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Paul B. had ich live in his tank about 30 yrs. It can go subclinical. You can live with ich for years. But if you have a stress event like temp spike, tank move you will very likely get a massive ich outbreak.
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This is true, but don't necessarilly do what I do. It is better to quarantine and not have ich in your tank. Ich has always been in my tank, I know because when a fish is near death from either old age or an accident they get ich. I have a hippo tang that every once in a while is covered to such an extent I am sure he will be dead in the morning. He seems to be getting much better and I rarely ever see ich on him anymore. At least in the last month or so.
A couple of months ago I had a tank accident which severly stressed the fish. Due to this the fish that were ich free for all the years they were in the tank came down with ich. Some of my fish were ich free for 10, 12 and 18 years.
I run my tank differently than most people but for some reason ich is not a large concern for me. Most tanks do not run like this and if ich is in your system you will probably lose all of your fish.
My tank is an experiment and almost all of my fish are in breeding condition, fish in that condition have a "partial immunity" to ich.
This is only my opinion and I do not recommend anyone to run their tank as I do but I do recommend that people keep their fish in breeding condition which will go a long way to keeping them alive. If your fish are not building nests or exhibiting breeding behavior or dying before ten years then they are not as healthy as you believe. Their scales should shine like velvet with no abrasions and their colors should be vibrant, not the way they look in the store. Fish can only get into this shape by getting the correct food, not just flakes and pellets, they need fresh food like live black worms, fresh clams etc. and they need it every day. When I used to breed damsels in the seventees all I had to do was to feed live worms for two weeks and the fish would start to lay eggs. They would also look much different than fish on a typical fish diet of commercially prepared fish food.
I also give vitamins especially vitamin "A". Cod liver oil is mostly vitamin A. Fish in the sea eat mostly other fish. A large part of a fish is his liver and his liver is mostly vitamin A. Thats where Vitamin A comes from that you buy in a drug store. Our fish diet is severly limited in this vitamin and I believe they need it. It is an oil and it stinks. I put a drop in a little water, shake it up and since the oil floats I put a few flakes of food or freeze dried food in. The food soake up the oil and I feed it to the fish. It also leaves a small oil slick on the water but this will leave in a few minutes.
Have a great ich free day.
Paul