Third Anniversary of COVID-19

By Arvind M. Dhople, Ph.D., Professor Emeritus, Florida Tech

                Across the world, millions are left with lingering symptoms of COVID-19 infection.  For many people, what started out as a relatively mild case of COVID-19 persisted into a lingering condition that took weeks or months before their suffering subsided —- some are yet to fully recover.  They live with long COVID, a condition health care providers have struggled to understand and accurately diagnose since the COVID-19 pandemic was declared by the World Health Organization (WHO) on March 11, 2020.

                March 11, 2023 marked the third anniversary of COVID-19 pandemic.  While the world is determined to move on from the acute phase, at least 65 million people are estimated to struggle with long COVID, a debilitating post-infection multisystem condition with common symptoms of fatigue, shortness of breath, and cognitive dysfunction, impairing their ability to perform daily activities for several months or years.  Although the majority of patients infected with COVID-19 recover within a few weeks, long COVID-19 is estimated to occur in 10-20% of cases and affects people of all ages, including children, with most cases occurring in patients with mild acute illness.  The consequence is widespread global harm to people’s health, wellbeing, and livelihood – an estimated one in ten people who develop long COVID stop working, resulting in extensive economic losses.

                Some progress has been made in our understanding of its multifaceted nature, like the possible causes, including viral persistence, autoimmunity triggered by the infection, reactivation of latent virus, and inflammation-triggered chronic changes leading to organ damage, which might explain the different types exhibited by long COVID patients.  Several candidate treatments are being tested, based on different symptoms and biological mechanisms.  Because of long COVID-s diverse symptomatology, reliance on self-reported symptoms, and a lack of diagnostic tests many patients struggle to obtain a definitive diagnosis.  As a result, long COVID is often easily dismissed as a psychosomatic condition.  Given what we now know about the effects of long COVID and its biological basis, it must be taken seriously. On a global scale, long COVID has not received the attention it deserves and there is a general lack of public awareness.  In many places, data on long COVID are absent, especially in low-income and middle-income countries.  Where studies have been done – such as in India, China, and South Africa – long COVID has been found.  A global coordinated multidisciplinary research agenda, bringing together governments, non-governmental organization, and civil society, is essential to improve our understanding of the cause and pathogenesis, clinical diagnosis, treatments, risk factors, and prevention of long COVID.  It was only in December, 2022, that the USA and the European Commission had a conference to foster international cooperation.  In August, 2022 the USA set up the National Research Action Plan on Long COVIDF, which led to the US National Institutes of Health (NIH) to allocate $1.15 billion to the Researching COVID to Enhance Recovery (RECOVER) project.  The EU has yet to define a research agenda for long COVID and Long COVID Europe (a network of patient associations) is calling for €500 million in EU emergency research funds.          

                Without specific treatments for long COVID, attention needs to fall on prevention – keeping COVID-19 cases low and ensuring vaccination – and patient-centered multidisciplinary care.  Patients, many with complex multimorbidities, need multisectoral physical, cognitive, social, and occupational support.  Primary care has suffered in many countries, waiting lists have lengthened, and health systems are struggling.  Education and awareness on the clinical management of long COVID in primary care remains insufficient and inequities in care continue.  Delays in care and support prolong and exacerbate the symptoms of long COVID.  The acute months of the COVID-19 pandemic motivated an unprecedented response from governments, international organizations, pharmaceutical companies, and civil society.  Long COVID has not received anywhere near the same level of attention or resources: the result has been widespread harm to health, societies and economies.  3 years in, more is needed to recognize, treat, and support patients with long COVID.