The pandemic may be long gone in the minds of many, but for some, the symptoms of Long COVID are here to stay. Yet, despite the growing incidence of cardiac and neurological sequelae among those previously infected with COVID-19, little is being done to study these effects when compared with the initial efforts to study COVID-19 in the nascent days of the pandemic.
This is a shame. Since the effects of such derelictions will become a lingering burden for all of healthcare in the years to come – the effects of which we are only beginning to understand.
“These risks and burdens were evident even among individuals who were not hospitalized during the acute phase of the infection and increased in a graded fashion according to the care setting during the acute phase (non-hospitalized, hospitalized and admitted to intensive care). Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial. Care pathways of those surviving the acute episode of COVID-19 should include attention to cardiovascular health and disease.”
These are the concluding lines in the abstract of a recent study in Nature that chronicled the long-term effects of cardiac complications following a bout of COVID-19. It serves as a harbinger for future studies to come. Unfortunately, these studies will be limited by both study design and public perception.
Long-term studies that evaluate the downstream effects of a disease are notoriously difficult to conduct. They rely on active patient engagement and input, long after the disease has come and gone, and well after the patient affected actually cares to devote any additional time or energy toward the disease.
Myocarditis, the cardiac condition made famous after it was discovered to appear in patients following a bout with COVID-19, was studied extensively by the CDC. But for all its sophistication, the CDC is still reliant on self-reporting and active engagement by patients, many of whom are still suffering in the wake of the pandemic’s devastation.
They have neither the desire nor the ability to dedicate what amounts to essentially a volunteer effort to disclose personal information in a study about a disease they would rather forget and a time they would sooner move on from.
Of course, health policy experts could come in and provide economic and social support for these patients, particularly those willing to help in the studies. But health policy has a funny way of swaying toward the political winds. Two of the most ardent supporters of COVID lockdowns, Dr. Anthony Fauci and Dr. Leana Wen, now hold equivocal positions on them and maintain a forlorn wistfulness when discussing the value of social distancing.
The data never changed, but the perception of the data around lockdowns did. And consequently, so did their opinions. This is not unique to either Drs. Fauci or Wen, rather, it is typical of public health policy.
For years, veterans struggled to garner the medical attention they needed for traumatic brain injuries sustained in combat. Their symptoms fluctuated, and with the lack of symptomatic consistency came a lack of credibility. As a result, many veterans suffered in silence. But once the political persuasions stepped into the picture, health policy changed around traumatic brain injury and veterans began receiving the care they needed.
Interestingly enough, the same varying mix of both psychological and neurological symptoms that appear in traumatic brain injury also appear in patients with Long COVID. Something Neurological researchers at Northwestern University in Chicago, IL are quickly discovering.
“The main quality of life markers affected in [patients with long-haul COVID neurologic symptoms] seem to involve depression, anxiety, and pain. These are clearly issues combining both psychological factors and physical factors and are distinct from measures of cognitive dysfunction.”
Long COVID may be an ever-changing array of symptoms presenting across a spectrum we have yet to fully see. And though every new clinical presentation is another point along this continuum, we can already predict the effects of this condition in aggregate.
Long COVID will hit the healthcare system where it hurts the most, by increasing the disease burden of two conditions that bear the most weight – cardiac disease and mental health. According to the CDC, these conditions rank among the ten most costly chronic conditions to treat.
By most clinical estimates, Long COVID will continue affecting patients for years to come and merge into some variation of a cardiac and psychiatric chronic disease. Yet we are restricting research dollars to study Long COVID at precisely the moment the disease is transitioning from an acute to chronic condition.
We had no qualms in doling billions upon billions of dollars in vaccine research and treatment studies. Hell, we hardly made a fuss when we were giving out subsidies like candy. But when the time comes to study the long-term effects of COVID, we suddenly become fiscal misers. Now inflation matters – whereas before, flooding the economy with cash was saving the country, now we look to fiscal frugality as the current measure for sound economic policy.
Funny how economic policy mirrors health policy – both susceptible to the political whims of the day, both transient in its position and short-sighted in its outlook.
In the years to come, we will look back and lament the lack of earnestness in studying Long COVID. We will question how we could be so surprised at how pervasive and impactful Long COVID proves to be. And we will look for people and things to blame.
It will be just like the early days of the pandemic.