It was March 11, 2020 when the director general of the World Health Organization, Tedros Adhanom Ghebreyesus, declared Covid-19 a pandemic. In those days the tsunami was rising and then hitting the world with all its violence. 3 years have passed and, now that the wave has receded, the ‘ghosts’ of a pandemic that everyone would like to leave behind are around 65 million people caught in the grip of Long Covid, imprisoned in an infinite 2020. The negative buffer he decreed that the virus has left them, yet it is always with them and forces them to a life in black and white, a vague memory of the one before. On this silent army ‘The Lancet’ magazine, one of the scientific community’s bibles, turns the spotlight on with an editorial: ‘Long Covid: 3 years later’. The message is clear: “Long Covid is often easily dismissed as a psychosomatic condition. Given what we now know about its effects and biological underpinnings, it must be taken seriously.”
The faces of Long Covid are women, men, even children. Fatigue, shortness of breath, brain fog and cognitive dysfunction are some of the symptoms that accompany them in their day. It is “a debilitating post-infection multisystem condition”recalls the Lancet, which “compromises the ability to carry out daily activities for several months or years. Although most patients infected with Sars-CoV-2 recover within a few weeks, Long Covid is estimated to occur in 10-20% of cases and affects people of all ages, including children, with the majority of cases occurring in patients with acute mild disease, resulting in widespread global damage to health, well-being and livelihoods. of people. In fact, it is estimated that one in 10 people who develop Long Covid stop working, with consequent huge economic losses“.
In 2021, the editorial reads, “we have called for a coordinated research and health care program to address this new medical challenge. However, progress has been terribly slow due to lack of attention and resources.”
“Some progress has been made in our understanding of the multifaceted and heterogeneous nature” of this condition. In a commentary in ‘The Lancet Infectious Diseases’, scientists Akiko Iwasaki and David Putrino consider possible causes, including viral persistence, autoimmunity triggered by infection, reactivation of latent viruses, and chronic changes triggered by inflammation that lead to organ damage, factors that could explain the different phenotypes of Long Covid patients.
How is it being done? Several candidate treatments are being tested, based on different symptoms and biological mechanisms. The crux – the editorial explains – is that “many patients struggle to obtain a definitive diagnosis”, due to the diversified symptoms of Long Covid, the fact that one has to depend on what is self-reported by people, the lack of tests diagnostics and a consensus definition. “On a global scale, Long Covid has not received the attention it deserves and there is a general lack of public awareness,” reports the Lancet.
In many realities the data are absent, especially in low- and middle-income countries. Where studies have been conducted instead – such as in India, China and South Africa – Long Covid has been detected. Hence the appeal: “A globally coordinated multidisciplinary research agenda, bringing together governments, non-governmental organizations and civil society, is essential to improve our understanding of cause and pathogenesis, clinical diagnosis, treatments, risk factors and prevention of Long Covid. Only in December 2022 did the United States and the European Commission hold a conference to promote international cooperation” on this front.
In August 2022, the US established the National Action Plan for Research on Long Covid, which led the National Institutes of Health (Nih) to allocate $ 1.15 billion for the ‘Recover’ project (Researching Covid to Enhance Recovery). The EU has yet to define a research agenda for Long Covid and the Long Covid Europe network of patient associations is asking for 500 million euros in EU emergency funds for research.
Without specific treatments, the Lancet notes, “the focus must fall on prevention, keeping Covid cases low and ensuring vaccination, and patient-focused multidisciplinary care.” Patients, many with complex multipathologies, need multisectoral “physical, cognitive, social and occupational” support, the authors of the editorial list. “The outlook for such care only appears to have deteriorated. Primary care has suffered in many countries, waiting lists have lengthened and health systems are struggling.” Education and awareness about the clinical management of Long Covid in primary care remains insufficient and inequalities in care continue. Trusted and authoritative platforms to support and guide patients are still lacking in many contexts.
“Delays in treatment and support for those who deal with post-virus sequelae on a daily basis prolong and exacerbate the symptoms of Long Covid”, warns the Lancet. The months of the acute crisis of the Covid pandemic “have motivated an unprecedented response from governments, international organizations, pharmaceutical companies and civil society – concludes the scientific journal – Long Covid has not received anywhere near the same level of attention or resources : the result was widespread damage to health, societies and economies. After 3 years, it takes several more” to get to properly recognize, treat and support patients.