When the covid-19 pandemic first stormed the globe three years ago, the coronavirus was believed to be largely a respiratory ailment that also damaged the cells that line the blood vessels. But research is now showing that the virus can spread throughout the body and remain lodged in organs. This might offer one clue about the lingering phenomenon of “long covid” and suggest why it will remain a serious problem for individuals and the heath-care system for some time to come. The entire world will have to prepare for a legacy of long-covid sufferers.
It is not yet known how many people have long covid, why and what their prospects for recovery are, let alone what the long-term impact on society will be. The U.S. government reported in August that “no laboratory test can definitively distinguish” long covid from other causes of illness. But some general definitions are that long covid, or “post-acute sequelae of covid-19,” is a series of symptoms that continue or develop after the initial infection, that persist three months or more after the first sickness, and that can include fatigue, shortness of breath, cognitive dysfunction, pain, difficulty sleeping, racing heart rate, gastrointestinal problems and other ailments that interfere with everyday functioning.
Research is providing new insights into why. In a study published in Nature in December, researchers carried out 44 autopsies in search of how far and wide the virus had spread in patients who had died, a group largely older and unvaccinated. The researchers found that the virus can spread throughout the entire body and that it is capable of crossing the blood-brain barrier, infecting and replicating in the human brain, but they also noted that it seems to reserve most of its damage for the respiratory system. A separate study, published in Nature in January, pointed out that long-covid symptoms can crop up in the heart, lungs, immune system, pancreas, gastrointestinal tract, neurological system, kidneys, spleen and liver, blood vessels and reproductive system. It is also possible that covid causes long-term damage to the endothelial cells that line blood vessels, and that such damage is leading to persistent symptoms.
The U.S. Census Bureau added questions about long covid to its Household Pulse Survey last year, and the results suggest, according to a Brookings Institution analysis, that some 3 million Americans might be out of the workforce due to long covid. That’s 1.8 percent of the entire U.S. civilian labor force, representing $168 billion in lost annual earnings. The National Bureau of Economic Research found in a September study that in a typical week of the pandemic, 10 workers per 1,000 missed an entire week of work due to their own health problems, compared with six in an average week in the years before. That study estimated covid reduced the U.S. labor force by 500,000 people at an annual cost of $62 billion. Worldwide, a conservative estimate is that 10 percent of the documented 651 million covid cases might have long covid — that’s 65 million people.
This could portend enormous changes in workplaces, economies and health care. President Biden last spring took initial steps to begin research into how the government and health-care system should respond. But much is still unknown, such as whether long covid will unleash a tidal wave of disability claims from workers who find they no longer have the stamina or good heath they enjoyed before the pandemic. The Department of Health and Human Services has determined that long covid can be a disability under the Americans With Disabilities Act, but to qualify for Social Security Disability Insurance and Supplemental Security Income, people must be unable to work and have health conditions lasting for at least a year, and it is unknown how many will meet this criteria. Another worrisome prospect is that those suffering long covid will lose not only jobs and income but also health insurance to support their treatment.
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What’s needed now is to recognize the seriousness of the coming crisis — and to devise plans for dealing with it. The COVID-19 Patient Recovery Alliance, a collaboration of health-care organizations, came up with a promising list of recommendations in 2021-2022 for Congress and the administration, centered on acquiring more data about who suffers long covid, and creating tools and strategies to help health-care systems, clinicians and caregivers respond. It’s time for all hands to be engaged. The National Institutes of Health should take leadership by appointing a senior official to drive the science about long covid forward, across all fields. The nation and the world should not hesitate to prepare for what is shaping up to be the pandemic after the pandemic.
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