The effects of Long COVID might rival heart disease and cancer

Three years into the global COVID-19 pandemic, an estimated four million Americans report that long COVID is severely impacting their daily lives. Scientists are still trying to better understand the condition that brings with it severe brain fog, blood clots, and a whole host of awful medical conditions that don’t go away. Now, a study published August 21 in the journal Nature Medicine found fallout from COVID-19 can persist even two years after infection. 

[Related: What patients find at long COVID clinics: rejection, outdated therapies, and unanswered questions.]

Some of the health problems associated with long COVID in this study include blood clots, diabetes, heart issues, blood clots, diabetes, neurologic complications, gastrointestinal disorders, fatigue, and difficulties with mental health.

The researchers found that people who had COVID, including patients hospitalized within the first 30 days and those who were not, were still at an elevated risk of developing these conditions two years out.   

“For far too many people, the continuing and enduring risk of long COVID and its long-term, adverse effects on health are sober reminders that the pandemic is not in the rearview mirror,” study author and Washington University clinical epidemiologist Ziyad Al-Aly said in a statement. “The continuous struggles of people with long COVID are vivid, daily reminders of the detrimental and long-lasting legacy of COVID-19.”

In the study, researchers looked at the de-identified medical records of nearly 140,000 veterans who survived for 30 days after contracting COVID-19 in 2020. They compared their health outcomes to close to 6 million other patients within the VA health system who did not have evidence of infection. No one in the study was vaccinated, as the vaccines had not been developed yet, and antiviral treatments targeting to COVID-19 were also not available. 

The authors applied statistical models to examine the health risks that were associated with the virus two years post-infection. Within that time frame, they collected data from those who had COVID-19 and from the non-infected control group at five different periods in time to see if and when the risks of 80 long COVID-related conditions declined or equalized.

When compared with the control group, post-infection risks of death and hospitalization among those who were not hospitalized decreased and became on par with the non infected control group at six months and 19 months. 

For those hospitalized for COVID-19, risk of death and hospitalization remained elevated two years post infection. The risk for 52 of the 80 long COVID-related conditions in the study also remained elevated.

“This suggests a difficult and protracted road to recovery among those whose disease was sufficiently severe enough to necessitate hospitalization while infected with the virus,” Al-Aly said.

[Related: Getting COVID more than once might be even worse than we thought.]

The team also tallied the risks for over 80 different complications that are associated with long COVID and turned it into a health metric called a disability adjusted life year (DALY). Each DALY stands for one year of typically healthy life lost to illness. The team found that long COVID created over 80 DALYs, for every 1,000 people who weren’t hospitalized due to their initial infection.

Based on the Institute for Health Metrics and Evaluation’s Global Burden of Disease study, long COVID creates a higher burden of disability per every 1,000 Americans than cancer (roughly 50 DALYs) or heart disease (about 52 DALYs). 

“Our findings highlight the substantial cumulative burden of health loss due to long COVID and emphasize the ongoing need for health care for those faced with long COVID,” said Al-Aly. “It appears that the effects of long COVID for many will not only impact such patients and their quality of life, but potentially will contribute to a decline in life expectancy and also may impact labor participation, economic productivity, and societal well-being.”

Some important caveats to the study are that typically VA patients are older, in their 60s, and roughly 90 percent of patients were male. 

The team noted one encouraging note that the risks of death or hospitalization to those who were not sent to the hospital—the majority of people infected with the virus— declined and became insignificant at six and 19 months.

Decreasing the risk of long COVID should be a focus of public health policy, according Al-Aly. “Reducing the risk of infection and transmission with updated vaccines — including vaccines that block transmission — may be a critical strategy to reduce the risk of long-term health problems,” he said. “We also need an urgent, coordinated approach that matches the scale and gravity of long COVID to find treatments as soon as possible.”

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