“We must come to the aid of the ultra-vulnerable – millions upon millions of people who are least able to protect themselves. This is a matter of basic human solidarity. It is also crucial for combating the virus. This is the moment to step up for the vulnerable.” – United Nations Secretary General, March 2020
In the depths of the winter 2022, I contracted, most unfortunately, COVID-19 for the second time. Although the initial effects of the illness where subdued due to my vaccinations, the virus continued to impact my life over the coming months. I was not affected as badly as some yet this was to be my first taste of what has become globally recognised as ‘long COVID’. I experienced intense brain fog, unable to concentrate and focus on simple tasks, compounding with inner ear issues impacting my balance and my hearing. I struggled to maintain the normative standards of my life. Sometimes, just moving about was practically an impossibility due to the problems with my inner ear. This made walking to the shop feel quite literally like a rollercoaster ride. I struggled to perform academically at a time in which my studies were at their most intense. At most, it took at least three months for me to fully recover. Now, with the benefit of hindsight and rumination, I am left wondering just what the impacts of ‘long COVID’ are going to be on the global population. What sorts of economic and social impacts will the long-lasting effects of the virus have when considered on a global level? What will be the most appropriate and effective course of action to tackle what is clearly going to be a long-term health problem? COVID is here to stay, and it seems as if the World Health Organisation (WHO) has its work cut out.
What is WHO?
Established in 1948, WHO was the brainchild of a United Nations’ strategy to create a global health agency. Its mission is to improve global public health, keep the world safe, and serve the vulnerable, as per its broad legal mandate to act as the directing and coordinating authority on international health work. It is funded by its member states in both an assessed and voluntary basis. Historically, the United States has usually been the top contributor although it was to be outdone by Germany in the 2020-21 period. It is active in over 194 countries worldwide, providing guidance on the best ways to deal with health emergencies such as COVID-19. Part of the organisation’s goals include protecting one billion people from health emergencies such as epidemics and pandemics and ensuring a further one people billion enjoy better health and well-being. Where and how does long-COVID present challenges to WHO’s mandate and goals?
Initial Economic Impacts
The initial economic impacts of the COVID-19 pandemic are rather well documented. Scholars argue COVID-19 has been the most severe pandemic since the 1918 Spanish Flu due to the interconnected nature of globalisation which enables and enhances the spread of infectious viruses. The convergence of production and consumption activities via global networks result in close contact among people across continents and countries. The outbreak of the virus in China, a global production centre, meant the Chinese economy bore the initial brunt of the pandemic. As Chinese production decreased in 2020 (by 13.5% in the first two month compared to 2019), supply shock initiated a domino effect whereby the global economy and the intertwined national economies experienced a deepening pandemic-driven crisis. These are, however, merely the results of the outbreak of the pandemic and its various ensuing lockdowns. What is of more concern now is the long-term impacts of COVID-19 on global health. As more and more people across the globe become incapacitated with long-COVID, the decades to come may see a long-term and intrusive decline in relative health standards. When considered across the scope of the globe, and in relation to WHO’s goals, long COVID is going to present a significant issue to health, well-being, economic productivity, and social life.
What is Long COVID?
“COVID is setting us up for a hundred years of problems”– Chair of Gerontology at USC Leonard Davis School.
So, what is this ‘long COVID’ I keep banging on about. The NHS defines long COVID as those who continue to experience symptoms lasting longer than 12 weeks and WHO’s definition is in agreement. Symptoms include a litany of nightmare-inducing health impacts such as chest pain, heart palpitations, tinnitus, and ear problems. One patient reported to the NIHR (the UK based National Institute for Health and Care Research) that she was hospitalised after the initial infection, feeling “as though life was being sucked out every minute and I thought I would die”. This was not the end, however, as the patient continued to suffer “debilitating symptoms of severe fatigue, recurrent sore throats and brain fog.” To make matters worse, no health authority can accurately say how long recovery takes. As per The Guardian video below, hospitals and healthcare services which are already under stress may face a growing number of patients experiencing ongoing COVID symptoms. Taking all this into account, the NIHR argues that the sheer scale of chronic ill health and disability after COVID-19 must be seen as the next big challenge to global health.
What about COVID-19 makes the virus so uniquely debilitating? The virus can affect many system of the body including, but not exclusively, the respiratory, cardiovascular, neurological, gastrointestinal, and musculoskeletal systems. SARS-CoV-2 is able to damage multiple systems and organs by entering cells named ACE2 which are present all throughout the human body – in the lungs, heart, liver and brain. As a result, patients admitted to hospitals with COVID-19 exhibit cognitive impairment, hypoxic brain injuries, cardiovascular issues and even altered mental status and psychiatric conditions. Not only does long COVID include a plethora of physical conditions, the neurological symptoms, which are common, pose substantial problems for recovery and rehabilitation. As is clear, this virus, which is now a globally endemic phenomenon, is evidently going to lead to large portions of the population dealing with chronic long-term health issues. Just a brief look at the UK figures for long COVID in 2022 is revealing in of itself. An estimated 1.7 million (which is 2.7% of the population) people living in private households in the United Kingdom alone were experiencing long COVID. As more and more of the global population contract COVID routinely and repeatedly, we will be faced with a serious long-term decline in health. Serious questions remain about the aftermath of COVID as Professor Eileen Crimmins, holder of the AARP Chair in Gerontology at USC Leonard Davis School, argues that “COVID is setting us up for a hundred years of problems.”
Know Thy History: The Spanish Flu
This is not the first time that a pandemic has gripped the attention of the globe. Although the 1918-1919 H1N1 pandemic claimed at least 50 million lives, the full impact would not be realised for more than 60 years after the fact. A 2009 study on individuals born in 1919 (second or third trimester foetuses in the pandemic) revealed that these individuals experienced 25% more heart disease and increased risk of diabetes. Furthermore, U.S. census data indicates children born in early 1919 attained less education and had lower economic productivity over their lifetime, suggestive of a higher level of developmental impairment. I understand that there was overlap with World War One which may have had an impact, however, if we look at studies from countries that were neutral in the war, such as Norway, much evidence suggests the average number of admission to psychiatric institutions increase seven-fold in the six years following the pandemic. Could the tissue damage and wide bodily impacts of SAR-CoV-2 be indicative of an increased risk of heart disease, health issues, and psychological damage as seen in the wake of the Spanish Flu? Will we also witness a global decline in economic productivity and educational levels? It is paramount that WHO begins prevention and aid strategies today for a better tomorrow.
Issues of Measurement and Metric
Tracking this disease and its cases is all very well and good during the middle of the emergency. However, as I have demonstrated, this virus and its impact are here for the long haul. As such, the continued use of simplified metrics of measurement – such as current trends in numbers of infected – raises the risk of underestimating the long-term impact on the population. For instance, policy and public narratives focusing on short-term prevention of deaths and the economic damages of lockdowns fundamentally shun the potentially damaging long-term disease-related disabilities that will affect global well-being and productivity. One set of metrics, called DALYs and QALYs, measure the impact of ill health on a person’s life course. These metrics combine the years of life lost because of premature death, and the years lived while experiencing the disabling consequences of disease. These metrics enable a full understanding of the international impact of disease. Harnessing these types of metric is going to become more and more important as nations and WHO begin to understand and research the impacts of long COVID.
WHO and Long COVID
It is paramount WHO begins to tackle what is evidently a long-term global health problem which will affect large portions of the population, possibly removing them from the economy and placing them in need of prolonged healthcare. WHO recognises that around 10-20% of people infected by SARS-CoV-2 may go on to develop symptoms that can be diagnosed as long COVID. On top of that, more than 17 million people across the WHO European Region are believed to have experienced long COVID in the first two years of the pandemic. What we are witnessing is the beginning of a far-reaching and persistent global health issue. In relation to WHO’s mandate, this is well within the organisations’ area of expertise. It will, furthermore, impact their goals of providing better health care to one billion people globally. Questions also continue to arise about the impact long COVID will have on peoples’ ability to function in the economy and in society. Will there be any support for these people, who have suffered much as it is?
It is also well worth noting, as the United Nations Department of Economic and Social Affairs does, that COVID-19 and its long lasting economic and health impacts are going to disproportionally effect poor people. For example, homeless people who may experience long COVID may be unable to access healthcare services, safe shelter to recover or even running (and safe) water. WHO must begin to address, through policy action, the social crisis created by COVID-19 which may also increase inequality, exclusion and global unemployment in the long term. WHO, while also focusing on research for long COVID, must look into comprehensive, universal social protection systems which enhance people’s capacity to manage long COVID.
New Possibilities and Developments- Understanding and Researching Long COVID.
Both WHO and the Long COVID Forum Group suggest the research priorities for long COVID should centre around improving its clinical characterization as well as further research and development into therapeutics. NICE is currently developing guidelines which will recommend how to identify, refer, and treat patients with long COVID, suggesting breathlessness may be investigated using a tolerance test suited to each individual. There have been further developments by scientists in the United Kingdom using xenon gas scan methods to pick up lung abnormalities previously unidentifiable by routine scans, reported on the BBC news.
All these measures and vigorous research provide some much-needed light in a tunnel which still may have no true end.
Questions for WHO
How does WHO plan to tackle the ongoing and continuously developing social crisis, created by long COVID, along the lines of inequality, exclusion, discrimination, and global unemployment?
Will funds be allocated on a global scale to research medicines to relieve long COVID much like the STIMULATE-ICP study led by UCL researchers in the UK?
How does WHO plan to tackle the evident long-term negative health problems presented by COVID-19 and long COVID considering the organisations goals to ensure better health and well-being for one billion people?
What potential measures might be taken to alleviate the potential decline in education levels and economic productivity following COVID-19?
I am eager to learn from WHO what exactly the strategy is going to contain for the management of long COVID. Primarily, my career orientation is leading me towards disaster relief which is somewhat relative to long COVID, especially in light of the simple fact the long term disasters in health are often overlooked and overshadowed by more pressing and immediate natural disasters. I am extremely interest in how WHO is going to manage this issues area with special regards to global inequity in healthcare access. Furthermore, it will be interesting to find out the consensus in the organisation regard the long term economic impact long COVID may have when considering the evidence surrounding the H1N1 pandemic’s impact on economic and educational development.
Written and edited by Fraser Brown