The COVID-19 pandemic has irrevocably changed people's lives in the 21st century. However, more than two years after the disease first emerged, a return to some sense of normalcy seems imminent as we become adept at managing acute COVID-19 infections. Despite countries still fighting fluctuations in disease incidence, the development of effective vaccines and improvements in patient treatment and outcome have helped us learn to "live with the disease”. While we have seemingly moved past the acute pandemic stage of COVID-19, the detrimental effects of the next phase of the COVID-19 pandemic may be less obvious.
How Common is Long COVID-19?
While most people recover from acute COVID-19 infection in roughly two weeks, some individuals have lingering health problems for weeks or months following initial infection with SARS-CoV-2. In fact, studies estimate that approximately 30 percent of people infected with COVID-19 will develop long COVID-19. The WHO defines long COVID 19 (also known as long COVID, long-haulers, post-COVID-19 conditions, post-COVID-19 syndrome, and post-acute sequelae of SARS-CoV-2 (PASC)) as an "illness that occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms and effects that last for at least two months" and are unexplained by any other diagnosis. Therefore, even though individuals no longer test positive for COVID-19, they still have persistent detrimental effects after the initial COVID 19 infection that could seriously affect their ability to function normally.
Healthcare authorities have not pinpointed the exact reason for developing long COVID-19, and symptoms associated with the condition can affect multiple organs. The leading theory is the formation of micro clots that drives inflammatory responses. This inflammation surge then leads to tissue damage or prolonged inflammation, with the immune system struggling to shut off inflammatory responses. Another theory that could explain the variety of symptoms is that COVID-19 is a vascular disease, and post-COVID-19 conditions develop due to the demolition of the vascular system following an acute infection.
People who develop long COVID-19 display a plethora of symptoms, such as brain fog, difficulty concentrating, anxiety, depression, muscle pain, insomnia, fatigue, difficulty breathing, sensory abnormalities, gastrointestinal issues, chronic pain, and a rapid or faint pulse. Symptoms are common, despite the mildness or severity of the initial infection. Long COVID-19 is more common in patients that experienced severe COVID-19 (half of the patients hospitalized with COVID-19 will develop long COVID-19). However, many long COVID-19 cases are identified in patients with asymptomatic COVID-19 infection (roughly 20 percent of asymptomatic COVID-19 patients will develop long COVID-19). Up to 75 percent of people who developed long COVID-19 were not hospitalized with COVID-19. One study cohort of nearly 2 million patients further demonstrated that the development of long COVID-19 does show some correlation to prior chronic illness, with two-thirds of the study participants disclosing comorbidities like diabetes, existing heart conditions, or auto-immune disease. The study also revealed that vaccination against COVID-19 does seem to lend some protection against developing long COVID-19.
At the same time, long COVID-19 may also increase the risk of developing new chronic health conditions related to heart problems, diabetes, or strokes. However, the novelty and variability of long COVID-19 make it challenging to diagnose, monitor, and treat. Moreover, limited data on the impact and duration of long COVID-19 is available, with some individuals going on two years as a long-hauler. We can only speculate on the time frame in which these individuals may continue to display symptoms. While long COVID-19 greatly impacts patient health and quality of life, the effect of long COVID-19 patients on an already overburdened healthcare system may be catastrophic.
Significant Implications to Social and Economic Wellness
The implications of long COVID-19 are likely to be farther reaching than acute COVID-19 infection since long COVID-19 may last longer and be more debilitating than a mild or asymptomatic acute infection. This also muddies the water when determining the end of the pandemic, as simply surviving COVID-19 or recovering from acute infection does not mean total recovery from COVID-19. The sheer volume of patients that will likely suffer from long COVID-19 will significantly impact healthcare systems. While the enduring effects of long COVID-19 on health infrastructure have not yet been fully elucidated, chronic illness and conditions that require long-term follow-up care will place significant strain on healthcare infrastructure.
In terms of business continuity, long COVID-19 may lead to significant labor shortages since COVID-19 is most prevalent among people between the ages of 19-59, that make up most of the workforce. Consequently, it is natural to conclude that this will also be the age group most affected by long COVID-19. People suffering from long COVID-19 may need more time off work or may no longer be suited to perform tasks easily completed pre-COVID-19 infection. This is worrisome considering the prevalence of people complaining of brain fog or difficulty concentrating among these patients, especially since these symptoms are harder to diagnose, track and monitor due to a lack of clear treatment protocols. Additionally, labor shortages will occur not only due to people in this age group affected by long COVID-19 but also because family members or friends that support patient rehabilitation or provide follow-up care may need to adjust their own work schedules to accommodate an increase in dependency required by long COVID-19 patients.
While healthcare providers and insurance companies were very forthcoming at the beginning of the pandemic (by offering free COVID-19 treatments and providing vaccinations), the prevalence of people requiring longer-term care has made it unfeasible to accommodate the growing number of patients that require a variety of care related to long COVID-19. Access to primary healthcare has diminished during the pandemic, and healthcare infrastructures may take years to recover from the effects of the acute phase of the pandemic. Furthermore, public health policy has not kept up with the changing patient landscape, making it difficult for patients to seek federal funding and coverage for treatment. Add to this a growing number of previously healthy patients that now suffer from chronic illness and need long-term follow-up care, and we are left with a disastrous imbalance between healthcare supply and demand. Patients may also believe they are out of the woods and then experience symptoms of chronic illness months after recovering from the acute illness. This is a significant issue, especially for patients who do not have access to proper healthcare and treatment centers. Governments will not be able to carry the costs of this growing long COVID-19 epidemic, which may lead to out-of-pocket expenses for long-term rehabilitation or specialist care.
How to Protect Yourself from Long COVID-19
The best way to protect yourself from long COVID-19 is to avoid getting infected with acute COVID-19. Since you can develop long COVID-19 following even mild or asymptomatic infection, individuals must continue to emphasize basic healthcare precautions like social distancing, proper masking, and frequent hand washing. Even if governments relax COVID-19 restrictions, individuals should access their individual risk profiles, consider the long-term effects, and take every measure to protect themself from COVID-19 infection. If you end up infected, it is crucial to seek appropriate care and advocate for yourself, as many physicians are slow to acknowledge the seriousness of post-COVID-19 conditions.
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