The Risk for Long COVID increases with each Infection

A growing body of research is all coming to the same conclusion: SARS-CoV-2 reinfections are cumulatively increasing the risks for long-term health consequences. A recently published study from Canada (Experiences of Canadians with long-term symptoms following COVID-19 (statcan.gc.ca) is one of the more recent studies on this subject.

In a survey of Canadians, as of June of this year, approximately 2/3 of those surveyed reported a confirmed or suspected case of COVID-19 since the beginning of the pandemic, and many of this group reported reinfections, as well.

Approximately 3.5 million Canadian adults reported Long COVID symptoms at any point of the pandemic (occurring in about 16% of all adults previously infected), and as of June, 2.1 million were reporting persistence of their symptoms. Roughly half reported no improvement in their symptoms since their onset. [Note: I have discussed what Long COVID is, the nature of the symptoms, the suspected pathophysiology of the disease, and other long-term health consequences of COVID-19 extensively in prior blog posts if you need a refresher.]

Of note, while most countries use one- or two-month’s duration of symptoms in their case definition of Long COVID [The World Health Organization uses two months in its case definition]; Canada has a more restrictive case definition requiring at least 3 months for the duration of symptoms before calling it Long COVID.

People of the world are at risk for reinfections due to:

1. The waning of both vaccine-induced and infection-induced immunity;
2. The low percentage of children that have been vaccinated;
3. The low uptake of annual COVID-19 boosters;
4. The low rate of antiviral treatment of early COVID-19 to minimize the chances for serious illness and Long COVID.
5. The high percentage of persons who are asymptomatic or pauci-symptomatic (few symptoms often mistaken for allergies or a “cold”) but nevertheless capable of transmitting the virus to others.
6. Lack of media attention and/or misunderstanding of what the end of a public health emergency means and what it doesn’t mean;
7. The significant transmission levels of SARS-CoV-2 across the world and the infection of immunocompromised persons, both of which are driving the evolution of increasingly immune evasive variants;
8. The abandonment of most non-pharmaceutical measures to reduce infections in communities;
9. The resistance to adopting enhanced ventilation and air filtration in schools and other public buildings;
10. The significant transmission of infection in health care facilities;
11. The general public’s lack of understanding of the long-term health risks from COVID-19;
12. Disinformation campaigns that promote infection as a way to boost immunity or to achieve herd immunity (both of these assertions have been disproven);
13. The misinformation campaign of “vax and relax”;
14. The lack of reporting of cases and community transmission levels;
15. The marked reduction in testing;
16. Confusing guidance on isolation and quarantine that was also often not evidence-based; and
17. The well-documented fact that many employees are not staying home when ill, sometimes due to the lack of sick-time or paid time off.

The surveys revealed that the risk for long-term symptoms increased with each infection:

14.6% of those surveyed reported long-term symptoms following their first infection. That percentage increased to 25.4% with two infections and to 37.9% with 3 or more infections. In other words, this study (and others) suggests that the risk for long-term symptoms and Long COVID is cumulative.

I should also point out that there may be other long-term health consequences from COVID-19 that do not cause symptoms and there are other conditions, as have occurred following some other viral infections, that may not become manifest for years or decades.

There has also been little public discussion as to the economic implications of Long COVID – worker productivity, increases to employer health plan costs, rising insurance premiums, loss of employment, disability rates, and increases in life insurance pay-outs, among others.

In this study, of those that developed Long COVID, 22.3% were impacted to the extent that they missed time from school or work – on average 24 days. Given the large numbers of Canadians afflicted, the researchers estimated a total loss of about 14.5 million days of work and school among all Canadian adults. [Note that the population of the US is roughly 10 times that of Canada.] Approximately 5.3% of Canadian workers sought disability or worker’s compensation for Long COVID, and 93.8% of these applicants were approved. Of note, some of the most common occupations involved those with serious shortages in the U.S., e.g., healthcare, social services and education.

I fear that the majority of the population in the U.S. have become far too misinformed and complacent about COVID-19 and the risks for long-term health consequences. Unfortunately, I also fear that we will only come to appreciate these years from now, with profound regret, as we see the true impact of this disease and multiple reinfections, and God-forbid, not only in adults, but sadly our children.