Long-term covid is a public health problem

The covid-19 pandemic has given rise to one of the most alarming and demanding global public health challenges of the last 100 years, with significant health, social, emotional and economic repercussions.

Scientific progress is gradually making it possible to deal with the new virus through very significant advances in diagnosis, therapy and prevention.

As a result of this, there are currently a dozen highly effective vaccines in preventing serious illness, and even death from covid-19.

However, just a few months after the official declaration of the pandemic, and after hundreds of thousands of people had become acutely infected throughout the world, the first news began about the persistence of highly varied symptoms in a not inconsiderable percentage of the population. population, weeks and even months after contact with the virus.

The first stages of this “pandemic hangover” were confusing, with dozens of symptoms reported, a total ignorance of the reasons that caused them, no therapeutic options to address them and the inability to predict which patients would suffer the sequelae after the infection.

A situation somewhat similar to that experienced a century ago during the 1918 pandemic, with many survivors suffering from anxiety, depression and misery.

Today it is well known that one of the great health consequences that the post-pandemic is leaving is called long-term or persistent covid, or as the Anglo-Saxons would say,

Patients suffering from the disease number in the hundreds of thousands around the world and many have entered their third year without being able to fully recover their health, having lost work and hope along the way.

Over the last few months, the scientific community has been deciphering some of the unknowns related to the disease, its evolution and etiology, and has a more precise understanding of many of its consequences.

A first notable aspect of long-term covid is the incredible range of clinical symptoms, up to 200 described, associated with post-infection.

From anosmia, fatigue, muscle pain, respiratory problems, hair loss, cough and loss of libido, to anxiety, depression, cardiac and cognitive disorders.

These sequelae that are intensely associated with pre-existing comorbidities, and with socioeconomic aspects of the population, but not with the intensity of the disease or with the type of subvariant of a constantly evolving virus.

The etiology is not entirely known.

but several hypotheses are formulated, such as the settlement of the virus in tissues and organs in the form of reservoirs, the direct and indirect action of microclots developed during covid-19 or the involvement of a deregulated immune system.

The effects of the virus on the brain, and therefore on the central nervous system, deserve special mention.

Despite the enormous questions that exist, some studies suggest that the entry of the virus would affect olfactory cells, astrocytes and neurons, promoting inflammation and with it brain damage.

Undoubtedly, the complexity and heterodoxy of the disease and the difficulty of categorizing it in terms of its prevalence or symptoms greatly hinders the design and development of clinical trials aimed at evaluating possible drug candidates.

It is estimated that one in eight infected suffers from this persistent condition, an even higher percentage in those over 65 years of age.

A prevalence of such magnitude causes important labor repercussions.

A Brookings report estimates that about 16 million Americans have chronic symptoms, and that between two and four million are on sick leave.

A situation that creates an economic hole derived from labor inactivity that would amount to about 200,000 million dollars.

Given so much evidence and prevalence, why have not more efforts been made to understand the disease and have treatments been tried to address it?

It is evident that medicine does not like what it does not quite understand, and in many cases the easiest thing to do is to ignore it.

Something, by the way, that has happened and occurs in many other post-viral conditions, which end up becoming chronic and causing patients and relatives to lose patience and health.

It is time to address long-term covid as a public health problem.

Promote more clinical trials, multidisciplinary scientific collaborations, listen to patients and provide the health system and its professionals with tools that allow them to deal with their treatment efficiently.

Just as science has turned to the search for a remedy to reduce mortality from covid in an extraordinarily short time in scientific terms, for the good of the whole of society, it is necessary for institutions and the pharmaceutical industry to adopt a determined position and collaborative that manages to face, in the shortest possible time, a disease that diminishes the quality of millions of people around the world.

Gorka Orive

is a full professor at the University of the Basque Country (UPV/EHU).

Vitoria-Gasteiz, CIBER-BBN scientist and UIRMI University Institute and founder and CSO of Geroa Diagnostics.

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