Crushing fatigue. Brain fog making straightforward tasks almost impossible. Shortness of breath walking up the stairs.
Just some of the many symptoms people with long Covid (post-Covid-19 condition) have experienced according to patient groups, researchers and clinicians the World Health Organization (WHO) has worked with since cases of prolonged suffering from Covid-19 started to be recognised in mid-2020.
Mostly data is only available from high-income countries, which means that we don’t currently have a clear picture on how many people are actually suffering. Current estimates suggest that tens of millions, and perhaps more, have contracted long Covid, and about 15% of those diagnosed with the condition have experienced symptoms for at least 12 months.
It can affect anyone, but according to the latest data from WHO and the Institute for Health Metrics and Evaluation (IHME) women are twice as likely as men to have contracted the condition and those hospitalised with severe Covid are more likely to develop the condition. From all the interactions WHO has had with those living with the condition, carers, civil society groups and experts, it’s very clear that the condition is devastating people’s lives and livelihoods.
It’s added a significant burden to health workers and the health system overall, which is still dealing with additional waves of infection and the knock-on backlog of essential medical services that have been severely disrupted.
The world has already lost a significant number of the workforce to illness, death, fatigue, unplanned retirement due to an increase in long-term disability, which not only impacts the health system, but is a hit to the overarching economy. While the pandemic has changed dramatically due to the introduction of many lifesaving tools, and there is light at the end of the tunnel, the impact of long Covid for all countries is very serious and needs immediate and sustained action equivalent to its scale. There are five key elements to drive the effort forward.
First, it’s really important to keep listening to the patient groups, researchers and health workers dealing with this condition, which we are still learning about. Governments should use their first-hand knowledge to help shape policies that aim to diagnose, support and treat people quickly. It’s also critical for health professionals to communicate that although the road to recovery may be long and frustrating at times, people do get better.
Second, the best way for people to prevent long Covid is to avoid infection and while that is extremely difficult given the intense circulation of the virus globally, we can reduce the severity of Covid by ensuring equitable access and appropriate use of tests, therapeutics and vaccines. While almost 70% of people have received a vaccine, in low-income countries just 22% have been vaccinated. This inequity leaves billions of people vulnerable to infection, which will almost inevitably lead to increased numbers of patients with long Covid. All lives have equal worth so there needs to be concerted efforts to get life-saving tools to people that need them. Innovations are only as powerful as the people they reach.
Third, we need systematic data collection on patients with long Covid. At the present time, most of the data collected and research conducted on long Covid is from high-income countries, leaving us blind to the impacts in low- and middle-income countries. Not knowing the scale of the challenge or if the condition presents differently around the world or in certain patient populations, undermines the overarching response and delays the scientific community from understanding the nature of long Covid and how best to treat it. WHO has a clinical data platform which aggregates anonymized information on patients with long Covid. I urge countries to share data to quickly close knowledge gaps.
Fourth, while there has been a large amount of research on long Covid, there needs to be sustained investment to expand our scientific understanding so better treatments and clinical management can be developed. Again, this has to be global, not just confined to high-income countries and WHO will continue to update the clinical management guidance which includes recommendations for rehabilitation so that clinicians and health professionals across the world have access to the latest science and data.
Finally, people with long Covid need care and support. For countries with Covid-specific clinics, waits are often lengthy so it’s important to start integrating multi-disciplinary care into health systems as patients need a range of services. This includes, but is not limited to, health and care workers with expertise in neurology, rehabilitation, psychology, speech therapy and respiratory therapy. Delayed clinical care in patients with long Covid not only impacts their quality of life but the length of time they have symptoms.
Early in the pandemic, it was important for overwhelmed health systems to focus all of their life-saving efforts on patients presenting with acute infection. However, it is critical for governments to invest long-term in their health system and workers and make a plan now for dealing with long Covid. This plan should encompass, providing immediate access to antivirals to patients at high risk of serious disease, investing in research and sharing new tools and knowledge as they’re identified to prevent, detect and treat patients more effectively. It also means supporting patients physical and mental health as well as providing financial support for those who are unable to work.
On behalf of the scientific community, health workers and the patients with long Covid WHO has worked with, I urge all leaders to seriously ramp up support so that we can minimise the suffering and improve the health of those affected so they can return to living their fullest lives.
Dr Tedros Adhanom Ghebreyesus is director general of the World Health Organization
