By Lance Chilton
Most of us are worried about how long COVID will last. Some of us are concerned about Long COVID. All of us should be worried, probably about both.
The pandemic is certainly not over; experts say it will continue to affect life in this country until at least spring 2022 – and probably longer if we don’t do better at 1) immunizing reluctant groups in the US, and 2) immunizing the rest of the world, much of which has not had access to COVID vaccine.
But Long COVID, the persistence of symptoms well after a person has gotten over an acute COVID infection, is also of considerable concern. It’s not enough that COVID, as of today, has taken over 648,000 American lives. It appears to also decrease the quality of life of as many as one half of those infected. Since 40 million Americans have been infected since the beginning of the pandemic, that would mean 20 million people would have life-altering symptoms.
What sorts of problems are seen in “Long COVID”? Physical symptoms include sleep problems, heart palpitations, joint pain, enduring fatigue and muscle weakness, and chest pain, at least one of which was still present in 49% of Wuhan, China COVID victims 12 months after their infection. One quarter noted anxiety or depression or both a year after diagnosis. It’s unlikely that American experience of after-effects of infection is appreciably different.
According to an editorial in the respected medical journal Lancet, “With no proven treatments or even rehabilitation guidance, long COVID affects people’s ability to resume normal life and their capacity to work. The effect on society, from the increased health-care burden and economic and productivity losses, is substantial. Long COVID is a modern medical challenge of the first order.”
How can we treat patients suffering from Long COVID? The Lancet article suggests that rehabilitation needs to be made available, but that as yet no one knows what type of therapy may be effective. Tedros Adhanom Ghebreyesus, WHO’s Director-General, wants member countries to engage in recognition, rehabilitation, and research for the long-term consequences of COVID-19, as well as collection of data for long COVID and what works in its treatment.
Of course, as in all of medicine, a penny for prevention is worth a pound of cure. Primary prevention, by which epidemiologists mean preventing a disease in the first place, would require vaccines getting into the arms of nearly everyone around the world. Secondary prevention, the avoidance of effects of the disease would, in the case of COVID infection, be finding something (an antibody product maybe, an anti-viral, a stimulant, psychotherapy perhaps?) that would prevent those symptoms of Long COVID. Tertiary prevention, the improvement of quality of life by reducing disability, limiting or delaying complications, and restoring function produced by long COVID, would assume that the long-term symptoms had already occurred; how would we make those less likely to be life-changing? The best therapies should be the subject of intense research, given the need. We should do all of these, of course. The Lancet article that lays out the problem and hints at possible preventive strategies, is a vital read, and is available at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01900-0/fulltext.