Long-Term Long Covid - by Eric Topol
Unfortunately, what was seen at 6 months largely continues out to 2 years.
... [New paper at] Nature Medicine addresses what happened 2 years later to nearly 140,000 people who had Covid, compared with almost 6 million people non-infected controls.
... in the non-hospitalized group a substantial proportion— about 30%— of the 80 sequelae, including GI and neurologic, remained significantly elevated.
... I’d like to point out the data analyzed in this study was enormous, as I tried to capture with one of the supplemental tables below, representative of many others. The authors took on many advanced analytic approaches with weighting, conditional modeling, and sensitivity analyses that I’m not going to review here.
... While this is the first comprehensive and systematic study of Covid at 2 years, it unfortunately is within a highly skewed population. The demographics of nearly 90% men, with a mean age 61 years, is far different than the prototypic person with Long Covid who is more apt to be female and age 30-39 years. Furthermore, to get 2 year follow-up it meant studying a population who had Covid early in the pandemic, before vaccines or the marked evolution of the virus with new variants, including Delta, which was more virulent that the ancestral or Alpha strains that preceded it. So please keep this in mind—the results are important but they may well not be representative of the real world, broader population, of Covid and Long Covid. That’s already a major hole in our knowledge base since there is no other report yet to systematically address a more representative population.
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Summary
At two years after Covid, there’s a persistent and considerable burden of symptoms and multi-system organ involvement in an important subgroup of people. It’s also unpredictable who will be afflicted with protracted symptoms and new medical diagnoses. While there still is no validated treatment (the Big Miss, as recently reviewed), Long Covid marches on, not just over time for most of those already suffering, but also among newly infected or re-infected individuals — like we are seeing now with increase in cases in the United States and many other countries. The main emphasis here, beyond the enduring and very concerning symptoms and organ dysfunction, is that we are still in the dark. It will take many years to fully know the sequelae of Covid, be it from unforeseen, delayed adverse outcomes like what occurred many years after influenza or polio, or the secondary outcomes of organ systems that are clearly affected, or via promotion of autoimmune conditions or pro-inflammatory pathways, potentially exacerbating risk of atherosclerosis. We’re going to need many more years of careful follow-up to fully understand the ways and extent Covid has hurt us. Meanwhile, beyond the known strategies for prevention of infection, we must consider finding effective ways to treat people who suffer from Long Covid as an urgent and foremost priority.
