The Long Road with Long COVID
With infections dropping, COVID-19 seems to have become obsolete. What’s next?
In July 2022 over 6.6 million people were getting infected (officially) from COVID every week and over 12,600 were dying from that infection. From that summer surge until now, that number has plummeted to 999,848 infections and 6,021 deaths – both of course underestimates.
At the same time, attention in global media on COVID-19 has also dropped almost out of site. But the public health emergency is still in place globally and in the U.S. and there remain sticky, long-term issues to consider. After emerging from the COVID-19 pandemic, what should we be looking out for when it comes to this virus?
Of course, COVID-19 has reshaped many aspects of our lives and our health care systems. Globally, debates will continue on how to prepare for the next pandemic. But let’s consider the impact the COVID-19 pandemic had on both mental and physical health. As we take these strides away from our years of lockdown, with all the advances of new vaccines technologies, it is important to remember that there are millions of people still fighting COVID-19.
Here at Globe, we felt it would help, in a two-part series, to discuss both the physical health concerns posed by the post-viral infection, as well as the social concerns of COVID-19 long term for the world's vulnerable populations.
We begin with the most prominent, but least understood: mainly, the long term effects of COVID-19 on people’s physical health – the syndrome known as “Long COVID.”
Based on studies done by the Centers for Disease Control and Prevention (CDC), one out of five survivors aged 18-64 and one out of every four survivors aged 65 years and above present with at least one ongoing symptom post COVID-19 recovery. This is an astoundingly high number of patients who are still wrestling with COVID long after it has faded from the headlines.
In fact, 43% of those infected with COVID-19 globally have reported experiencing post COVID-19 symptoms. With over 200 symptoms associated with it, Long COVID can affect virtually all organ systems. However, the most common ones relate to the lungs, cardiovascular systems, and neurological system. In countries with biodata bases like the UK and in special clinical studies of COVID patients over time, researchers have documented severe damage in multiple organ systems as well as immune system strain and inflammation.
As with much of public health, the impact of COVID-19 and therefore Long COVID has disproportionately affected individuals based on a range of socio-economic factors, specifically ethnicity, age, obesity, pre-existing co-morbidities, and some other environmental factors.
COVID-19 and Long COVID are not just a medical phenomena but also reflect the increased social division and global inequity in a way not seen since the HIV pandemic. In fact, in Canada it was found that after adjusting for age, sex, deprivation and relevant co-morbidities, Black, Asian and minority ethnic groups were nearly 1.5 times more likely to die from COVID-19 related complications. Furthermore, it poses another threat to healthcare capacity as it promises a continued strain on medical resources.
However, everyone is at risk for Long COVID, not only those who fit into the “at risk” category. There is in fact only around a 50% decrease in your likelihood to get Long COVID from your second infection. This does not mean complete immunity! COVID, and the long term impacts of Long COVID, can seriously impact even the healthiest of immune systems. We must remain vigilant and conscious of decisions that may impact our health.
Despite a massive push for research and innovation that COVID-19 created in the area of vaccines, there is a significant lack of treatment options and research into Long COVID. The U.S. federal government alone invested over 2.3 billion dollars in research and development for mRNA vaccines. With only one antiviral drug available to treat COVID-19, Paxlovid, which is still not available in most LMICs, there is still a long way to go. “We cannot say we are learning to live with COVID-19 when 1 million people have died with COVID-19 this year alone, when we are two-and-a-half years into the pandemic and have all the tools necessary to prevent these deaths,” WHO Director-General Tedros Adhanom Ghebreyesus said. This division in access to drugs and treatment will continue and worsen with the increasing number of Long COVID cases that are presenting. These complications are only emphasized by the fact there are still doctors that do not believe Long COVID exists.
Widespread ‘COVID fatigue’ has taken over, meaning there is much less of a push to find out more about this virus. In part 2 of this article, *Vulnerable and Forgotten*, we look at the challenges that COVID-vulnerable populations are facing in the “post pandemic” world.
Looking forward, it is clear that governments and global health partners must look beyond just vaccine development if the world is going to truly manage the next “phase” of COVID-19. However, there are some promising developments. Currently, Post COVID Treatment Centers are emerging in many hospitals to cope with the increasing number of cases. The UK and Italy are two examples of European countries who have opened treatment centers equipped to deal with the wide range of symptoms that come with post-COVID infection.
For Dr. Piero Clavario, the director of a post COVID rehab institute in Genoa, Italy, we have a basic task of building our knowledge base beyond what existing testing has shown us. Such Long COVID centers, according to Dr Clavario, must “...investigate aspects that escape standard virology and pulmonary exams.” These centers have the necessary equipment as well as understanding that detecting post-COVID complications sometimes requires a multi-organ analysis.
Although the care pathway for Long COVID is still evolving in most countries, there are some recognized resources for use by clinical teams that are geared towards individual patients and their symptoms. A key piece of most of these care pathways includes rehabilitation therapies, especially pulmonary rehabilitation. Finally, there are the beginnings of major research studies into the pathology of Long COVID and its possible treatment. For example, Stanford University, in collaboration with Pfizer, are in a Phase 2 clinical trial studying two potential therapeutics with the aim to manage Long COVID, including Nirmatrelvir and Ritonavir. This study is estimated to wrap up in November of 2023.
In clinical settings, drugs such as Metformin have showed a 42% reduction in the risk of Long COVID, 63% if taken within 4 days of infections.
Despite these promising new developments, we still have a lot to learn about the risks and treatments of COVID-19.
Long COVID is real. It is very present in the lives of tens of millions of patients around the world, many of whom do not have access to proper health care or rehabilitation. COVID-19 may have faded from the front pages, but of course it continues to cause anguish for those who lost loved ones during the outbreak. But if we do not work harder to understand the ongoing impact of the virus for so many Long COVID sufferers, we will multiply that anguish many fold.
So, what can you do to help minimize the effect of Long COVID?
Luckily, there are simple steps that everyone can take!
Speak to your doctor if you believe you are demonstrating symptoms. Although Long-COVID is very common, these persistent symptoms may be a sign of other health problems, so be sure to consult your physician.
Continue to wear a mask in public, especially if you are presenting symptoms or interacting with vulnerable populations.
GET VACCINATED!! Although studies are still ongoing to determine whether the vaccine is effective at combating Long COVID, it undeniably helps prevent COVID-19 infection. Be sure to stay up to date on your boosters!
Stay updated on the latest information being produced by your local health authority.
Ed Kelley is the Chief Global Health Officer of ApiJect and former Director for Integrated Health Services at the World Health Organization
Charlotte Mackay is a Research Assistant with ApiJect.
References and Useful Resources
https://doi.org/10.1016/S1473-3099(23)00053-1
https://clinicaltrials.gov/ct2/show/NCT05576662
https://www.who.int/publications/m/item/weekly-epidemiological-update-on-COVID-19---27-july-2022
https://www.cnn.com/2020/07/19/health/long-COVID-italy-uk-gbr-intl/index.html
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