Writing in Science, Ziyad Al-Aly and Eric Topol say:

“SARS-CoV-2 infection increases the risk of a wide array of chronic diseases and will contribute to a rise in the burden of cardiovascular disease, diabetes, neurologic impairment, and autoimmune conditions. This will increase demand on health systems and raise health care costs, and their impact may take many years to fully manifest. Long Covid affects the development and educational attainment of children and reduces labor participation and economic productivity in working-age adults. Both the direct effect of increased risk of death in people with Long Covid and the indirect effect on mortality through increased burden of chronic diseases caused by SARS-CoV-2 (e.g., cardiovascular, metabolic, and neurologic diseases) may contribute to further decline in life expectancy, potentially erasing decades of progress. Addressing these challenges will require continued focus on strengthening prevention efforts and urgently finding treatments for Long Covid.”

In this comprehensive perspective, they summarise the current understanding of Long Covid and make recommendations for governments to tackle the magnitude of the problem, saying:

Preventing infections and reinfections is the best way to prevent Long Covid and should remain the foundation of public health policy. A greater commitment to non­pharmaceutical interventions, which include masking, especially in high-risk settings, and improved air quality through filtration and ventilation, are requisite. Updating build­ing codes to require mitigation against air­borne pathogens and ensure safer indoor air should be treated with the same seriousness afforded to mitigation of risks from earth­quakes and other natural hazards. Reducing the risk of serious outcomes after COVID-19 and some prevention of Long Covid can be attained with vaccination of a wider spec­trum of the population. Given the dwindling appetite for COVID-19 boosters, strategies to improve uptake (e.g., pairing it with the annual influenza vaccine) may be effective. Development of more durable, variant-proof vaccines that are not vulnerable to evasion by the ever-mutating virus need to be acceler­ated. Nasally or orally administered vac­cines that induce strong mucosal immunity to block infection and transmission should be pursued, and there are preliminary sup­portive data from clinical trials. It is also necessary to broaden the pipeline of SARS-CoV-2 antivirals, especially because of rising resistance.”

Many of those with Long Covid say until people experience the illness, they simply cannot understand it. This first person perspective of an adult in their thirties illustrates the public health error of believing vaccines alone are sufficient to protect people. And this perspective describes the price paid by a teenager as a result of repeat infections.

Industries around the world are experiencing staff shortages. As ING reports, Dutch retailers are having to restrict opening hours because they cannot find workers1. The German economy minister, Robert Habeck, has said that without migrant workers, the German economy would collapse2. We’ve previously written about the rise in staff shortages and the need for government action to prevent repeat infection by SARS-CoV-2. Economists in America are struggling to explain the sustained increase in retirees3 with more than 2.5 million excess retirees per month than expected.

Correlation is, of course, not causation. There could be a variety of reasons why the world is suddenly seeing increased retirement, rising disability4,5, staff shortages in a range of industries in almost every country, continued pressure on healthcare systems6, and a massive rise in chronic school absences in almost every country that reports figures6.

As Drs Al-Aly and Topol write in their perspective, we do not yet fully understand the causes and long-term consequences of Long Covid, but SARS-CoV-2 seems to have the potential to do multifaceted harm with each infection and reinfection. These harms include reactivation of latent viruses, persistent infection, and dysregulation of the immune system, and as previous studies have found, dose matters - it seems a sufficiently high viral load can overcome prior vaccine or prior infection-acquired immunity7, and severity of acute illness can make a material difference to health outcomes8.

Governments keen to reopen economies listened to those who gave optimistic assessments of this novel pathogen and who said that once the virus was no longer a novelty for our immune systems, repeat infections would be unlikely to cause harm. We now know this is not the case, and data from around the world is starting to show that Long Covid is more prevalent in people who have had a higher number of infections9. We repeat our call for leaders to recognise the scale of the problem facing us and to act to prevent further harm6.

As evidence mounts of the toll taken by SARS-CoV-2 reinfection, we join Drs Al-Aly and Topol in calling for a comprehensive approach to reducing the number of COVID-19 infections, using the broad public health strategy and tools they suggest to lower the risk of exposure to SARS-CoV-2 in everyday life. We also echo their call for more investment in research and therapeutics to help the millions around the world already affected by Long Covid.

While we wait for governments to recognise the severity of the problem and the need for action, we recommend people do whatever is reasonably possible to reduce the severity and number of SARS-CoV-2 infections they experience over their lifetime. Click here for advice on how to reduce your risk.