require specific assessments for airborne diseases to determine minimum respiratory protection.
“After years of denial the international consensus is now shifting,” says Bar-Yam.
"The reasons for these changes are measurable. Respiratory diseases are one of the major reasons Canadians seek care at a hospital. But recent surveillance data from Canada’s hospitals shows between 25 and 50 per cent of patients hospitalized with COVID were infected inside health-care facilities over the last two years.
"A 2024 study in Open Forum Infectious Diseases found that universal masking at a St. Louis hospital cut hospital-acquired respiratory viral infections by about 35 per cent. Fewer infections in the hospital had other benefits. It translated into substantial cost savings in terms of drugs and care and quicker recoveries and shorter hospital stays for cancer and transplant patients. And it resulted in fewer staff shortages and interruptions in care.
Risks to children, and protections
"Bar-Yam’s second major focus is on kids and what should be done to shield them, given that new studies clearly indicate children are just as susceptible to long COVID as adults, and particularly after repeated infections.
“Long-term harm from COVID, especially in children, is now undeniable,” he states.
"At the beginning of the pandemic it was widely assumed that COVID had little impact on children or adolescents. Recent research says otherwise, notes Bar-Yam. “Now this new information has to be digested by society.”
"A study in The Lancet Psychiatry first sounded the alarm in 2022. It looked at more than a million patients, adults and children, over a two-year period and reported that the risk of cognitive deficit, dementia, psychotic disorder or seizures remained increased even at two years after a COVID-19 diagnosis. Children did not face an increased risk for mood and anxiety disorders compared with adults but did have an increased risk of “cognitive deficit, insomnia, intracranial haemorrhage, ischaemic stroke, nerve, nerve root, and plexus disorders, psychotic disorders, and epilepsy or seizures.”
"A 2024 JAMA study challenged the “misperception” that long COVID is rare in children or resembles that of adults. It reviewed the health outcomes of thousands of children aged between six and 17, both infected and uninfected. It found 10 to 15 per cent of children and adolescents developed long COVID after one infection, a rate similar to that of adults.
"The researchers also noted substantial differences in symptoms in children and adolescents, which make it harder to see what is happening. While school-aged children experienced more neurocognitive conditions, pain and gastrointestinal symptoms, adolescents reported pain, fatigue/malaise-related symptoms and loss in smell or taste.
"A 2025 study in The Lancet Infectious Diseases has further clarified matters, concluding that children and adolescents face a significantly higher risk of various long-COVID symptoms after reinfection with SARS-CoV-2. In fact, a second infection doubles the long-COVID risk for a child.
"The symptoms and conditions of long COVID in children can include inflammation of the heart muscle, changes in taste and smell, blood clots, heart disease, acute kidney injury, fluid and electrolyte disturbance, generalized pain, abnormal liver enzymes, chest pain, fatigue and malaise, headache, musculoskeletal pain, abdominal pain and cognitive impairment. When the Omicron variant was prevalent in 2023 and reinfections became routine in schools, the risk of long COVID increased across almost every measure tracked by the researchers.
"Many public officials have over the years claimed or hoped that reinfections of COVID would be milder or carry less long-term risk in children. “But we found increased risks for a broad range of conditions, challenging the assumptions many had that children bounce back quickly,” noted lead author Bingyu Zhang, an applied mathematics and computational science PhD student.
"The weight of science on the risk repeated COVID infections can pose to children’s health, says Bar-Yam, is “no longer murky.” He urges parents to take precautions, including masks, vaccinations and advocating for well-maintained and properly calibrated ventilation systems in schools.
"Bar-Yam recognizes that in many places COVID and concerted public health responses to the risk it still poses have been politicized along polarized lines. So he recently started Unpolitics. The initiative is dedicated to “rebuilding connections and creating a space where people, physicians, scientists and community organizers can act on what reality requires and not partisan or special interests and their priorities. It is about restoring links between knowledge, responsibility and benefits of co-ordinated action, the kind of action that actually improves lives and strengthens communities. The purpose of action is the public good.”
"He remains undaunted. “The fight in the big pandemic public health story,” says Bar-Yam, “has moved from proving COVID is airborne to building a public health system that acts like it.”
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