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Researchers from the universities of Arizona, Oxford and Leeds examined dozens of previous studies on long Covid to examine the number and extent of people affected, the underlying disease mechanisms, the many symptoms that patients develop, and current and future treatments.
Long Covid, also known as the post-Covid-19 condition, is described as symptoms lasting three months or more after acute Covid-19. The disease can damage multiple organ systems, resulting in reduced functionality and symptoms such as fatigue, cognitive impairment (often known as ‘brain fog’), difficulty breathing and restlessness.
Long Covid can affect almost everyone, including all age groups and children. It is more prevalent in women and people of low socioeconomic status, and the reasons for such differences are being studied. Researchers found that while some people recover gradually from long Covid, the condition can persist for years in others. Many people suffering from long Covid are still unwell before a vaccine arrives.
“Long COVID is a devastating disease with profound human life and socioeconomic implications,” said Janko Nikolich, MD, PhD, senior author of the paper, director of the Aegis Consortium at the University of A Health Sciences, professor and head of the Department of Immunobiology at the University of A College of Medicine – Tucson, and member of the BIO5 Institute.
“By studying it in detail, we hope to understand its mechanisms and identify targets for therapies against it, as well as possibly treatments against other infection-related complex chronic conditions such as myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia.”
If a person is fully vaccinated and has completed their booster doses, the risk of developing long Covid is very low. However, 3%-5% of people worldwide develop long Covid even after an acute Covid-19 infection. According to the Centers for Disease Control and Prevention, long Covid affects an estimated 4%-10% of the US adult population, and 1 in 10 adults with Covid develop long Covid.
The review study also found that a variety of biological mechanisms are involved, including persistence of the original virus in the body, disruption of the normal immune response, and microscopic blood clots, even in some people whose initial infection was mild.
There is no proven treatment for long Covid yet, and current management of the condition focuses on ways to relieve symptoms or provide rehabilitation. Researchers say there is a dire need to develop and test biomarkers, such as blood tests, to diagnose and monitor long Covid and find treatments that address the root causes of the disease.
People can reduce their risk of developing long Covid by avoiding infections – for example, wearing a tightly fitting mask in crowded indoor spaces – taking antivirals promptly if they become infected with Covid-19, avoiding strenuous exercise during such infections, and ensuring they keep up with Covid vaccines and boosters.
“Long Covid is a frustrating condition, but there are grounds for cautious optimism,” said Professor Trisha Greenhalgh, lead author of the study and from Oxford’s Nuffield Department of Primary Care Health Sciences. “A variety of mechanism-based treatments are being tested in research trials. If proven effective, these will allow us to target particular subgroups of people with precise treatments. Barring treatments, it is becoming clear that long Covid places an enormous social and economic burden on individuals, families and society. In particular, we need to find better ways to treat and support ‘long-haulers’ – people who have been ill for two years or more and whose lives are often turned upside down.”
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