Long-term COVID symptoms and consequences of the pandemic: what we know now (2023)

The devastating toll of COVID-19 is often measured by hospitalizations and deaths, but the impact of the pandemic is wider and wider.

Some patients complain of persistent, often debilitating symptoms within months of their onset.

Other consequences, such as increased rates of dementia and heart disease, may emerge years or decades into the future, based on early findings -- similar to the increased risk of cancer and cardiovascular disease later in life for smokers.

The impact goes beyond the immediate impact of the coronavirus, too.

Stay-at-home orders and other measures aimed at slowing the spread of infectious diseases lead to delays in health services and socioeconomic disruptions that worsen physical and mental health in ways that are difficult to quantify.

All this means that while COVID-19 is no longer a global public health emergency, its legacy will linger for a long time.

What are the health effects of HASCOVID-19?

Most people infected with SARS-CoV-2 (the coronavirus that causes it) fully recover after developing mild or no symptoms. Many, though, have not sparked a crisis not seen since the Spanish flu pandemic of 1918-19.

An estimated 15 million people died globally in the first two years of the pandemic alone, some of it as a result of overburdened health systems.

U.S. life expectancy saw its biggest two-year drop in a century.

For those who were critically ill but survived, an estimated three-quarters developed post-intensive care syndrome — a collection of brain, lung and other bodily problems.

Even for patients who are not hospitalized,Coronavirus diseaseIncreased risk of diabetes and autoimmune diseases, sensory problems and organ damage. Pregnant women and newborns, especially boys, face additional risks.
Ongoing health problems experienced by some patients, often referred to as long-termCoronavirus disease, has been described as pandemic after pandemic because of the sheer number of people affected—according to conservative estimates, at least 65 million people, accounting for 10% of the more than 651 million documented cases worldwide.


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What about indirect effects?

The COVID-19 crisis has disrupted the wellbeing, jobs and incomes of people around the world. According to a 2022 World Bank report, economic activity shrank in 90% of countries and global poverty increased for the first time in a generation.

Health systems are stretched to their limits and beyond, disrupting routine services from cancer screening to maternity.

The pandemic has exposed weaknesses and inequalities in health systems and exacerbated skills shortages for health workers.

These factors shrink immunization coverage, allow deadly diseases like polio to spread, and increase deaths from tuberculosis and malaria.

Unprecedented stress from social isolation and precarious employment led to a 25% increase in the global prevalence of anxiety and depression in the first year of the pandemic. Homicides also spiked in American cities during that period, even as overall crime rates declined.

How are the children coping?

School closures are estimated to have affected 95% of the world's student population, making it one of the largest disruptions to learning in history.

Combined with distance learning, illness and isolation, young people lost more than a third of a school year's learning value, according to a meta-analysis published in the journal Nature Human Behaviour.

This has resulted in students falling behind in grades, having a harder time doing homework - and more teenage pregnancies. Less physical activity and more screen time lead to more children who are overweight or obese, and higher rates of myopia.

UNICEF reports that nearly 67 million people worldwide miss out on routine vaccinations.

Protective measures that keep children away from each other hinder the usual way the pediatric immune system is trained.

Once restrictions began to ease, many viral epidemics followed, including a deadly liver disease that required transplants for some.

Disrupted sleep, stress and anxiety linked to the pandemic have sparked a surge in mental health-related hospitalizations, as well as a surge in suspected suicide attempts and drug overdoses.

What about long-term COVID?

Long COVID is a loosely defined umbrella term used to describe new, recurrent, or persistent health problems of varying severity that occur after symptomatic or asymptomatic infection with the virus.

Some common symptoms include cough or shortness of breath, loss of smell or taste, fever, body aches, trouble sleeping or concentrating, mood changes, and digestive problems.

There aren't any diagnostic tests or biomarkers for long-term COVID, but doctors may look for abnormalities in tests of brain blood flow, some immune cells, and levels of reactivated virus.

All that uncertainty makes the condition confusing, sometimes an object of suspicion and contempt, and leads some afflicted to experience stigma, medical gaslighting, and difficulty accessing disability benefits.


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What are the prospects for recovery?

Based on an analysis of data from 2,197 patients published in May in the International Journal of Infectious Diseases, researchers in Paris found that more than 90 percent of adults with long-term COVID recover gradually within two years.

However, long-term effects are still being felt due to links to diabetes, cardiovascular disease, and conditions such as Alzheimer's and Parkinson's and may take decades to fully materialize.

A study published in JAMA Neurology in 2022 found that survivors over the age of 60 were more likely to develop cognition a year after discharge than uninfected survivors Decreased capacity - this suggests that COVID may be contributing to the increased global burden of dementia.

What causes long-term COVID?

In some cases, there may be more than one driver.

The direct impact of the virus on organs and tissues can cause problems, such as when it easily causes bleeding and clots in the lungs, or damage caused by the body attacking healthy tissue that is mistaken for foreign.Some cases have involved reactivation of Epstein-Barr virus and other herpesviruses that persist after infection.

Other potential triggers include lack of oxygen in the blood, microbial imbalances in the gastrointestinal tract, or the harmful effects of life-saving treatments, including the use of mechanical ventilation, corticosteroids, sedatives, and pain medications in intensive care.

As researchers work to understand the condition, the parallels to other diseases are coming into focus and providing insights into causes and treatments.

For example, some people experience racing heartbeat and dizziness after standing up—signs that they may have a condition called POTS, or postural orthostatic tachycardia syndrome.

POTS can occur due to malfunctions in the autonomic nervous system that controls heart rate, body temperature, and other involuntary responses.

Others experience extreme fatigue after physical or mental exertion—an energy crash—similar to chronic fatigue syndrome, or ME/CFS. People with chronic fatigue often say it started with a flu-like illness, leading researchers to think an acute viral infection might be the trigger.

What are the risk factors for long-term COVID?

According to a 2023 meta-analysis, several conditions were significantly associated with higher risk of long-term COVID: female sex, overweight, smoker, pre-existing comorbidities, and previous hospitalization or ICU admission. Age is a factor, and younger people are at lower risk.

The study found that the proportion of new cases declined as levels of vaccination and prior infection increased, and as subvariants associated with less severe disease spread.

Other studies have noted that the more times a person is infected, the risk increases. Socioeconomic deprivation, belonging to certain racial groups, and being bisexual or transgender also place individuals at greater risk. Some studies have found that taking the antiviral drugs Paxlovid and molnupiravir, and the diabetes drug metformin for acute episodes of COVID-19 can reduce long-term COVID risk.

Do we need to keep vaccinating?

This is uncertain. As of March, the World Health Organization recommends getting vaccinated and staying up-to-date on booster doses as a way to prevent Covid and its acute sequelae.

But the agency also supports prioritizing vaccinations for individuals at risk of severe disease, mainly the elderly and those with underlying medical conditions, recommending a booster dose 6 to 12 months after the last dose, depending on age and other risk factors.

The U.S. Centers for Disease Control and Prevention issued its own guidelines in May, advising everyone over age 6 to get the newer vaccine from Moderna or a Pfizer-BioNTech partner.

The WHO said its vaccine recommendations were made for the prevailing situation, which is subject to change and does not mean that it needs to be strengthened every year.

At the same time, as the COVID-19 emergency ends, the government's free booster shots for all are coming to an end in many places, which could lead to a drop in acceptance rates.

What are the economic consequences?

Prolonged COVID has weakened labor force participation and increased healthcare spending.

At the end of 2022, the U.S. government estimated that it would put about 1 million people out of the labor force at any given time — about $50 billion in lost wages a year.

The Institute for Fiscal Studies estimates that around one in 10 people with long-term coronavirus infection will stop working by mid-2022, with patients often taking sick leave.

Chronic fatigue causes at least 1 in 4 patients to be permanently bedridden or homebound, and people who suffer from it for at least four years have less than a 4 percent chance of recovery, according to Solve ME/CFS, a Los Angeles-based nonprofit organize.

DePaul University researchers estimated in 2022 that before the pandemic, 1.5 million Americans lived with the syndrome, costing $36 billion to $51 billion a year in treatment and lost productivity. They projected that Covid could increase the prevalence to between 5 million and 9 million, bringing these costs up to $362 billion.


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