America's healthcare system will struggle to deal with Covid 'long-haulers'
Post-viral fatigue syndrome (PVFS) isn’t new, but that won’t stop Covid “longhaul” syndrome from toppling an already unsteady medical system. The symptoms faced by so-called long-haulers – Covid patients who don’t seem to fully recover, even months after infection – can be debilitating. Understanding the similarity of long-haul syndrome to previous outbreaks (as well as the differences) should advise an incoming administration on the need for massive healthcare reform.
Post-viral fatigue syndrome has followed many viral outbreaks, such as the Spanish Flu of 1918, the 2002 SARS-CoV, the 2009 influenza, and the Ebola outbreak of 2014 – to name a few. PVFS is also frequently linked to Epstein-Barr virus (EBV), which can cause infectious mononucleosis (mono, sometimes called the “kissing disease”). Similar to Covid-19, EBV may present with no symptoms – especially in children – but it has been linked to the triggering of autoimmune disorders.
The threat of long-haul syndrome isn’t its novelty, but rather its history. Post-viral fatigue is often categorized with (and sometimes becomes) chronic fatigue syndrome (CFS), an illness that effects women at four times the rate as men and still eludes effective treatment. Current reports estimate that at least 10% of people reportedly infected with Covid-19 have gone on to develop long-haulers syndrome. As of Thanksgiving, the United States will have surpassed 12m cases of Covid. At 10%, we can anticipate a heavy addition to the already staggering rate of chronic illness in the US; if our healthcare system doesn’t adapt, it will likely fail.
What exactly is long-haulers syndrome? It’s too early to know. As of now, the phrase is a catch-all diagnosis. It appears that long haulers can be divided into two main groups: those who experience physical damage to their organs, and those who exhibit symptoms without clear physical explanation. The latter is most similar to classic PVFS, and the former seems to be a consequence of Covid’s function as a vascular disease – novel for a respiratory virus.
As a vascular disease, the widespread inflammation caused by the immune response to Covid can inflame the inner lining of endothelial cells, which line our blood vessels. Simultaneously, when the virus enters the cells via the ACE2 receptors, it can cause exocytosis – basically, causing the cells’ guts to spill out, which further increases systematic inflammation. The vascular injury triggers wide-spread clotting, which may explain many of the seemingly weird and unrelated symptoms of acute Covid. This circular reaction may have long term consequences, such as tissue damage and scarring. Whether the injury is obvious, or not, both groups of long-haulers can suffer long-term damage to the lungs, heart, brain and immune system.
It’s not uncommon for a virus to trigger autoimmunity when there is a predisposition. An overactive immune response (such as that seen in Covid) can cause self-antigens to attack a person’s own body. Autoimmune conditions such as diabetes, systematic lupus, rheumatoid arthritis, celiac disease and multiple sclerosis have all been linked to a viral stimulus.
We are also seeing low-grade systematic inflammation in patients who recover from Covid-19. Systematic inflammation has been linked to chronic fatigue, autoimmunity, type 2 diabetes, metabolic syndrome, cardiovascular disease and obesity, among others.
The NIH estimates that 8% of the US population has an autoimmune disease. The national obesity rate is above 40%. Diabetes affects more than 10.5% of the population. In other words, the US already has a chronically ill population – and Covid-19 is only going to
make that worse. Economically speaking, preventable chronic diseases account for nearly 75% of aggregate healthcare spending in the US, or an estimated $5,300 per person annually, according to the CDC. Six in 10 adults in the US have at least one chronic disease; four in 10 have two or more chronic diseases. We have long been an unwell nation, even before Covid-19. If anything, Covid long-haul syndrome shines a necessary spotlight on the United States’ chronic problem.
The current health care model doesn’t work. There needs to be more emphasis on lifestyle interventions with a broader understanding of integrative practice. The goal of these prevention strategies is to help Americans live longer, live healthier, and live cheaper. Simply put, preventative healthcare saves money and lives. For instance, researchers have recently discovered that type 2 diabetes can be reversed with early intervention. Headway has been made in treating multiple sclerosis and lupus with immune treatments, as well as with diet and exercise. Almost all chronic diseases are preventable by integrative practices and early intervention.
It must also be noted that chronic illness affects mental health, which manifests physically, increasing the risk for diabetes, sleep disorders, chronic pain, and heart disease, among others.
Simultaneously, health care must be made more accessible – including preventative healthcare, which can no longer be considered as an add-on to traditional care. We know that some communities of color experience chronic illness at overwhelmingly higher rates. We know that autoimmunity affects women at strikingly higher rates than men. We know that chronic illness disproportionately affects those in lower socioeconomic groups. Health must not be a privilege of wealth, whiteness, and gender. The cost is too great.
Currently, we are in the acute stage of a crippling pandemic caused by an invisible pathogen. Layered on top of that is a second pandemic, the mental health costs of this virus. Then there is a third layer: a hyper-partisan political climate, which exacerbates the first two. When a medical mask becomes a sign of political division, we are in grave danger.
Jennifer Lutz is a health and science journalist who writes for the New York Daily News, BuzzFeed, and other publications. Recently, Jennifer served as the director of the True Health Initiative (THI), an NGO dedicated to public health and lifestyle intervention. Dr Richard Carmona, MD, MPH, FACS, was the 17th Surgeon General of the United States and is a Distinguished Professor of Public Health at Arizona State University. He also holds faculty appointments as a Professor of Surgery and Pharmacy
When a medical mask becomes a sign of political division, we are in grave danger