The silent burden of post Covid-19 health impact

COVID-19 is no longer a scare around the world because the pandemic is over. It is now a long-term disease, just like any other infectious disease that is treated according to standard guidelines. However, there is a silent, creeping burden of post-COVID-19 impact on public health, with post-COVID consequences even at very low transmission rates.

The silent burden of COVID-19 arises from complications from previous COVID-19 exposure. These conditions called COVID-19 post-acute sequelae (or long COVID) refer to the aggravation of pre-existing conditions or the development of new symptoms ranging from neurological conditions to fatigue, brain fog, multiple organ damage, etc.

The silent, undetected burden of long-term COVID presents differently in people. Hence, it is sometimes difficult to identify. It is therefore necessary to consider the previous history of COVID-19 in patient management of seemingly unrelated new diseases to reduce public health burdens that will soon arise from COVID-19 complications or long-term COVID.

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Also, there is a need for public awareness of the spread of new variants (forms) of COVID and post-COVID conditions (long COVID), which can develop into serious conditions that lead to death. Back in the year 2020, who would guess that a new virus that emerged in late 2019 would cripple the world in a pandemic that has infected to date over 760 million people and killed over 7 million people globally?

Coronavirus disease 2019, known as COVID-19, is an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) characterised by rapidly spreading respiratory illnesses affecting multiple organs in children and adults. COVID-19 causes a barrage of mild to moderate symptoms and, in severe cases, leads to death, but long-term COVID presents like chronic conditions. In most cases, long-term COVID is identified months after recovery from COVID-19.

The acute infection involves viral attachment to a receptor on the surface of host cells, in particular angiotensin-converting enzyme-2 receptors on lung cells, to infect humans. Several other events take place after the virus attaches itself to the host cell, and these include viral replication and viral release, which cause acute infections, but long-term COVID continues to develop over a long time.

The COVID-19 pandemic put the world to a stop in 2020 because public health experts and scientists were caught unprepared by the magnitude of the widespread spread of the virus, the overwhelming effects on the health systems, and unprecedented deaths. Covid-19 was a newly discovered virus, but it was later found to be very similar to the known SARS and MERS viruses, which cause severe respiratory illnesses.

In the early months of the pandemic, there were no known drugs to treat the unknown virus or vaccines to prevent its continuous spread. Several strategies were used to manage patients, many of whom developed severe cases that led to a high number of deaths. It then became apparent to the world, including first-world countries, that we were not pandemic-ready!

This was due to the high shortage of ICU facilities and staffing, as well as the shortage of medical supplies. Strategies included social distancing, whereby movements were largely restricted, and social gatherings—this reduced the transmission—but the virus soon defied this strategy and continued to spread. Therefore, therapeutics and other preventive approaches were quickly developed.

Another public health concern of the COVID-19 virus is the changes in parts of its genetic makeup (genome), a term called mutation, just like other viruses. These variants differ slightly in their genetic makeup, the severity of COVID-19 illnesses they cause, and the ease of transmission. As a prevention strategy for COVID-19, many vaccines were rolled out globally. In the wake of the pandemic, some vaccines prevented infection, but soon the COVID-19 virus continuously mutated, causing many vaccines to be discontinued or booster shots (2nd, 3rd, and 4th doses) introduced.

New variants are now causing rising cases of COVID-19 in western countries, like the JN.1 and KP.2 variants in the UK and US as of July 2024, but in Nigeria, transmission has been insignificant, with the BA.2.86 variant circulating according to the CDC; however, the burden of long-term COVID is not yet known. Scientists are still in search of more treatments for COVID-19 emerging variants and, more importantly, understanding the silent burden of long-term COVID.

The currently used drugs, including Remdesivir, Molpunavir, etc., only treat acute early-stage infections, but drugs are yet to be developed to prevent or treat long-term COVID, which may impact the world as an increase in chronic diseases, thereby increasing the public health crisis. Scientists will continue to research new therapies and strategies to combat COVID-19 and its consequences to prepare for any future pandemics and post-COVID sequelae.

Dr Titilope Dokunmu, is an associate professor of biochemistry and expertise in pharmacology, and molecular biology.