Experts study long Covid effects to address chronic illness post-pandemic. Photo / the Washington Post
Outbreaks of new types of infections and, yes, even pandemics are becoming increasingly likely, and we need to prepare for not only the next one but also its long-lasting physical and mental effects, experts said.
“The reality is that pandemics are going to hit. They’re going to hit again,” said Ziyad Al-Aly, a clinical epidemiologist at Washington University in St Louis who researches long Covid. “It’s not a matter of if. It is a matter of when.”
In the past five years, Covid-19 has caused serious amounts of chronic illness and disability. The Sars-CoV-2 virus continues to infect people every day, and an estimated 20 million Americans are still dealing with the many symptoms of long Covid.
Researchers are improving our understanding of the biological causes of long Covid and working towards treatments. These advances may help not only people facing chronic illnesses today but also post-infection syndromes of the future.
Experts are worried that despite the hard-won lessons of Covid, we are not fully prepared for the next pandemic and its aftermath because of decreases in research funding and support, and polarisation of public health measures.
Climate change and increasing human encroachment into wildlife habitats mean a higher risk of diseases spreading.
“I would argue that probably we’re less prepared for this now than we were even prepared for the Covid-19 pandemic,” Al-Aly said.
Long Covid originally surprised researchers and clinicians, but in retrospect, there were clues that infections could lead to chronic health conditions in some patients, researchers said. Other illnesses and pandemics have caused post-acute infection syndromes that bear striking similarities to those of long Covid.
Therefore, long Covid is new and very much not new.
We now know that “we have post-infectious disease syndromes that occur, and that it’s not unique to Covid, but Covid really brought it to the forefront,” said Michael Osterholm, director of the Centre for Infectious Disease Research and Policy at the University of Minnesota.
During and after the 1918 flu pandemic, people complained of feeling lethargic, memory problems and hazy thinking – which sounds a lot like the “brain fog” and other neurocognitive effects of long Covid.
Farmers couldn’t tend to their crops or shear their sheep, leading to economic distress.
Years after the flu subsided, there was a rise in Parkinson’s-like symptoms tied to the illness.
There was also a coinciding epidemic of encephalitis lethargica, or sleeping sickness, that some believe to be related to the flu, though this link is disputed.
Similar long-lasting symptoms followed outbreaks of the respiratory viruses Sars-CoV-1 and Middle East respiratory syndrome (Mers) in the decades before Covid. Some people also face persistent symptoms following Lyme disease, Ebola and dengue.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a still-mysterious chronic condition marked by persistent fatigue and malaise after exertion, is also suspected of having similar underlying causes as long Covid; a 2024 meta-analysis found approximately half of long Covid patients have ME/CFS.
The difference with Covid, of course, is “just the sheer volume of people who had Covid and got long Covid,” which made it much easier to study and research compared with the other post-acute syndromes, said Wes Ely, a professor of medicine and co-director of the Centre for Critical Illness, Brain Dysfunction, and Survivorship at Vanderbilt University Medical Centre.
The pattern is now more apparent: while many people escape unscathed, “it’s clear that there’s a wave of chronic disease and disability after pandemics”, Al-Aly said.
This should factor into preparing for future pandemics and their after-effects.
“We need to think about both the short and long term from the get-go when designing antivirals, designing vaccines” and identifying patients early to get them help earlier, Al-Aly said.
In many ways, the United States may be less prepared to deal with the long Covids of tomorrow than you would think.
Understanding the biological causes of long Covid will help.
“Investing in an understanding or unlocking the secrets of long Covid” is going to pay dividends not only for long Covid but could be repurposed more broadly for post-viral illnesses of the present and future, Al-Aly said.
But now, many of those resources and investments are at risk.
The Office of Long Covid Research and Practice, established in 2023 at the Department of Health and Human Services to co-ordinate the sprawling research efforts about the condition, has been closed.
The HHS Secretary’s Advisory Committee on Long Covid – a group of long Covid physicians, researchers, patients and their advocates meant to advise on gaps in knowledge and research priorities – was terminated before its first meeting.
Though Health Secretary Robert F. Kennedy jnr has stated his commitment to finding long Covid treatments, citing long Covid’s impact on his son, there had not been any new structures put in place for long Covid research as of June.
Meanwhile, clinical trials searching for long Covid treatments are continuing, but researchers fear that future funding may be at risk, following cuts to dozens of long Covid research grants (some of which were later restored).
The Trump Administration’s budget proposal will cut HHS funding from US$127 billion ($211b) to US$93.7b, including a 40% cut to the National Institutes of Health, which had been an important source of support for long Covid research as the historically largest public funder of biomedical research in the world.
“I think we have a lot of work to do. And, you know, it’s terribly unfortunate so much of this work has been now stopped by this Administration,” Osterholm said.
However, the multibillion-dollar Recover Covid Initiative launched by the NIH allowed researchers to set up clinics and study long Covid at a “much bigger scale than they ever have been before”, said Leora Horwitz, a professor of population health and medicine at the New York University School of Medicine.
“I think they’ve put us in a good position now to recognise similar sorts of conditions of future as-yet-unknown pandemics.”
The infrastructure set up by Recover has allowed for the long-term tracking of in-depth health data and could be a model for what to test in future pandemics, said Horwitz, who co-leads the branch of Recover studying adult patients, which includes almost 15,000 participants at 83 sites across 33 states.
More importantly, there is now broader recognition that a subset of people can develop prolonged symptoms from infections, Horwitz said.
Experts said that many of these developments and understanding were driven by fierce advocacy from the community of long Covid patients, who have prompted politicians to act.
However, the US healthcare system remains strained even without contending with another pandemic, said Osterholm, who pointed to a projected shortage of physicians and other health care professionals.
Fixing the healthcare system is important, he said. “If we don’t invest right now, the bottom line is we’re going to just do a repeat all over again in the next pandemic,” Osterholm said.
At the same time, many of the public health tools for mitigating infection spread and severity – and therefore risk of long-term symptoms – have become increasingly politicised.
Masking, vaccination, antivirals, and improved indoor air quality have all helped combat Covid and are valuable tools to implement should another pandemic arise, Al-Aly said.
But people are increasingly tuning out these public health conversations and resisting being reminded of the pandemic, “like almost collective amnesia”, he said.
“We paid a heavy price for this knowledge, and literally more than 1.1 million people died” in the US, Al-Aly said.
Now it’s a “question of whether there will be the political will and also the public sentiment to actually utilise this information for public good”, he said.
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