Here at Med-ucate, our goal is to increase knowledge of health topics in populations that may not have access to a strong health education system. We normally hold volunteer-run classes in-person at local schools, but we also believe that health education is so much more than a weekly 30-minute class. Health issues are more relevant than ever in this post-pandemic nation, and we believe medical literacy is an important step to understanding the world around us.
Hello, and welcome back to a new year of Med-ucate blogging! We’ve got a ton of ideas for upcoming posts, but we’ll be kicking things off today with an overview of the condition so-called “Long COVID."
A bit of context — this article and a few similar ones upcoming are intended to build off of a December 2022 list published by the Institute for Health Metrics and Evaluation titled “11 Global Health Issues to Watch in 2023, According to IHME experts.” The article can be accessed here: https://www.healthdata.org/news-events/insights-blog/acting-data/11-global-health-issues-watch-2023-according-ihme-experts
This blog is a timely summary of some of the most important health topics found in the world today. Covering issues from diabetes and dementia to road injuries and poverty, it emphasizes the importance of healthcare to the rest of our lives. But we’re more than 11 months into 2023 now — it’s time to check up on these concerns. What are these issues? How is the world responding? What are the prospects? And of course, how can we do better? In this article, we’ll explore one of the first listed issues: Long COVID.
“Long COVID” is a vernacular term turned mainstream. The field of COVID research is constantly expanding as world agencies try to cope with a disease no one knew of before 2019, so the large populations that have been hit the hardest are, perhaps bleakly, a primary source for much-needed data. When patients who tested negative for the virus and were viewed as “recovered” still complained of symptoms, their doctors listened. “Long COVID” is more than a collection of symptoms; it’s a serious disease that may develop after a COVID-19 infection. Thanks to recent research, we know some things:
“Long COVID” is a long-term (or “chronic”) complication of short-term (or “acute”) infection with the COVID-19 virus.
There are several factors that affect the likelihood of developing “Long COVID,” but it can happen after any COVID-19 infection.
The symptoms are many and varied. They also might vary in intensity over time.
Medically speaking, “Long COVID” probably results from multiple mechanisms of lasting damage caused by infection with the virus.
The prognosis is uncertain. People might gradually recover from some symptoms, but some cases have shown signs of becoming lifelong.
Right now, the “next steps” for the world seem to be a reduction in new COVID-19 cases and continuing research on “Long COVID.”
Let’s get into each item one by one!
“Long COVID” is a long-term (or “chronic”) complication of short-term (or “acute”) infection with the COVID-19 virus.
Medically speaking, “Long COVID” is a “sequela,” or a pathological condition that is caused by a temporary medical event or condition but continues affecting patients after they’ve recovered from the initial problem. Sequelae come in many forms — for example, migraines after traumatic brain injury, post-traumatic stress disorder (PTSD) after a bullet wound, and lasting bodily damage after a short-term viral infection. Many people with “Long COVID” are declared negative in COVID-19 antibody tests, but their bodies are still dealing with the effects of the virus.
There are several factors that affect the likelihood of developing “Long COVID,” but it can happen after any COVID-19 infection.
Existing research on “Long COVID” has tentatively identified several factors that may make a patient suffering from an acute COVID-19 infection more likely to develop “Long COVID.” These range from being female and an adult to habitual smoking and existing health issues like obesity, asthma, or chronic obstructive pulmonary disease (COPD). Also, having a more intense primary infection with COVID-19 might make someone more likely to develop “Long COVID.” Because it’s such a newly studied condition, researchers still haven’t pinpointed anything to certainty, and some studies, like that by Davis et. al in 2023, cite how as many as a third of people with “Long COVID” had no previously identified health conditions.
The symptoms are many and varied. They also might vary in intensity over time.
The most common symptom of “Long COVID” is fatigue, but more than 50 other possible complications have been proposed. These include pain like chronic headaches or chest pain, neurological symptoms like attention disorders, insomnia, cognitive impairment, or memory issues, and lasting dysfunction like nausea, heart palpitations, or a cough that won’t go away.
Medically speaking, “Long COVID” probably results from multiple mechanisms of lasting damage caused by infection with the virus.
A frustrating part of research on “Long COVID” is that its many varied symptoms probably come from varied ways that infection with the virus damages the body. For example:
Chest pain or other heart issues could come from blood vessels that were damaged, became more prone to blood clotting, or are chronically inflamed as a result of COVID-19.
Some symptoms that deal with heart or gastrointestinal trouble might be neurologically related to dysfunctional signaling in the brainstem or a prominent nerve that descends from it, the vagus nerve.
Psychological problems associated with “Long COVID” may be connected with lasting viral infection or inflammation in the brain, or they may be exacerbated by previous conditions.
Gastrointestinal issues might also be related to the COVID-19 virus’s possible impact on the bacteria naturally present throughout our bodies, like the microbiota in the digestive tract.
Other causes have been proposed, like lasting problems with the immune system, which might even allow other viruses already present in the body to cause further issues.
The prognosis is uncertain. People might gradually recover from some symptoms, but some cases have shown signs of becoming lifelong.
“Long COVID” is a new disease, so we only have a couple years’ worth of data on its effects. We know that around two-thirds of people who still show COVID-19-related effects after four weeks of infection recover completely by the twelfth week. We also know that some people still haven’t recovered yet. It’s too early to declare “Long COVID” as unhealable, and research has shown that some symptoms might improve over time, like gastrointestinal issues, trouble breathing, or coughing. However, in some cases, pain might increase, and some studies indicate that neurological issues could worsen. Recently, some comparisons have been made between “Long COVID” and chronic fatigue syndrome (CFS/ME). Like “Long COVID,” CFS often begins after an acute infection. Research still doesn’t fully understand the mechanisms of this syndrome, but it can result in chronic pain and exhaustion after accomplishing ordinary tasks. It is possible that very severe cases of “Long COVID” may tie into CFS.
Right now, the “next steps” for the world seem to be a reduction in new COVID-19 cases and continuing research on “Long COVID.”
Unfortunately, we don’t currently have an ideal, one-size-fits-all treatment plan for “Long COVID.” We know how to manage symptoms individually, like rest and activity management for fatigue, medication for some types of pain, and counseling for mental health issues. Implementation of these strategies can result in positive improvements to quality of life for “Long COVID” patients. However, on a global scale, nations have two more priorities: reducing new COVID-19 infections and expanding our knowledge base of this disease. We’ve made some positive steps in both directions. Recently, the World Health Organization (WHO) published data that shows a significant decrease in new cases worldwide from before 2023 to now. More people are vaccinated against COVID-19 than ever before, and many scientists are hopeful that this trend of COVID reduction will continue. Additionally, research on this topic is ongoing and has constantly uncovered new information. After the 2021 establishment by the United States National Institutes of Health (NIH) of the “RECOVER Initiative,” dedicated to researching “Long COVID,” countless studies on the topic have been published. This year, the US government created the Office of Long COVID Research and Practice, which will emphasize the importance of continuing to explore this condition and all of its causes.
Thanks for checking out this week’s article! We’ll be checking out more “Issues to Look out for in 2023” in upcoming posts.
If you have personal questions about your health, always reach out to your primary care physician to learn more.
References and Further Reading
Centers for Disease Control and Prevention. (2021, September 16). Long covid or post-covid conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
Chan, A. (2022, December 20). 11 global health issues to watch in 2023, according to IHME experts | The Institute for Health Metrics and Evaluation. www.healthdata.org. https://www.healthdata.org/news-events/insights-blog/acting-data/11-global-health-issues-watch-2023-according-ihme-experts
Davis, H. E., McCorkell, L., Vogel, J. M., & Topol, E. J. (2023). Long COVID: major findings, mechanisms and recommendations. Nature Reviews Microbiology, 21(3), 1–14. https://doi.org/10.1038/s41579-022-00846-2
Global Burden of Disease Long COVID Collaborators. (2022). Estimated Global Proportions of Individuals With Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021. JAMA, 328(16), 1604–1615. https://doi.org/10.1001/jama.2022.18931
Greenhalgh, T., Sivan, M., Delaney, B., Evans, R., & Milne, R. (2022). Long covid—an update for primary care. BMJ, 378, e072117. https://doi.org/10.1136/bmj-2022-072117
Lopez-Leon, S., Wegman-Ostrosky, T., Perelman, C., Sepulveda, R., Rebolledo, P. A., Cuapio, A., & Villapol, S. (2021). More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Scientific Reports, 11(1), 16144. https://doi.org/10.1038/s41598-021-95565-8
World Health Organization. (2023). WHO COVID-19 dashboard. World Health Organization. https://covid19.who.int/