Economic losses, health care burdens and the urgent need for better global policy

In a study recently published in the journal Natural medicineResearchers conducted an interdisciplinary review to examine the current scientific evidence on long coronavirus disease (Long COVID) and its impact on individuals, health systems, and the national and global economy. They also created a roadmap for future research and policies on Long COVID.

Review: Science, research and politics on Long COVID. Image credit: p.ill.i / Shutterstock

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One of the long-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections is the complex range of post-acute sequelae, commonly referred to as Long COVID. The symptoms of Long COVID are related to various organ systems other than the pulmonary system, including the cardiovascular, endocrine, immune, nervous, gastrointestinal and renal systems.

Common symptoms of Long COVID include fatigue, brain fog or cognitive impairment, and post-exercise malaise. Studies have also shown that Long COVID affects people of all ages, regardless of gender, race, ethnicity, and health status at onset. Some variants of SARS-CoV-2, such as Delta, carry a higher risk of Long COVID than others, such as the omicron variants. While vaccinations against coronavirus disease 2019 (COVID-19) can reduce the risk of Long COVID, SARS-CoV-2 reinfections can also trigger Long COVID.

In this review, the researchers examined the current state of research on the mechanisms and treatment options for long-COVID and its impact on health systems, individual health and the economy.

Long-COVID research

The large variability in the severity of Long COVID symptoms among different individuals and the heterogeneity of Long COVID studies pose a challenge in assessing the Long COVID burden. In addition, the nature of COVID-19 vaccines, their effects, and the impact of reinfection further complicate the deciphering of the Long COVID burden.

Studies have shown that complex mechanisms and numerous pathological pathways contribute to the complex symptoms of Long COVID. Mitochondrial dysfunction, dysregulation of immune mechanisms, viral persistence in tissues, and dysbiosis of various microbiomes have been investigated as possible mechanisms and identified as triggers of Long COVID.

The retention of SARS-CoV-2 fragments in various tissues is thought to trigger an immune cascade of inflammation and tissue damage that leads to the persistent symptoms that constitute Long COVID. Other possible mechanisms include neuroinflammation, vascular dysfunction, and metabolic disturbances.

COVID-19 vaccines and other non-pharmaceutical methods of disease prevention have been found to reduce the risk of Long COVID. Vaccines have been reported to reduce the risk of Long COVID in adults by 40%. Additionally, research suggested that the use of antivirals to treat acute SARS-CoV-2 infections may reduce the risk of Long COVID in individuals with various comorbidities. While research on gut microbiome modulations and their role in improving Long COVID symptoms is ongoing, conclusive results are not yet available.

The lack of appropriate diagnostic tools, standardized treatment pathways and sufficient awareness among healthcare professionals have been limiting factors in the development of treatment protocols for Long COVID. Existing research suggests that Long COVID is an evolving complex syndrome that requires a tailored treatment and management approach.

Effects of Long-COVID

The consequences of COVID-19 have wide-ranging implications, ranging from impacts on the daily lives of individuals to implications for the global economy and the Sustainable Development Goals. The persistent symptoms of Long COVID reduce the ability of individuals to perform everyday functions, resulting in a reduced quality of life.

Nearly 75% of individuals who have experienced symptoms of Long COVID report reduced ability to work, limited social behavior, and limited ability to engage in social activities, which also impacts their families and communities. In addition, the social exclusion that some individuals experience due to Long COVID symptoms also impacts their mental health, which has a cumulative impact on their self-esteem and self-worth.

The prolonged need for medical care due to Long COVID also adds to concerns about the already overburdened health systems of most countries. The strain on health systems due to Long COVID has led to longer waiting times for consultations and medical care, as well as higher costs. The lack of standardized diagnostic and treatment protocols also hampers health care providers.

The significant strain on the healthcare system and the decline in labor force participation due to the impact of Long COVID on individuals’ ability to work have also impacted the economies of many countries. Many countries are struggling with productivity losses and labor shortages in the wake of the COVID-19 pandemic. Statistics from 2022 show that the United States has suffered a loss of $3.7 trillion due to Long COVID, a figure equivalent to the global recession of 2008.

In addition, the worsening of existing social inequalities as well as lower labour force participation and economic productivity have significant impacts on several Sustainable Development Goals related to social well-being and health.

Roadmaps for Long-COVID research and policy

The review also presented a comprehensive roadmap for future Long COVID research and policy development, focusing on long-term care and treatment of Long COVID patients, as well as prevention initiatives.

The researchers believe that a coordinated and equitable patient-centered approach is essential to understand the biological mechanisms of Long COVID, identify biomarkers, develop improved diagnostic tools, and assess therapeutic and clinical outcomes.

Policy plans include measures to prevent SARS-CoV-2 infections, improved and equitable access to health care, and support for long-term COVID patients. The researchers believe that the establishment of global collaborations and professional support groups and societies is necessary to achieve effective measures.

A new #LongCovid comprehensive review @NatureMedicine https://t.co/WT5oSq6kfQ
from @zalaly @ahandvanish @LisaAMcCorkell @leticiasaurus @swulfie @VirusesImmunity and I
This thread from Ziyad walks you through the key pointshttps://t.co/hFbsn8j3bs pic.twitter.com/wpDQNNuxXT

— Eric Topol (@EricTopol) 9 August 2024