According to recent research, the impact of long COVID is not only persistent but also expanding, even as national institutions face challenges in organizing effective trials for potential treatments.
According to a study published in Nature Medicine, patients who were previously hospitalized with COVID-19 continued to face a significantly increased risk of death or deteriorating health due to long COVID complications, even three years after their initial battles with the virus.
According to the researchers, even individuals who did not require hospitalization for their initial cases still faced the risk of long COVID and its associated problems. The study revealed that after three years, long COVID resulted in 91 disability-adjusted life years (DALY) per 1,000 people. DALYs represent the number of years lost due to poor health or premature death. This incidence rate is higher than that of heart disease or cancer.
Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis and lead author of the study, emphasizes that individuals are experiencing the emergence of new diseases due to infections that occurred three years ago. This challenges the belief that these viruses are contained within themselves or become inconsequential after the initial acute phase.
The study, which includes over 130,000 patients, stands out as the most extensive research conducted to date, following the virus’ trajectory over a complete three-year span. Building upon previous findings by Al-Aly and his colleagues at the two-year milestone, the study revealed that patients faced increased susceptibility to long COVID-related ailments, encompassing diabetes, lung issues, fatigue, blood clots, and gastrointestinal and musculoskeletal disorders.
According to Al-Aly, at the three-year mark, individuals with mild initial cases of COVID-19 experienced complications primarily in the neurological, gastrointestinal, and pulmonary systems. However, those who had been hospitalized faced persistent risks that affected a total of seven organ systems. These risks included severe conditions like strokes, heart attacks, heart failure, and even Alzheimer’s disease (Fortune).
The study involved renowned researchers Al-Aly and Dr. Eric Topol, who is the executive vice president and a professor of molecular medicine at Scripps Research. The research was conducted using patients from the Veterans Affairs St. Louis Health Care system. Consequently, the demographic of the study participants is predominantly male, white, and slightly older compared to other patient studies.
According to Akiko Iwasaki, director of the Center for Infection & Immunity at the Yale University School of Medicine, the data is encouraging as there were no new onset adverse health problems discovered in the third year after infection. However, Iwasaki, who was not part of the study, pointed out that certain illnesses related to post-acute infection could still emerge years later. She emphasized the importance of conducting long-term follow-up studies for extended periods to gain a better understanding.
More health challenges for hospitalized patients
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During the three-year study, it was found that individuals who had been hospitalized due to their initial COVID cases encountered the most significant difficulties. This serves as a somber reminder of the crucial role that interventions, such as vaccinations and antivirals, play in combating the virus. It is important to note that the participants in the study were enrolled in 2020, a time when vaccines and antivirals were not yet widely available.
According to the researcher, the situation is much more severe for hospitalized individuals. They face a significantly higher risk and a longer duration of risk, as their burden of disease is astronomically higher compared to non-infected and non-hospitalized individuals. Therefore, the prevention of hospitalization becomes crucial in such cases.
The study discovered that the risk of experiencing new long COVID complications decreased over time for both hospitalized and non-hospitalized patients. According to Al-Aly, this is a positive development. Additionally, the risk of death became “insignificant” after the first year for individuals who did not require hospitalization, which includes the majority of individuals who have contracted COVID.
According to the researchers, individuals who required hospitalization due to their cases faced a persistent risk of death even in the third year. Moreover, this group also experienced a significantly higher burden of health compared to those who did not require hospitalization. Specifically, they had approximately 90 DALYs per 1,000 people, while the non-hospitalized group had about 10 DALYs per 1,000. To put this into perspective, both heart disease and cancer typically cause around 50 DALYs per 1,000 people.
Dr. David Putrino, director of the Cohen Center for Recovery from Complex Chronic Illness at Mt. Sinai School of Medicine, emphasizes that the difference in DALYs between the two groups should not be misconstrued as a lack of suffering for individuals with long COVID from less severe acute disease. He clarifies that this disparity simply indicates that, three years later, they are experiencing less immediately life-threatening consequences compared to those who were initially hospitalized.
The lingering presence of long COVID serves as a reminder that this virus is far from ordinary. Scientists believe that viral persistence, chronic inflammation, and immune system dysfunction all play a role in this condition, although further research is required to fully understand it.
What is the outlook for tackling long COVID?
The duration of long COVID, or how long it lasts, is still being studied and understood, according to Al-Aly. He characterizes long COVID as a complex constellation of over 80 different health issues, some of which, such as stroke or heart disease, may have long-term implications for patients.
According to Al-Aly, there is still much that remains unknown. He emphasizes that the current study only covers a span of three years, leaving a significant gap in our understanding. The future, particularly the ten-year mark, holds many uncertainties that are yet to be explored. In light of this, the research team is actively seeking support from their funders to extend the study and continue monitoring the patient cohort for at least a decade.
Researchers are leading the way in speeding up the progress of trials for long COVID treatments due to various reasons. However, these initial efforts have faced criticism for both the wastage of funds and precious time. During a hearing in front of a U.S. Senate committee in January, Al-Aly informed the committee members that a minimum of 20 million individuals in the country have been affected by long COVID. On a global scale, this number is estimated to be at least 65 million.
The meeting stood out for being the inaugural Congressional hearing on long COVID since the onset of the pandemic. This latest study aims to reignite interest in a condition that has long-lasting effects and an uncertain trajectory, potentially motivating the National Institutes of Health to make a more significant effort in addressing the issue.
Al-Aly emphasizes the need for greater boldness and ambition in our trials. He expresses concern that the current pace is too slow and warns that without significant changes, it may take decades to obtain definitive answers.
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