Long Covid could affect a billion people in just a few years
Experts say long COVID, a new chronic condition defined by an array of symptoms that endure long after the initial COVID infection is quickly growing into a major public health concern already overwhelming primary-care physicians.
Long COVID may already affect between 7 million and 23 million Americans who previously had the virus, or up to 7% of the U.S. population, according to the U.S. government data..
Different estimates of how many people are affected with long COVID vary widely—from 10% to 80% of COVID survivors. More than half of COVID survivors report symptoms that persist after six months, Penn State College of Medicine researchers reported last year.
It’s a poorly understood condition that could disable over a billion worldwide in just a few years, says Arijit Chakravarty, a COVID researcher and CEO of Fractal Therapeutics, a drug development firm.
“Everyone puts all the attention on death and not as much attention on morbidity and loss of quality of life,” says Dr. Panagis Galiatsatos, an assistant professor at Johns Hopkins’ Division of Pulmonary & Critical Care Medicine who treats long-COVID patients. “I think we need to put more attention into not catching any kind of virus or issue.”
A difficult condition to define
The World Health Organization defines long COVID as a condition that occurs in someone who had COVID, with symptoms that cannot be explained by another diagnosis, that last for two months or more.
The symptoms can persist following the initial onset, or come and go over time, the organization says, adding that a diagnosis of long COVID usually wouldn't be made until three months after acute illness.
The Mayo Clinic defines long COVID as a set of symptoms stemming from COVID that persist for more than four weeks after diagnosis.
In reality, long COVID is likely an umbrella term for a combination of issues and conditions: people who have long-term COVID infections who are able to continue to spread the disease; people whose COVID aftereffects clear up after a few weeks; and people with long COVID itself, in which people aren’t infectious but experience all kinds of symptoms for much longer.
What’s more, COVID patients whose disease was severe enough to require ICU admission may suffer post-ICU complications like muscle weakness, shortness of breath, cognitive issues, anxiety, and depression—symptoms that look a lot like long COVID, but are not, further muddying the waters, Galiatsatos says. Those issues might occur due to extended periods of immobility and ventilator use, and other traumatic medical events.
“For me, long COVID is fatigue, chest discomfort, cognitive issues that can’t be explained by anything else,” he says.
But another organ system, like the musculoskeletal system, can result in different symptoms like bone aches or burning, tightness in the chest, joint pain, and muscle spasms.
It seems like most any ailment—from ear numbness, a sensation of “brain on fire,” and hallucinations—could be symptoms of long COVID, according to a landmark July study published in British medical journal The Lancet.
The study identified more than 200 potential long-COVID symptoms in 10 organ systems, with 66 symptoms typically lasting more than seven months. Researchers surveyed nearly 4,000 sufferers with confirmed or suspected COVID from nearly 60 countries, with illness of a month or longer.
The condition also seems to be evolving as new variants evolve—at least somewhat, Galiatsatos says.
“I see patients with a lot more lingering fatigue than with the Delta variants,” he says. “The prior variants seemed to cause a lot more neurological, mental health, and cognitive issues. But fatigue definitely seems to be a bigger player more recently.”