Weekend Long Reads: Long COVID

by Kevin Schofield

This weekend's main "long read" deals with a scary topic: "long COVID." This is how the medical community has come to refer to incidents where a patient diagnosed with COVID-19 initially seems to recover but continues to suffer ongoing symptoms for weeks or even months. Doctors have established two categories of long COVID: "ongoing symptomatic COVID" (OSC), in which symptoms continue on for four to 12 weeks after the initial illness; and "post-COVID syndrome" for symptoms that persist after 12 weeks.

Long COVID is still an emerging phenomenon since COVID-19 has barely been around long enough to start to complete longitudinal studies, but by existing estimates, 10% or more of the general population who contract COVID-19 will have some form of long COVID to follow, and the percentage is much higher in some high-risk populations (including those hospitalized with COVID-19). But little is still known about exactly what the risk factors are for long COVID, and how they compare to COVID-19 itself.

A large team of medical and public health researchers in the U.K. teamed up to study the risk factors, using data from the U.K. healthcare system. They found that the risk of long COVID increases with age (as does the risk of hospitalization or death from acute COVID). Obesity also dramatically increases the risk of long COVID. They also found correlations with asthma and with having one or more mental health disorder; while the reason for this link isn't understood yet, the coronavirus is well-known for attacking both the lungs and the brain.

Long COVID is very serious stuff, and it will have significant impacts on the United States and the world. In the short-term, to the extent that the symptoms are debilitating, it will affect individuals' ability to take care of themselves as well as their ability to hold down a job; along those lines, it will also affect workplace productivity and disability claims (last week President Biden announced that long COVID is an acceptable justification for a disability claim). But there also might be an additional long-term burden on our already struggling health care system.

That leads to our second, and very much related, long read: the History of Polio. Polio has been with us since the earliest days of recorded history, literally thousands of years ago, but only in the twentieth century did it cause epidemics. Like COVID-19, it's caused and spread by a virus. Also like COVID-19, the vast majority of people who catch it are asymptomatic. But small proportions of the population who are infected have more severe cases. Some get flu-like symptoms: fever, sore throat, headache, and vomiting. In others, it can cause temporary paralysis, lasting anywhere from days to a year. Another small group are permanently paralyzed — and for many of that group, polio eventually kills them. But there is one more group, who after originally having a moderate case of polio, develop "post-polio syndrome" 15 to 40 years later, with progressive muscle weakness, fatigue, loss of muscle function, and joint and skeletal degeneration (which can be very painful).

The United States saw two major outbreaks in the twentieth century: the first around 1916, and the second more serious one starting in 1952 in which 57,628 cases were reported, 3,145 died, and 21,269 were left with some level of paralysis.

I bring up polio for two reasons. First, it was a huge success for vaccines: Dr. Jonas Salk introduced his first-generation polio vaccine in 1955, and it and future generations of polio vaccines have not only eradicated the disease from the United States — the last naturally occurring case was in 1979 — but we are now on the verge of eliminating it across the entire planet.

Second, the history of polio in the United States points to the ongoing costs of letting a debilitating illness with "long" effects simply run its course. By one estimate, the U.S. spent over $36 billion in 1955 on polio vaccination between 1955 and 2015, but it saved $180 billion by doing so. Those estimates don't consider the costs for caring for those left paralyzed by the disease. But they also don't factor in the human costs to families, friends, and communities for the lives lost and the people brought low by polio. Since it's been 42 years since the last naturally occurring case here, it's mostly fallen out of our collective consciousness — but there are those who still remember, including some who still suffer from post-polio syndrome.

There are important lessons from polio that we can't forget as we wrestle with COVID-19. The first is how much we all benefit when a vaccine is widely adopted, both individually and as a society. Polio is gone, the "iron lung" is long since retired, no child in the U.S. has died or become paralyzed by the virus in over 40 years, and the virus has nearly been eradicated worldwide. The second is that a serious, contagious virus like polio — or the coronavirus — doesn't just miraculously disappear one day; even if the virus is eradicated, its impact is felt by individuals for months or years, and by society for decades. That's true even when only a tiny percentage of the population suffers its worst effects.

Risk Factors for Long COVID: Analyses of 10 Longitudinal Studies and Electronic Health Records in the UK

History of Polio

Featured image is attributed to Shawn Spencer-Smith (under a Creative Commons, CC BY-ND 2.0 license).