Long Covid: Rethinking our future
I often find that a person’s response to Covid-19, especially in the current climate where we have announced a “going endemic” phase, is often linked to the amount of evidence they read about Covid-19. 19.
A poorly discussed issue, regarding our Covid-19 risk, is the severe effect of Long Covid and the long-term health impacts (post-Covid conditions) of a Covid-19 infection.
There is a growing body of evidence that requires our attention. Let me summarize some of the evidence that is already available.
Even if individual research may be limited in size, the implementation of collective work should make us aware of this health threat.
I am indebted to Stephen Reicher, Professor of Social Psychology at the University of St Andrews in the UK, for some of the insights and links contained in this article.
How common is Long Covid and does vaccination help?
There is limited data on Long Covid locally, although the Ministry of Health (MOH) has information on its website.
An MOH press release in February 2022 said that 10% to 15% of people infected with Covid-19 have Long Covid. International data suggests that the problem is much larger.
A meta-analysis and systematic review published in April 2022, which combines data from 50 international studies, suggests that the global prevalence of Long Covid (post-Covid-19 conditions) is 43%.
The rate in hospitalized patients was 54% and in non-hospitalized patients 34%. In this review, Long Covid rates were highest in Asian studies.
There are fewer studies of Long Covid risk after asymptomatic infection, but data is emerging that 20% to 30% of asymptomatic infections can lead to persistent symptoms.
Some studies show that vaccination reduces the risk of Long Covid by around 50%, however, it does not completely eliminate the risk.
What is the impact of Long Covid on the brain, heart and other organs?
A detailed UK study (published in April) of people who received intensive care for Covid-19 compared to matched controls showed persistent cognitive impairment (mean IQ loss of 10 points) six to 10 months after admission with only gradual recovery.
A large year-long longitudinal cohort study (over 1,400 participants with a control group), from Wuhan, China (published in March) showed that 12% of survivors had cognitive impairment 12 months after discharge.
The risk was higher for people with severe cases, those with non-severe Covid-19 had a risk of early cognitive decline.
A meta-analysis and systematic review (published in March) examining changes in cognitive functioning after Covid-19, summarized data from 27 studies involving more than 2,000 people.
Impaired executive functions, attention and memory have been found in post-Covid-19 patients compared to healthy controls.
One study showed 0.5% to 2% brain shrinkage after infection compared to before the pandemic, even in mild infections.
A large US study (published in February) looked at more than 150,000 people with Covid-19 and compared their heart risks with controls a year later.
They conclude: “Our results provide evidence that the one-year risk and burden of cardiovascular disease in acute Covid-19 survivors is substantial.
“These risks and burdens were evident even in people who were not hospitalized.”
The risk was two to three times higher for infected people to have strokes, arrhythmias, ischemic heart disease, pericarditis, heart failure and clots (thromboembolic disease) one year after infection.
There is growing evidence to suggest that there is an increased risk of diabetes following Covid-19 infection, both in non-hospitalized and hospitalized patients (higher in those with severe Covid).
More data and studies can be cited, but hopefully the point is clear, that Long Covid is not benign and can have long term health consequences.
This impact does not only concern people who are hospitalized, but includes asymptomatic infections. Children are not spared either.
Many scientists are now talking about the burden of disability that will come with this pandemic.
What should we do then?
The purpose of this sharing is not to instill a feeling of fear or apprehension about the future, but to inform us of our risks. The declaration of an “endemic passage” made many relax.
Others who don’t read the science and data ignore the risks and even scoff at those who are more cautious.
What is needed is a measured and careful approach that keeps our family safe as we continue to meet the needs of work, school and play.
Some suggestions for us to consider:
1. Don’t recklessly follow those who claim we can “just get infected and go on with our lives.” Call back if you haven’t already.
2. Work to maintain your protection through reliable masks and effective indoor ventilation to reduce your risk of infection. Avoid risky events, especially crowded and unmasked outdoor events or venues.
3. Reduce your risk of long-term complications by staying as fit as possible, especially maintaining a healthy body weight and keeping an active mind.
4. If you’ve been infected in the past, consider seeing your doctor to screen for heart and metabolic disease.
5. Finally, remember that with the limited testing currently, we cannot use case numbers to guide us on a new wave, especially one that may be more serious. Hospital admissions are markers of delay and we will only see an increase two to three weeks after a new wave.
Stay up to date with science and data as it develops so we can change our behavior based on the best evidence.
Datuk Dr. Amar-Singh HSS is a consultant pediatrician. Comments: [email protected]