While it might seem that we are coming out the other side of the pandemic, for many people, the effects are here to stay, argues Adriana Cooley

It is quite extraordinary that we live in a time where, on live TV, the only thing our public-health secretary can say to the six million people on the NHS waiting list, is that the list will expand drastically to exceed ten million by 2024, and that it is your fault for not coming forward sooner, during a pandemic.

Sajid Javid’s attitude exemplifies the Tories’ current strategy towards our health. One of contempt, and one of frustration, at not having privatised the NHS fast enough. If the Tories had treated the pandemic from the point of view of preserving health rather than profit, we would have a world-class test-and-trace system, full sick pay and isolation support, a fully funded and publicly run NHS, and ultimately a virus that wouldn’t have been able to circulate and evolve with such deadly and catastrophic consequences.

Instead, we have a pandemic disaster that is continuing to unfold, with no end in sight. The initially grossly unpopular and failed herd-immunity strategy has been redeployed now that hostility against it has waned. Aside from wanting to appease a rabidly covid-sceptic group of backbench Tories, this is what lifting the final barriers of protection against the pandemic have been about. It makes no sense from a public-health perspective to make lateral flow tests no longer free to order – despite reportedly spending £37 billion on test and trace – unless you want to discourage testing and have people spread the virus unknowingly. Or to eliminate isolation mandates entirely.

This article will attempt to argue why the pandemic is very far from over, and how the phenomenon of long covid is a hidden and ignored crisis, not just by our overlords, but by many of those on the left, and must be given renewed attention, given its scale and growth trajectory. The link between infections and deaths has been broken, but this is not the same for long covid. If our health secretary can’t do anything for those six million people on the waiting list, we certainly can’t expect him to give a thought to those with long covid.

Before we delve into this, I want to say from the outset that I am not an expert or specialist in the field of medicine or public health. This is my own research in which I’ll try to present the situation in an accessible way. With that said, I wish to start by countering some myths that persist about the pandemic in general, and long covid.

‘The virus will become “endemic” so we can go back to normal’

At the time of writing, it seems to me that the general feeling among many is that with Omicron, the virus is not as dangerous, we can let it rip, herd immunity will prevail, infections will continue to go down, the virus will become ‘endemic’. We can go back to normal.

Endemic means a state of equilibrium where the pathogen is always there at a consistent level. Associated with the term endemic is the conception that the virus will become less dangerous, but this is not a one-way street. The more a flu or coronavirus circulates, the more opportunities it is given to mutate. Viruses can mutate to become more or less deadly, as we saw with Delta, which became more virulent than the original. Omicron is only less deadly due to the fact it doesn’t replicate so much in the lungs, but it is far more infectious and circulates more easily, therefore mutates more often. Before Omicron had reached peak infections in Denmark, it had already mutated into a 50% more infectious form.

Can we really expect covid to retreat into a steady or consistent state of circulation, given a virus that is mutating all the time with varying levels of infectiousness and differing forms and severities of disease? In addition, both vaccine and infection induced immunity wanes over time as demonstrated by the huge number of re-infections by Omicron.

‘Covid-19 is just like the flu or in the case of Omicron, a cold’

Covid-19 enters our body by attaching itself to a particular ACE2 receptor protein found on the surface of our cells. This is how the virus enters our tissue and begins replicating itself. These proteins are found in organs throughout our bodies, hence in severe cases where the immune system is unable to ward of the virus, it replicates throughout the entire body. This explains the large range of symptoms and, in many cases, permanent damage to the lungs, kidneys, heart, gut, skin, brain and other organs.  This is quite distinct from flu.

It is worth pointing out some other seemingly obvious differences:

• Covid-19 is far more infectious than the flu. The R-rate for the original strain of covid-19 was estimated to be about three. Recently the U.S. CDC updated their estimate to reflect the Delta variant having an R-rate of between five and nine. Then we had Omicron which is at this current moment the most infectious known variant of the virus, and the fastest spreading virus ever.
• We get far more ill from covid-19 than we do from flu: 2018 was the last bad flu season for the UK. At the peak, 750 people were hospitalised in one week. On January 12, 2021, over 4,500 were admitted to hospital with coronavirus on one day. This was of course before Delta and Omicron.
• Covid-19 is much deadlier than flu. In the bad year of 2018 in the UK, flu killed more than 1,600 people in one year. At its peak in the UK, covid-19 killed more than 1,250 people in one day. Again, this was pre-Delta.

Flu is also much less likely to result in long-term symptoms. Enter ‘long covid’.

What is long covid? How common is it?

Long covid is difficult to describe. We don’t even know what causes it. Long-covid or post-covid syndrome has become associated with a huge range of symptoms, sometimes debilitating and life changing, following symptomatic or asymptomatic infection. There is no known cure or proven treatment. It is very difficult to provide a consistent or agreed definition of long covid due to:

• Differing duration of symptoms.
• The large variety of symptoms.
• The fact that symptoms change, or new ones emerge.
• Symptoms are also very difficult to detect physically; fatigue, for example, is the most common reported symptom. How do we know if someone is fatigued, or just ‘lazy’, as the Tories would have you believe.

This partly explains the large variation in studies in terms of the risk of infection turning into long covid.

Symptoms

There have been over 200 symptoms identified for people with long covid across nine different organ systems. The most common of these is fatigue, post-exertional malaise (where symptoms worsen following physical or mental exertion), and ‘brain fog’ or ‘cognitive dysfunction’. Relapsing or changing symptoms over time is also extremely common. It’s also very common for people to suffer from multiple symptoms simultaneously, and similarly its quite rare for people to experience just one symptom.

Another common lingering symptom of covid is loss of the senses of taste and smell. According to a Swedish study of 100 healthcare workers from the first wave, one in ten is still suffering from a seemingly permanent loss of sense of smell, eighteen months after recovery. What kind of material impact does this loss of senses have on someone’s life? Most obviously it leaves people oblivious to warning signs such as the smell of fire, gas, food that is off etc. Other effects are less obvious: ‘Most people don’t acknowledge the importance of smell in their lives — until they lose it.’

Many sufferers are unable to eat due to their distorted sense of smell, with predictably devastating consequences. While most covid survivors recover their sense of smell fully, the damage to those who don’t recover after several months may be permanent.

Demographics and risk

One misconception is that long covid only affects older or vulnerable people. While those with underlying health issues, or ‘co-morbidities’, or those who are hospitalised, do have a higher risk of long covid, those reporting symptoms are predominantly of working age, i.e. 35 to 69 years of age (see appendix). Another misconception is that people only experience long covid following severe symptoms. Analysis of medical records in California found 32% of long-covid sufferers were asymptomatic, i.e. they had tested positive for covid, but didn’t experience any symptoms at the time of infection. Being super healthy and fit doesn’t protect you from long covid either; long covid in athletes is well documented. As of September 2021, Office of National Statistics (ONS) data showed there were 34,000 children living with long covid.

In reality, no one is safe from long covid.

Prevalence of long covid

So how do we go about estimating the scale of long covid? A Lancet editorial in August 2021 emphasised that with ‘no proven treatments or even rehabilitation guidance, long COVID affects people’s ability to resume normal life and their capacity to work,’ and is a ‘modern medical challenge of the first order.’ The US government also recognises the seriousness of the situation with $1.25 billion of funding for research alone committed in January 2021 to be released over four years.

Long covid is a very complex, little understood, and varied disease, therefore you can’t easily generalise the results of studies and other research to the overall population.

• A March 2021 Kings College self-reported symptom study found 4-5% of those catching covid are still reporting symptoms after eight weeks.
• In a January 2021 study of healthy young Swedish healthcare workers, one in ten were dealing with at least one moderate to severe symptom eight months later.
• In a September 2021 study of the health records of 270,000 people diagnosed with covid, 37% were found to have at least one of nine symptoms persisting between three and six months later. The results were compared with Influenza survivors which found a 50% increased likelihood of lasting symptoms in covid over influenza patients.

One of the most comprehensive self-reported data sets on long covid in the UK is from the ONS and is published monthly. This classifies responders into categories of those living with long covid. I have split these people into groups of:

• Living with Covid for more than 1 year after infection
• Living with Covid less than 1 year after infection

And in terms of differing levels of adversity:

• Adversely affecting day-to-day activities.
• Ability to undertake day-to-day activities limited a lot.
• Not reported.

I have presented these groups in the visualisations below:

It is worth saying that the ONS study is likely to be a significant under-representation as it is on the more conservative end of its estimates, and the estimates themselves are on the conservative side of other studies I reviewed.

In terms of making sense of the numbers, I believe there are some things we can be sure of:

• Long covid is widespread. There are a huge number of people, of predominantly working age, suffering with a range of symptoms with varying levels of severity.
• This number is growing and is likely to grow further with infections as there are currently no proven treatments for long covid. In addition, vaccinations only reduce your likelihood of getting covid by approximately 50%.
• The social consequences are likely to be huge, and are likely to reduce the supply of labour significantly. The Chartered Institute of Personnel and Development recently found that ‘one in four (26%) employers now include long COVID among their main causes of long-term sickness absence.’

What is to be done?

The Pandemic is not over. What impact will the Omicron wave (see graph below) have on the current growth trend of those living with long covid? We don’t know the answer to these questions yet, but the final ONS survey published in April 2022 will give us strong indications of the answer as it will show us the impact of the January Omicron wave.

We must be prepared for the worst-case scenario of the long-covid population growing at an unsustainable rate, particularly with the massive increase in infections due to Omicron, and the increasing rate of mutation. If the worst is confirmed, then we must confront the reality that virus circulation and infection must be controlled. We cannot let it rip.

We must be under no illusion that that the full severity will ever be publicly acknowledged by the current establishment; it will be seen as a labour-supply issue, and any response from a human-health perspective, will be deemed too difficult or costly. The ruling class will undoubtably look at alternative ways to increase the labour supply.

As socialists, the dilemma for us is arguing for a balance between virus circulation control and avoiding or limiting the health damage of lockdowns on a lockdown-weary population.

It is probably unrealistic to pursue an elimination strategy, although equally we shouldn’t rule it out. (Indeed, if we were faced with a scenario where the virus evolves to become far more deadly, a ‘zero-covid’ policy would be the only option.) The sentiments and principles around prevention and internationalism with the vaccine rollout should be supported. Long covid should be central plank of campaigning around the pandemic generally, in well formulated campaigns such as the ‘peoples’ covid inquiry’. Public health and the NHS that underpins it wasn’t handed to us, we fought for it. And we must continue the fight to preserve it with renewed energy and vigour.