THE LONG HAULERS
Bloomberg Businessweek|November 16, 2020
The human and economic costs of Covid-19 will linger long after a vaccine has arrived
Jason Gale

Eight months and more than 50 million documented cases into the pandemic, there’s still much we don’t understand about SARS-CoV-2. We do know that the majority of those infected with the novel coronavirus display no or mild symptoms. Worryingly, a not-insignificant portion of the 20 million people globally who’ve recovered suffer lingering effects, including lung, heart, and nervous system impairment.

Researchers are collecting patient data to determine the duration and depth of the health consequences. Meantime, post-Covid-19 clinics are opening to cater to an expanding population of so-called long haulers ( survivors left with scarred lungs, chronic heart damage, post-viral fatigue, and other persistent, debilitating conditions), a sign that enduring disability will perhaps weigh on health systems and the labor force long after a vaccine becomes widely available.

The phenomenon of what’s known as “long Covid” isn’t unique; postviral syndromes occur after many infections, including with the common cold, influenza, and Epstein-Barr. What’s novel about SARS-CoV-2 is the broad spectrum of symptoms that are being reported and the duration of months, not weeks. The long-term, multi-organ effects may prolong the pandemic’s economic legacy, adding to its unprecedented global cost— predicted by Australian National University scholars to reach as much as $35.3 trillion through 2025.

“Because Covid-19 is a new disease, much about the clinical course remains uncertain—in particular, the possible long-term health consequences, if any,” Carlos del Rio, executive associate dean at Emory University School of Medicine, and colleagues wrote in an Oct. 5 paper in the Journal of the American Medical Association that reviewed its persistent effects. Multidisciplinary care and thoughtfully integrated research are needed “to mitigate the adverse physical and mental health effects among hundreds of thousands, if not millions, of people who recover from Covid-19,” the report said.

Although it’s unclear how many Covid survivors become long haulers, a study underway in the U.K. with more than 4 million participants has found that 1 in 10 people is sick for at least four weeks. Surprisingly, people with mild cases of the disease are more likely to have a variety of “strange” symptoms that come and go over a longer period, according to Tim Spector, professor of genetic epidemiology at King’s College London, who’s leading the study.

King’s College researchers say their data suggest that, of those affected by the first wave of the virus in the U.K., 300,000 people would have had Covid symptoms for a month and 60,000 for three months or more. “This is the other side of Covid: the long haulers that could turn out to be a bigger public-health problem than excess deaths from Covid-19, which mainly affect the susceptible elderly,” Spector wrote in the foreword of an Oct. 5 report about the phenomenon for the Tony Blair Institute for Global Change.

The dearth of patient follow-up and incomplete data on the number of people afflicted by Covid-19 make it difficult to predict the pandemic’s long-term health and economic consequences, says Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. Murray, who plans to study the impact of post-Covid disease as part of the global burden of disease research he’s been conducting for almost 30 years, says there’s already enough information to suggest “it’s appreciable.”

That information will be critical for anticipating and funding future health-care needs, says Thomas File Jr., president of the Infectious Diseases Society of America, who predicts the pandemic will leave “a significant burden on our health-care system for years to come.”

The economic impact will be much greater if younger survivors endure decades of coronavirus related disability, says Olga Jonas, a former economic adviser at the World Bank who studies the impact of contagions at Harvard. Polio would have led to an estimated $215 billion in treatment costs in the U.S. from 1955 to 2015 had vaccines not become widely available, a 2006 study found.

There’s been little recognition so far of Covid-19’s ill effects on younger adults, says Hannah Wei, a 30-year-old long hauler in Canada, who helps conduct research on the disease for Body Politic, an online Covid survivor support group. An analysis of responses from 640 patients collected by the group, which includes scientists, in April and May found “recovery is volatile, includes relapses, and can take six or more weeks.”

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