Long Covid, a Record Breaking Health Condition – 24,000 Studies Done in Just 4 Years

Malaysia experienced significant impacts from the COVID-19 pandemic, recording over 4.4 million cases and 35,620 fatalities as of May 17, 2022 according to WHO. Since the onset of the COVID-19 pandemic in 2020, a perplexing and debilitating condition known as long COVID has emerged, affecting millions worldwide. This syndrome, characterised by a multitude of persistent symptoms, has significantly impacted the health and quality of life for many, while also imposing substantial economic burdens due to decreased productivity and workforce participation.

Malaysia is not spared from this global impacts of long covid. According to an online survey conducted in Malaysia, 21% of individuals diagnosed with COVID-19 reported symptoms of long COVID. The survey further indicated that females and those who experienced more severe acute illness had a higher likelihood of developing long COVID.

The scientific community has been spurred into action, producing an unprecedented volume of research on long COVID. With over 24,000 scientific publications dedicated to this condition in just four years, long COVID has become one of the most studied health issues in recorded history.

Long COVID encompasses a broad range of long-term health effects stemming from SARS-CoV-2 infection. These effects vary widely, from persistent respiratory issues like shortness of breath to severe fatigue and cognitive impairments that hinder daily functioning. More severe conditions such as heart failure and diabetes, which can last a lifetime, are also part of this constellation of symptoms.

Unvaccinated individuals being more than twice as likely to develop long COVID

A recent study published in the New England Journal of Medicine sheds new light on the evolving nature of long COVID. The research indicates that the risk of developing long COVID has declined over the course of the pandemic. During the initial phase in 2020, when vaccines were unavailable and the ancestral strain of SARS-CoV-2 was predominant, approximately 10.4% of adults who contracted COVID-19 developed long COVID. By early 2022, with the emergence of the omicron variants and widespread vaccination, this rate dropped to 7.7% among unvaccinated adults and 3.5% among vaccinated individuals.

This data underscores the protective effect of vaccination, with unvaccinated individuals being more than twice as likely to develop long COVID.

However, despite this decline, even a 3.5% risk remains significant. The ongoing influx of new COVID-19 infections continues to generate millions of new long COVID cases, adding to an already substantial population burdened by this condition. Initial estimates suggest that at least 65 million people globally experienced long COVID during the first year of the pandemic. Updated figures on the global burden and economic impact of long COVID through 2023 are forthcoming.

A comprehensive report by the National Academies of Sciences, Engineering, and Medicine highlights the extensive health effects associated with long COVID. Commissioned by the Social Security Administration to assess its implications for disability benefits, the report identifies over 200 potential health effects across multiple body systems due to long COVID. These include:

Cardiovascular Issues: New or worsening heart disease.
Neurological Problems: Cognitive impairments, strokes, and dysautonomia—a disorder affecting the autonomic nervous system, which regulates vital functions like blood pressure and heart rate.
Post-Exertional Malaise: Severe exhaustion following minor activities, often incapacitating patients for extended periods.
Gastrointestinal Disorders: Persistent digestive issues.
Kidney Disease: Deterioration in renal function.
Metabolic Disorders: New onset diabetes and hyperlipidemia (increased levels of bad cholesterol).
Immune Dysfunction: Ongoing immune system abnormalities.

More importantly, long COVID affects individuals across all demographics—children, adults, and seniors—regardless of race, ethnicity, or pre-existing health conditions. Notably, over 90% of those afflicted with long COVID had only mild initial infections.

The report also emphasises the broader societal impact of long COVID. It can severely impair an individual’s ability to return to work or school, diminish their quality of life, and reduce physical and cognitive functioning for months or even years after the initial infection. Many symptoms linked to long COVID, such as post-exertional malaise and chronic fatigue, are not currently recognised in the Social Security Administration’s Listing of Impairments but can significantly hamper an individual’s ability to engage in daily activities.

Research indicates that health problems related to COVID-19 can persist for years post-infection. A substantial study published earlier in 2024 revealed that individuals who had mild SARS-CoV-2 infections continued to experience new health issues three years after their initial infection.

This finding aligns with other studies showing that the virus can persist in various organ systems for months or years after infection. Additionally, immune responses triggered by the virus remain evident two to three years post-infection. These discoveries suggest that a past SARS-CoV-2 infection could lead to new health problems long after the initial illness.

Significant progress is also being made in understanding how long COVID disrupts bodily functions. Preliminary studies from the United States and the Netherlands have demonstrated that transferring auto-antibodies—antibodies mistakenly targeting one’s own tissues—from individuals with long COVID into healthy mice induces symptoms similar to those experienced by humans with long COVID, such as muscle weakness and poor balance. These findings imply that an abnormal immune response generating these auto-antibodies may be a fundamental cause of long COVID and suggest that treatments aimed at removing these auto-antibodies could be promising.

Despite substantial evidence highlighting the risks associated with COVID-19, public messaging often downplays its severity, incorrectly portraying it as no more than a mild cold or equating it with influenza. This misinformation stands in stark contrast to data showing that COVID-19 continues to outpace flu cases in terms of infections, hospitalisations, and deaths while causing far more serious long-term health issues.

While significant strides have been made in understanding and managing long COVID, much work remains. The condition continues to pose a serious public health challenge, demanding sustained attention from researchers, healthcare providers, policymakers, and society at large. Accurate information and continued vigilance are essential in addressing this ongoing crisis and mitigating its long-term impacts on individuals and communities worldwide.