Long COVID Will Linger Even After the Pandemic Leaves

Infection Control Today, Volume 26, Issue 2

Many people suffer from long COVID, and since COVID-19 is a fairly recent development experts aren’t sure what “long” means exactly. Weeks? Months? Years? A lifetime?

We will never get rid of COVID-19, but we can learn to live with it. Most experts believe it will become endemic, evolving into the sort of illness for which an individual may need a yearly vaccine, similar to treatment for influenza. Meanwhile, many people suffer from long COVID, and since COVID-19 is a fairly recent development—it was labeled a pandemic in March 2020—experts aren’t sure what “long” means exactly. Weeks? Months? Years?

A recent study illustrated that long COVID’s physical, mental, and cognitive symptoms can cling to some patients for at least a year. The patients in the study initially had to go to intensive care units (ICUs) because of the severity of infection. The exploratory prospective multicenter cohort study was conducted in the ICUs of 11 Dutch hospitals and was published in the Journal of the American Medical Association (JAMA). Investigators included 452 patients 16 years and older who survived ICU admission during the first COVID-19 surge (March 1-July 1, 2020). The patients were followed up for 1 year following their release from the ICU, and the final follow-up date was June 16, 2021. The main outcomes were physical symptoms (including frailty, fatigue, and other physical problems), mental symptoms (including anxiety, depression, and posttraumatic stress disorder), and cognitive symptoms self-reported 1 year after ICU treatment.

According to the Centers for Disease Control and Prevention (CDC), long COVID “is a range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if their illness was mild or if they had no symptoms.”

Linda Spaulding, RN-BC, CIC, CHEC, CHOP, a member of Infection Control Today®’s (ICT®’s) Editorial Advisory Board (EAB), said she’s “seen athletes in their 20s on the wait list for double lung transplants because of long COVID.” Infection preventionists (IPs) and other health care professionals on the frontlines are also in danger of contracting long COVID. “If health care workers have to give up their careers, then what comes next?” Spaulding asked, adding that the financial consequences of long COVID on the health care system could last “forever.”

Similar to HIV

As noted by Kevin Kavanagh, MD, another member of ICT®’s EAB, a core difficulty in society’s attempt to guide COVID-19 from pandemic to endemic is that COVID-19 is not just a respiratory virus. Kavanagh wrote in ICT®’s October 2021 issue that SARS-CoV-2 is similar to HIV because it can “silently spread throughout the host’s body and attack almost every organ.”

In the JAMA study, of the initial patient cohort, 301 (66.8%) were included in the study. The average age was 61.2 years, the average duration of ICU stay was 18 days, and 71.5% were men. A year after their release from the ICU, 74.3% of patients reported physical symptoms, 26.2% reported mental symptoms, and 16.2% reported cognitive symptoms.

The most commonly reported new physical symptoms were weakened condition (38.9%), joint stiffness (26.3%), joint pain (25.5%), muscle weakness (24.8%), and myalgia (21.3%). The respondents indicated their continued COVID-19 symptoms make it difficult to go about their day-to-day lives, with 58% of ICU survivors saying they had problems returning to work. This frequency of symptoms 1 year after recovering from severe COVID-19 disease is concerning, as much is still unknown about long COVID and the long-term health impact of COVID-19 infection.

In ICT®’s January issue, Kavanagh wrote that “much of the abandonment of public health measures has been spurred by a massive disinformation campaign, which has successfully convinced a relatively large portion of our population that, as long as one lives through COVID-19, all will be well. The young and healthy have especially embraced this narrative.”

It is a false narrative, Kavanagh warns, because “the premise that mild infections do not carry significant risks is false. In part, this belief is driven by those who have not died from COVID-19 being counted as ‘recovered’ as opposed to ‘survived.’ SARS-CoV-2 causes a system infection and is commonly detected in the heart and brain, exemplified by the loss of smell from brain tissue destruction and loss of cardiac function from myocarditis. Even those who develop mild COVID-19 can develop long COVID, which, in many cases, lasts for a year or longer.”

Avoid It

Of course, the best way to avoid long COVID is to avoid infection by COVID-19 in the first place. IPs and other health care professionals must continue to utilize nonpharmaceutical COVID-19 mitigation efforts, such as hand hygiene, social distancing, and masking, both inside and outside the hospital. That’s one of the takeaways of a recent study in Clinical Infectious Diseases.

That study involved monitoring 2425 fully vaccinated staff at 2 referral hospitals in Tokyo and comparing their data with that of a control group. Investigators with Japan’s National Center for Global Health and Medicine (NCGM) stated that “vaccination programs alone cannot eliminate the risk of infection…. Still, we could reasonably infer that the program has contributed to the sizable reduction in the number of COVID-19 patients among the staff during the largest epidemic [up until that point].” NCGM comprises 2 hospitals that also serve as research centers that focus on infectious disease.

Despite the effectiveness of the COVID-19 vaccines, the findings bolster the argument that we cannot vaccinate our way out of the COVID-19 pandemic. “NCGM has adopted comprehensive measures against nosocomial infection since the early phase of the epidemic,” the study stated. “The current data confirm the significant role of these measures to protect health care workers against…variant infection.”

The comprehensive nonpharmaceutical anti–COVID-19 measures adopted by NCGM include avoiding what the institution refers to as the 3 Cs: crowded places, close-contact settings, and confined and enclosed spaces without wearing a mask. They also include social distancing; cough etiquette; not touching the eyes, nose, and mouth; and hand hygiene.

The health care workers did a good job of following mitigation efforts inside the hospital but not so much outside of it. The study stated “infection among the staff had occurred mainly outside the hospital [household, community, etc].” Saskia Popescu, PhD, MPH, MA, CIC, another ICT® EAB member, suggests IPs should continue what they usually do, but also “focus [more] on discussing work and nonwork exposure risks and how people can be safe in both places.”

National Institutes of Health Effort

More data on long COVID will be forthcoming. On September 15, 2021, the National Institutes of Health (NIH) unveiled a $470 million study it hopes will mine data from 30,000 to 40,000 individuals who suffer from long COVID. The effort is called the Researching COVID to Enhance Recovery (RECOVER) Initiative.

Francis Collins, MD, PhD, NIH director, voiced some questions driving the need for answers. For instance, what causes long COVID? (The scientific name for long COVID is PASC [postacute sequalae of SARS-CoV-2]). “Is it a misfiring of the immune system that fails to reset after the infection with this coronavirus? Is it a triggering of some metabolic dysfunction? We don’t know,” Collins said.

A recent study in the CDC’s Morbidity and Mortality Weekly Report said long COVID symptoms exceed 4 weeks “among [individuals] who self-reported ever receiving a positive SARS-CoV-2 test result, with the prevalence of similar symptoms among [individuals] who reported always receiving a negative test result.” The self-reported aspect of long COVID tracking matters because medical experts, as Collins said, still do not know what it is.

Hopefully that will change.