An uncertain future for millions of COVID-19 long haulers — and for society

“Have you had any of the following symptoms: fatigue, loss of sense of taste and smell, muscle and body aches, shortness of breath?”

In the last year, I’ve asked about these symptoms more times than I can count. We think of them as the passing effects of an illness, an unfortunate nuisance that disappears as the illness is cleared and we return to our normal state of health. However, for some people with COVID-19, the usually temporary symptoms linger long past the initial illness. 

To better understand who is developing prolonged symptoms and which symptoms are most likely to persist, colleague Jenni Logue and I studied a group of people who had recovered from COVID-19 several months prior.

We examined a group of Seattle-area individuals who had tested positive months earlier for COVID-19, asking whether they still experienced effects of their illness. Surprisingly, 30% of participants reported at least one symptom at an average of six months after their acute infection.

Participants’ infections spanned “mild,” “moderate” and “severe” designations. Of note, 84% of the participants had a mild infection and 64% did not even seek medical care. With an average age of 48, our cohort was generally young and healthy. Yet 30% of those with mild illness reported a worse quality of life after they had recovered from the acute phase of infection.

We are starting to see the infections’ lasting, negative effects on the daily lives of those affected. Looking more broadly, there are large potential ramifications for local and national economies and health care systems. 

More than 27 million Americans have been diagnosed with COVID-19. If even a small percentage of these individuals develop long-term weakness or fatigue, the economic impact could be enormous.

The emergence of COVID-19 adds to the existing burdens our society faces from influenza and other respiratory viruses that cause billions of dollars in lost productivity each year. In addition to lost productivity from the period of acute illness, we have yet to see how these lasting symptoms affect people’s ability to work further into the future. 

We don’t yet know what therapies, drugs and procedures it will take to care for these patients who will see their lives disrupted for months post-infection, and whether these conditions will become chronic. An estimated 27.5 million people in the United States lack health insurance; it is unclear who will pick up the tab for those who need long-term treatment. Large studies will need to be conducted just to estimate the size of population affected and the extent of care needed.

For people experiencing lingering effects, clinicians and researchers are just starting to see the detrimental effects on simple activities such as managing personal hygiene, completing chores and caring for loved ones. Crucially, these reverberating burdens are not limited to people whose COVID-19 infections required hospitalization.

Boston Celtics standout Jayson Tatum recently spoke out about the fatigue and increased trouble breathing he has experienced since his COVID-19 illness, showing that even the fittest people can experience prolonged effects. Of course, most of us are not professional basketball players, and it is not the ability to run the court that concerns us, but the ability to feed children or aging parents, to go to work, to do the things we love.

Some institutions have established specialized clinics to care for these patients; for example, University of Washington Medicine recently launched a post-COVID-19 clinic. But in addition to multidisciplinary care, further research will be needed to understand the physical and biological mechanisms of “long COVID” and how best to treat them. Those resources will also need to be more widely accessible as COVID-19 continues to spread. 

Until vaccination is widespread, even mild COVID-19 infection will continue to have systemic and human costs long beyond the week or two of acute illness.

Health care systems and economies will continue to experience COVID-19’s burden. While systemic change is necessary, in the meantime we can act quickly to allocate resources to caring for affected patients and to understanding the protracted symptoms of the novel coronavirus and how they can best be treated.