Health

Op-Ed: Don’t Drop the Ball on Long COVID

So far, the response to this pandemic has been focused on addressing the acute manifestations of COVID-19 — but that is only the tip of the iceberg. We must not ignore what’s beneath the surface: the lingering health and mental health implications of long COVID.

Long after the initial infection should have resolved, a substantial number of people infected with SARS-CoV-2 continue to experience lingering health problems. Some patients even experience the emergence of new problems they did not have during the acute phase of the infection. The constellation of clinical abnormalities that characterize this phase of the disease is now generally referred to as long COVID (or more officially, post-acute sequelae of SARS-CoV-2, or PASC for short). People with long COVID have been dubbed long haulers. In addition to being at risk of long COVID, people who survive the acute phase of the COVID-19 infection are also at increased risk of death. The death and suffering among 30-day COVID-19 survivors will add to the already substantial toll of this pandemic.

Long COVID Health Risks

Long COVID is a multifaceted disease and can affect nearly every organ system and may result in serious chronic health conditions. Our research has also uncovered a significant risk of mental health conditions: new onset depression, anxiety, substance use disorders, and increased risk of opioid use. We must deal with this now to prevent it from ballooning into a suicide crisis or another opioid epidemic.

We also see a significant increased risk of serious conditions including heart disease (acute coronary disease, heart failure, arrhythmias), kidney disease (acute and chronic kidney disease), metabolic conditions (new onset diabetes), brain disorders (stroke, memory problems), and several other serious consequences. These are chronic conditions that have serious downstream ramifications on quality of life and life expectancy; they will require multidisciplinary care.

Evidence suggests that long COVID can happen in nearly anyone. Even those whose acute infection was mild and did not necessitate hospitalization during the acute phase of the infection are at risk. The risk in these people is small but not trivial. The risk is much higher in people who needed hospitalization, and is greatest among people who required intensive care during the acute phase of the infection.

Estimates suggest that approximately 10% of people with COVID-19 will go on to have long COVID. Given that more than 32 million people in the U.S. have had COVID-19, it is likely that at least 3 million of them will have long COVID. I fear this will likely represent a significant health crisis that will reverberate for years to come.

The aftereffects of COVID-19 will forever scar some affected individuals, families, and — due to the large number of people potentially affected and the disabling nature of some of the clinical manifestations of long COVID — will have wide reaching social and economic implications.

Preparing for a Long-COVID Fight

The best way to avoid long COVID is to avoid COVID-19 through vaccination. We must vaccinate as many people as possible as fast as possible. Every sector of society must be engaged in this effort. Civic and community leaders, neighborhood associations, non-profit corporations, corporate America, religious institutions, as well as federal, state, and local governments. This is an all-hands-on deck situation. We must not fail!

Governments and health systems must prepare for the tide of patients in need of multidisciplinary post-COVID care. Healthcare leaders must anticipate the needs for post-COVID care in their systems, develop capacity, and plan accordingly. Owing to the multifaceted nature of long COVID, post-COVID clinics should at least include providers able to address respiratory, cardiometabolic, mental, and neurologic sequelae. The U.K. National Health Service established 40 clinics for provision of post-COVID care. Several health systems in the U.S. have already started operating clinics for post-COVID patients. The experiences of these systems may serve as a blueprint to inform the establishment of post-COVID clinics.

We must also recognize that we are still learning about long COVID, and our understanding will certainly evolve over time. The principles of healthcare systems should be leveraged to iteratively optimize the composition and care pathways in these clinics as new evidence emerges and as experiences are accrued.

The burden of death and health loss due to long COVID is substantial. The data are clear. The evidence is compelling. It is imperative that governments and health systems act now and get ready for the problem to worsen. Let’s not be surprised when these patients start knocking on our doors. We must prepare for this now. We were caught unprepared for COVID-19, let’s not repeat the same mistake twice, let’s not drop the ball on long COVID.

Ziyad Al-Aly, MD, is a physician scientist, clinical epidemiologist, and long COVID researcher. He is the Director of the Clinical Epidemiology Center and the Chief of Research and Development Service at Veterans Affairs St. Louis Health Care System in Missouri.

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