Beware long covid, the epidemic’s sting in the tail

One in every 20 people infected with covid-19 will go on to develop long covid, the debilitating condition characterised by crippling fatigue, respiratory problems and serious cardiovascular issues, an Imperial College London REACT-2 study published at the end of June found. The findings indicate that in the UK alone, some 2 million people are already suffering its life-changing effects.

In Malta, where official figures put total infections so far at 31,834, that would suggest that close to 1,600 people may already be struggling with the disabling effects of this little-understood condition.

That’s an alarming statistic, but, according to new University College London research published in The Lancet on 15 July, it could actually be falling short of true numbers of patients.  And, of course, the more people who contract the infection in the first place, the greater the number of long term sufferers there will be.

According to Health Minister Chris Fearne’s last press conference, the government’s current anti-covid strategy is aimed at limiting the number of sick people who need hospitalisation, banking on widespread vaccination to protect most from the worst effects of the virus.

As infection numbers leap by treble figures every day since the ill-conceived, uncontrolled opening of Malta’s borders two weeks ago, more and more people are at threat not only of potentially getting seriously ill and requiring hospital care, but also, and separately, of developing long covid.

The government’s tardy, reactive new measures to control the influx of non-vaccinated travellers and impose quarantine on those that do arrive may have some effect on lowering fresh imports of the virus.

But failing to enforce social distancing regulations and allowing large numbers of events to continue taking place when we know the virus, and particularly the highly contagious Delta variant, is already circulating within the community, means many more people are going to be infected before this third, devastating wave is brought under control.

There’s been little mention of long covid from Fearne or any of his government colleagues. In the UK, it’s being described as an urgent public health issue: surveillance programmes like REACT-2 have been gathering data for months, while long covid clinics have been established across the country to offer treatment and support to sufferers.

In most countries, the condition is rapidly being recognised as a serious illness that’s affecting millions of people. Potential sufferers could be anyone unfortunate enough to have caught covid, whether their illness was severe or mild, or even, in some cases, whether or not they had any symptoms at all while they were positive for the virus.

The UCL data published on Thursday represented the findings of the largest-ever international study of people with long covid. Its conclusions imply a situation that’s fast developing into something seriously alarming. The researchers, who surveyed 3,762 people with long covid from 56 countries, found that the condition causes myriad additional health problems that haven’t yet been taken into account.

They identified more than 200 symptoms including lasting organ damage, brain fog, hallucinations, tremors and tinnitus as well as systemic issues such as temperature regulation and neurological problems.

Two-thirds, or 2,454, of those surveyed reported symptoms lasting for more than six months, with 66 of the 203 identified being recorded into the seventh month. Over 20% reported having had to give up work, and a further 45% have been forced to go onto reduced working hours. Several reported persistent symptoms more than 16 months after having caught the virus.

In the UK, long covid clinics have been treating sufferers for months, though the authors of the study warn that many symptoms haven’t yet been recognised and therefore aren’t being taken in account when diagnoses are made. They caution that there could be tens of thousands of people struggling alone with long covid that doctors miss because of this.

We’ve known about long covid since very early on in the pandemic. Most of the people I know who got ill complained of shattering fatigue unlike anything they’d ever experienced before, which lingered for months after they got over the effects of the primary infection itself.

And yet somehow, the danger of this long-drawn-out, life-altering illness appears to be being almost entirely ignored in Malta’s current anti-covid measures. Attitudes to covid infections in children and young adults have been fairly casual, with many assuming that as it appears younger people don’t suffer the worst effects of acute covid, the risks to children of becoming infected are minimal.

But studies into long covid in kids have found that almost half of all children aged 6-16 may be left with worrying, long-lasting effects. That’s a devastatingly high percentage, and one all parents need to be aware of.

It’s still unknown whether the vaccines can help protect against long covid, or whether they do anything to alleviate the illness. An article in The Atlantic in March suggested that a few long covid sufferers saw an easing of their symptoms after being inoculated. But others were too wary of introducing anything related to the pathogen that devastated them to risk getting vaccinated.

Long covid, in the midst of the panic over the acute phase of the disease, may seem like an anxiety too far. But the implications may be far more serious than many believe. There are precedents in history: the after-effects of the Spanish flu suffered by some survivors sound eerily similar to the complaints from long covid patients.

South African historian Howard Phillips’ book ‘Black October’ about the 1918 epidemic in that country describes in his book how the incapacity caused by the flu and its after-effects made a severe impact on the country’s economy. The debilitating lethargy that afflicted flu patients in what is now Tanzania has been blamed for causing the worst famine in that region in 100 years.

In the UK, doctors reported alarming levels of nervous disorders such as depression, while Norway recorded a seven-fold increase in psychiatric hospital admissions in each of the six years following the 1918 pandemic.

While some outbreaks of mysterious illness during and after the 1918 pandemic are less clearcut, such as the previously undescribed encephalitis lethargica that struck people across the world during and after the Spanish flu scourge, most countries reported widespread sufferers of the type of lethargy Phillips describes.

Long covid may not yet be fully understood, but one thing is self-apparent. If you avoid getting covid, you won’t get the persistent version. We don’t know yet whether the vaccines offer protection from long covid and we don’t know how long or how severely most people will be incapacitated by it.

The numbers published in the latest studies make clear that this isn’t a minor issue. Becoming blasé about soaring infection rates because fewer patients in this third wave, so far, have required hospital care, is foolish. The only guarantee against contracting this complex condition is making sure you don’t get covid in the first place. It’s far too soon to stop enforcing social distancing measures, or to be allowing large public events to take place.

Health Minister Fearne is playing with fire with his confused, ill-advised tennis game of opening, closing, re-opening, re-closing. Malta needs a properly laid, scientifically-informed plan to control the covid menace. And whatever the plan is, it must also take into account long covid. A failure to do so could be disastrous. We may not have all the information we need to contend with it yet, but we know enough to tell us that it’s crucial we take it seriously.