Long COVID: Implications and Recommendations

Long COVID: Implications and Recommendations
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A recent paper from our collaboration with a diverse, multidisciplinary panel of 386 academic, health, non-governmental organisation, government and other experts from 112 countries and territories broadly addresses COVID-19. "A multinational Delphi consensus to end the COVID-19 public health threat,” published by Nature on 3 November 2022, brings forward 57 actionable recommendations for governments, industry and other decision makers to consider.

Long COVID is fast-emerging as a new disease category or, at a minimum, a set of related health problems following from COVID-19 infection. As Dr Sonia Villapol - a co-author on our paper - has illustrated in her collaborations with others, COVID-19 has more than 50 long-term effects in some people, including children and adolescents.

The world must pay attention, in part because the math is dangerously simple: As of November 2022, more than 638 million COVID-19 cases were reported (although models report that the total number of infections is much higher). Of course, the number of people, globally, who have been infected at least once continues to grow daily. Some estimates suggest that perhaps as many as 1 in 5 people infected by COVID-19 will have one or more long COVID symptoms, 3 or more months from infection.

As new disease categories emerge, a variety of things can happen along several dimensions. By way of a few examples:

  • Socially, people may feel the sting of stigma. Until an emerging disease is fully recognised and appreciated, many may think, “Is this person really ill? Or is it merely psychosomatic”. Moreover, groups of people may experience outright discrimination. Consider the early days of HIV/AIDS, for instance.
  • Medically, people may suffer due to a lack of diagnosis (from the inability to test), persistent symptoms (from a lack of treatment options) and prolonged recovery periods (where therapeutic approaches are not fully understood or validated).
  • Financially, people may face the stress of third-party payers (particularly insurers) that do not yet recognise the disease category or when treatments and therapies are still in trial stages.
  • Operationally, a host of systems, databases and more must be updated, such as the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD). 

Long COVID is not unique from other emerging diseases and related health problems in this regard. What is unique, however, is that long COVID is emerging very quickly, with shockingly high numbers. Moreover, while SARS-CoV-2 remains broadly transmissible, the burden of disease will increase - possibly quite dramatically.

With this as background, the #COVIDconsensus study brings forward a few, key recommendations addressing long COVID:

  • Public health policy should take better account of the potential long-term impact of the unchecked spread of COVID-19, given ongoing uncertainties about the prevalence, severity and duration of post-COVID-19 morbidity (long COVID).
  • Promote multisectoral collaboration to accelerate the development of new therapies for all stages of COVID-19 (for example, outpatient, hospitalisation and long COVID).
  • Prioritise research funding for long COVID to develop diagnostic tools, treatment and care, and knowledge about extrinsic factors (for example, stigma and discrimination).

These recommendations are not exhaustive, particularly as the world continues to learn more about long COVID. They do, however, offer the potential for advances in addressing this fast-emerging health challenge.

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