Long Covid has become a parallel pandemic

The price of "living with Covid" in a free and open society is turning out to be much heftier than public health experts predicted.

Even with good vaccines and treatments, this year's US death toll is already many orders of magnitude higher than that of the other virus that circulates each year, the flu. A terrible flu season kills about 50,000 people, but already more than 226,000 have died from Covid in 2022 — and even if another wave is avoided and fatalities remain at their current "low" level, another 150,000 lives could be lost over the next 12 months.

Then there's the ballooning price of long Covid. Ongoing transmission, even if more like a slow burn than a raging fire, will mean the ranks of long-haulers will continue to grow. Long Covid has already pushed as many as 4 million people out of the workforce, according to a recent Brookings Institution report. As public concern over Covid fades, and funding dries up, it will become even harder to stem this parallel pandemic.

The government has put most of its resources behind solving the mystery of what causes long Covid. That's essential work, but very little of it is devoted to studying how to treat and prevent long Covid. Covid long-haulers deserve better.

The Centers for Disease Control and Prevention estimates that 1 in 5 people who contract the virus suffer lingering symptoms. Some slowly recover, but others find their quality of life drastically diminished for months or even years.

The only things that can get this parallel pandemic under control are better vaccines and treatments. But as society moves on from the emergency phase of the Covid pandemic, both may become more difficult.

Consider the increasingly challenging task of developing new vaccines. Infectious disease experts have advocated for developing universal coronavirus or intranasal vaccines — both worthwhile approaches for their potential to prevent the spread of the disease and maintain efficacy in the face of new variants. Either could significantly reduce the number of people joining the ranks of long-haulers.

But in a country that's "over" Covid, funding to move these projects beyond the stage of good academic ideas and into actual clinical studies will dry up. And with the government no longer spending billions on Covid products, companies have far less incentive to invest in them. All of that coincides with a much more challenging and expensive climate for getting new Covid vaccines and drugs across the finish line.

One major issue is the growing challenge of enrolling volunteers in clinical studies. "It's really hard to recruit people," says David Boulware, an infectious disease researcher at University of Minnesota's Medical School. Boulware, who has led several large clinical trials of potential Covid therapies, said it took over a year to convince 1,300 people to participate in an internet-based study asking whether vaccination minimizes symptoms of long Covid. During that time, tens of millions of Americans contracted the virus. They would have been eligible for the trial, but that early-pandemic enthusiasm to volunteer for the greater good seems to be evaporating.

Finding volunteers for such trials also depends on people continuing to test themselves for Covid at the first sign of a sniffle or cough. But how many people with mild symptoms are still bothering to find out if it's Covid or a cold? If testing becomes passé, many people who ignored a mild infection could find themselves wondering why they're struggling with brain fog or fatigue — and could also struggle to get the support they need.

For example, one theory is that long Covid is driven by virus particles that persist for weeks or months. Ideally, studies would test whether existing antivirals like Pfizer's Paxlovid could fully clear the virus and prevent long Covid. But even in the thick of the pandemic, academic researchers have struggled to get such trials going, largely due to lack of interest from drug developers. Their task is about to get even harder, because those types of studies will hinge on enrolling people within days of falling sick.

The US federal government needs to be considering how to end the emergency phase of the Covid pandemic without putting solutions for long Covid further out of reach.

For example, one step would be for the Food and Drug Administration to shift the goals of new vaccine trials to focus on preventing infection and speeding recovery. During the early stage of the pandemic, the mandate for any vaccine or therapy was simple: Keep people out of the hospital and prevent death. The current vaccines and boosters crushed those tasks.

But newer vaccines should be aiming to minimize the number of infections, and thereby minimize the number of people at risk for long Covid. That calls for gauging whether new vaccines can prevent infection or significantly cut down on transmission. Late-stage vaccine studies should also include long-term follow-up to answer the question of whether they reduce the risk of long Covid. Promising data might in turn revive enthusiasm for vaccines and boosters at a time when the public seems less sure of their value.

More needs to be done now to ensure that efforts to develop treatments and vaccines aren't hopelessly stalled as the pandemic's first phase winds down. How can testing continue to be accessible and encouraged in an endemic world? What incentives can the government offer companies to keep pushing forward with new vaccines? What are the best ways to encourage the public to roll up their sleeves for studies of those new vaccines? Millions of Covid long-haulers — and potentially millions more long-haulers to come — are relying on the answers to these questions.

Covid might no longer be a public health emergency — the days of constant ambulance sirens and packed ICUs seem, thankfully, behind us. But the parallel pandemic of long Covid can't be neglected in the transition back to "normal."

Disclaimer: This article first appeared on Bloomberg, and is published by special syndication arrangement.