'Long Covid' should be considered a 'major health crisis' and not a respiratory disease, but a systemic one, research leader says

Chart by Washington University in St. Louis; to enlarge, click on it.

By Melissa Patrick
Kentucky Health News

"Long Covid" may not be fully defined yet, but it affects 4 to 7 percent of the U.S. population and will have a major impact on our economy and health systems, according to research presented at the recent HealthWatch USA conference. 

Dr. Ziyad Al-Aly

"We think it's really a major health crisis," Dr. Ziyad Al-Aly, chief of research and development service at the Veterans Affairs St. Louis Health Care System, told the Sept. 14 online audience. "We think it's very, very important that governments and health systems prepare for the people in need of post-Covid care." 

Al-Aly is a clinical epidemiologist who also serves as the co-chair of the U.S. government-wide committee tasked to develop a national research action plan on long-Covid. 

Al-Aly noted that the phrase "long Covid" came from an early analysis of prolonged Covid-19 symptoms by a group of patients. Early surveys found some people were still experiencing weakness, fatigue, brain fog, muscle pain and other manifestations months after their initial Covid-19 infection.

He said these early surveys is what prompted further scientific research, and this group of researchers is now called the Patient-Led Research Collaborative.

"I really think this is a historic moment in the history of medicine, in the annals of medicine, that patients came to the fore and looked at all of us scientists [and said] something here is wrong and needs to be investigated, needs to be researched and really gave the disease, they gave the entity its name," Al-Aly said.

He said his team's research found that some Covid-19 patients, 30 days after infection, have had a variety of problems, including cardiovascular conditions, respiratory problems, persistent cough, shortness of breath, kidney problems, mental-health problems, musculoskeletal disorders, malaise, fatigue and anemia, and more. 

"So this is really not a respiratory virus," Al-Aly said. "It's really a systemic virus. It's a systemic illness that can affect nearly every organ system."

Further he said that while his research found that people who were hospitalized for Covid-19 have a much higher risk of long Covid, and that that risk was highest among those who were in intensive care or in need of mechanical ventilation -- anyone who has ever had Covid-19 is at risk.

"The risk was evident, even among those people who nursed it at home and did not need to be hospitalized," he said. "So this is really very important because the lion's share, the majority of people with Covid-19 don't ever get hospitalized."

His research also looked at how long Covid played out by race, sex, age and health status. While long Covid is a broad, umbrella term, he said his research found that it is "multifaceted" and "non-monolithic," meaning that some long Covid conditions were more pronounced in younger people, some were more pronounced in older people, and the same was true across race, sex and and baseline health status.

Al-Aly said his team is really concerned about some of the chronic conditions that are resulting from long Covid, including cardiovascular disorders, new-onset diabetes, kidney disease, and neurologic and mental-health disorders. 

"Some of these conditions could really impact life expectancy and could really stick with people for a lifetime," he said. 

For example, he said his team's research found that people who've had Covid-19 have a significantly increased risk of kidney disease, and that even in patients who did not require hospitalization, a trajectory of their kidney disease over time is the equivalent to aging two to four years, instead of just one. 

The increase in mental-health and substance use disorders among people who have had Covid-19 could cascade into a suicide epidemic in the next few years if these issues are not urgently addressed, Al-Aly warned. 

He added that his research has found that Covid-19 vaccinations reduce, but do not eliminate, the risk of long Covid. 

"Overall, the risk reduction that we see in our in our population is about literally 15% . . .  and that's not very high," he said. "It is definitely doing something; it is definitely contributing to risk reduction. But it's certainly not . . .  the panacea, or sort of the tool that can really totally ... eliminate the risk of long  Covid."

Al-Aly acknowledged that some other studies have found that Covid-19 vaccines provide greater risk reduction to long-Covid and said this is likely due to how each of the studies define the condition. 

He also touched on some of the major hypotheses around what is causing people to develop long Covid and said the leading one is that the virus is persisting or not clearing in some people and that is what provokes further inflammation and the aforementioned conditions. 

Al-Aly wrapped up by saying that our current focus on Covid-19 only addresses the "tip of the iceberg" and does not focus on the long-term manifestations of Covid-19 and its effect on life expectancy. 

All of the slides and videos from the speakers at the HealthWatch USA conference, titled "Frontline Worker Safety in the Age of Covid-19: A Global Perspective," will soon be available on its website.  HealthWatch USA is a non-profit organization that promotes health care transparency and patient advocacy and is based in Somerset.