The Long Tail of Long COVID Syndrome

 

·       Acute COVID cases are relatively low at this point, but Long COVID is continuing to strain healthcare resources and complicate other illnesses. Here in Colorado, a new study estimated that 1 of every 7 people who ever had COVID are still experiencing some level of Long COVID symptoms. When you consider that an estimated three-quarters of U.S. adults have had COVID at least once, this translates to a massive number of Americans with Long COVID symptoms. Only 1 in 5 U.S. adults received the latest COVID vaccine formulation, which also leaves them vulnerable to another round of infection or re-infection with current COVID-19 variants that are much more resistant to the older vaccine formulations and may also be able to overcome people's natural immunity from prior bouts with the virus. Unfortunately, another recent study estimated that 6 million children and young adults in the U.S. are also living with Long COVID; the prevalence among young people is likely to be even higher than that among adults, because a much smaller percentage of children and adolescents ever received the COVID-19 vaccine. Some of the most common symptoms of Long COVID involve fatigue, difficulty concentrating or thinking clearly (i.e., "brain fog"), and mental health symptoms such as anxiety or depression. A recent review summarized COVID's long-lasting effects on the brain, including drops of 3 to 11 IQ points on standardized cognitive tests.

      Separate from the research on Long COVID, a number of studies have noted the alarming rise in mental health conditions since 2020, especially among young people. Many of the studies have attributed the rise in anxiety and depression at the population level to extraordinary stressors, such as pandemic-related disruptions in society, the traumatic deaths of family or other loved ones, economic and political stressors, and other sudden life changes. Similarly, many commentators have noted a loss of basic civility at work, in public schools, on college campuses, and in public life since the start of the COVID-19 pandemic. On America's roads, both traffic fatalities and pedestrian death rates have surged since 2020, a consequence of faster and more reckless driving. Finally, although crime is much in the news and on many people's minds, criminology statistics show a mixed bag: Homicide is definitely up since the start of the COVID-19 pandemic, as is violence against people based on their membership in a particular demographic group (i.e., hate crimes). Robberies and auto thefts also increased, especially since the start of 2022. But drug offenses, sexual assault, and property-related crimes seem to have gone down; the more violent or impulsive types of crime are the ones that have seen the greatest increases. 

      Based on the co-occurring dramatic changes, it seems likely that these four societal trends -- mental health, incivility, aggressive driving, and violent crime -- are related to one another. Many commentators have suggested that bad behavior leads to worse mental health, or that governmental policy changes are the cause of more bad behaviors. But a common underlying factor to explain all four of these trends might actually be Long COVID. 

      Among adolescents and children, Long COVID symptoms most commonly involve the head and neck as well as the central nervous system, and can include “brain fog” in up to 44%, as well as elevated rates of mental health conditions. Although these conditions are less immediately life-threatening than the cardiovascular and metabolic complications often reported in adults, the affected population may ultimately be larger. Some of the widely observed pandemic-related learning loss in recent high school graduates therefore might be related to the thinking problems that are characteristic of Long COVID. Similarly, some of the recent rise in children's and adolescents' mental health conditions may be at least partially due to COVID-related inflammation rather than just stress.

      And what about the adults? A study using objective cognitive tests found deficits in memory, in attention, in executive functioning, and in verbal expression after COVID-19 infection. Severe COVID-related disease is known to have an inflammatory mechanism, and Long COVID has also been suggested to result from an ongoing inflammatory response in the body. Evidence from other disease states suggests that inflammation can account for some of the symptoms of Long COVID, especially those related to fatigue and cognitive impairment. In particular, an inflammatory response tends to reduce people's sense of control over their own behavior and results in a greater orientation toward immediate rather than long-term rewards. Inflammation also makes people more likely to feel tired, increases depression or anxiety, and interferes with restful sleep, as in my team's research on people with another condition that causes systemic inflammation, HIV. And if people with systemic inflammation are more likely to engage in alcohol and drug use, as argued by my PhD student Aimee Techau, then the higher levels of substance use seen during and after the COVID-19 pandemic could also be a direct result of Long COVID syndrome.

      Overall, then, it seems that many of the societal ills we blame on a lack of self-control or a breakdown of civil discourse might actually be medically meaningful symptoms of Long COVID syndrome. Death rates from acute COVID-19-related illness are no longer such a major concern, but COVID-19 may still be the ultimate cause of many of our contemporary problems. It's therefore possible that applying a health lens might be the solution to more than just public health difficulties; it might help us to address persistent problems in education, safety, crime, and even politics.

Here’s a list of 5 predictions for what may be on the horizon in Long COVID treatment, including monoclonal antibodies, antivirals (e.g., Paxlovid), anti-inflammatory medications, or antidepressants. The article also suggests that there might be distinct subtypes of Long COVID, which might require different treatment approaches. However, we don't yet know if that's true, or if so what the subtypes are. Current treatment for Long COVID, therefore, involves a mix of untested and palliative strategies, and overlaps a great deal with general health promotion approaches with the goal of improving sleep and nutrition, increasing exercise, and reducing stress. These are all strategies that can reduce inflammation and help people to think more clearly. Health promotion interventions therefore should be a high priority, not just for personal well-being, but to address the pernicious and lasting effects of Long COVID on society.