Long COVID – What doesn’t kill you may not make you stronger

Nine months into the COVID-19 pandemic and with the momentum of a second wave building, contesting views as to the relative imperative of protecting public health or protecting the economy have come to the fore. The respite from the first wave resulting from a comprehensive social lockdown of the country was squandered by a premature easing off of the measures and government encouragement to get things back to normal as quickly as possible has ensured that the virus continued to circulate during the summer months.¹

Matters have since become complicated by a coalition of voices from libertarians and the political right clamouring for a laisser faire approach to the pandemic in which public health takes second place to protecting the economy and individual freedom. This carries with it an implicit acceptance of the concept of herd immunity which has been described as ‘unethical’ by the Director General of the World Health Organisation, Tedros Adhanom Ghebreyesus. This reckless idea has been given temporary renewed momentum by the publication of a half-baked, self-aggrandising, so-called ‘Great Barrington declaration’, by a group of three scientists from an American libertarian think tank, endorsed by a ragbag of signatories.

By setting the economy in opposition to the lives and wellbeing of potentially millions of people around the world this group was ignoring the flimsy nature of the case for letting the virus rip in pursuit of some spurious goal of herd immunity. According to Tedros,

Herd immunity is a concept used for vaccination, in which a population can be protected from a certain virus if a threshold of vaccination is reached … Herd immunity is achieved by protecting people from a virus, not by exposing them to it … never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic.

Almost one year into the pandemic there is much we still don’t know about this new virus, including whether or not infection confers long-term immunity, the long-term natural history of the conditions it may cause and whether or not the Mounties are going to come over the hill with a vaccine that can protect the world population against a future recurrence.

This naive idea of pursuing herd immunity also ignores the growing evidence that large numbers of people might be surviving infection with the virus, even sub-clinically, but could be going on to develop a long-term debilitating syndrome of organ damage, so-called ‘Long-Covid’. The range of ‘long COVID’ symptoms that have been reported so far include breathlessness, chronic fatigue, neurological symptoms, anxiety and stress. In view of the thromboembolic phenomena associated with clinical COVID infection it would not be surprising if a variety of long-term end organ damage were to be added to that list in due course. If there is any scepticism about this condition it might be allayed by reading the personal testimonies of health care professionals who have themselves experienced the distressing sequelae of infection by this novel virus.^2–4

A similar phenomenon to Long-COVID seems to have followed the 1918/19 pandemic of influenza, in that case taking the form of post-encephalitic Parkinsonism which affected many thousands of people globally enduring for the remainder of their lives.⁵ It is an elementary epidemiological error to focus only on the incidence of a disease and to be preoccupied with considerations of mortality. This can lead to failure to address the long-term prevalence of conditions that don’t kill you but can generate a significant burden of long-term ill health and need for medical and social care. If we are being asked to put the economy before population health the least we can do is insist on total cost accounting. Many hundreds of thousands of people around the world have already died from COVID-19 in 2020; unless the public health systems can be properly mobilised to prevent its further spread the toll of misery and long-term ill health may be too dreadful to contemplate.