How will long Covid play out over the coming years? Eight experts weigh in |

The story of long Covid is just beginning, and no one – not even the experts – knows how it will play out.

The “known knowns” are that few, if any, health systems around the world are equipped to cope with the parallel pandemic of long Covid. It will have profound social and economic impacts above and beyond the already devastating effects of acute Sars-CoV-2 infection.

The “known unknowns” are the major gaps in our understanding of long Covid’s physiology – who it affects, why and how – and how these gaps are hampering attempts to treat those with the syndrome.

Experts say some solutions are obvious: better diagnostic criteria, better testing, better clinical trials and individualised treatments, alongside support systems for those affected. And most important of all, not getting sick in the first place. But will those solutions be deployed in time to mitigate the effects of the “mass disabling event” that has already begun?

Eight experts from around the world share their insights, questions and fears about the future of – and with – long Covid.

Professor Ziyad Al-Aly, clinical epidemiologist, St Louis, US: ‘My worry is that we’re going to be left with waves of people with chronic disease’

Long Covid is not a simple thing. The cardinal manifestations are brain fog and fatigue, but there are clearly symptoms of long Covid that are also manifestations of chronic disease, like an increased risk of diabetes, heart disease, kidney problems and neurological disorders.

Fatigue is potentially reversible but there are a lot of conditions that are potentially non-reversible, or chronic conditions that literally will scar people for a lifetime. I know in the public consciousness, people want to talk about fatigue and malaise all the time. A lot of times it’s the stuff that is most visible to patients, which is why they talk about it so much. Diabetes is a little more silent. Kidney disease is silent.

My worry is that we’re going to be left with waves and waves of people with chronic disease and that’s not only going to affect the lives and livelihood of these people, but it’s going to affect the economy, it’s going to affect education attainment, it’s going to affect their ability to maintain economic productivity and maintain a job and continue to be productive members of society.

Dr Shamil Haroon, public health researcher, University of Birmingham, UK: ‘We need good evidence on what works’

This is going to be one of the grand challenges of our time. The Office for National Statistics from the UK estimate that there’s around 2 million people in the UK with long Covid, which is just a staggering number.

We can’t send everyone to a specialist long Covid clinic because there simply aren’t the resources to do that. We need to think about scalable approaches, and we need good evidence on what works.

If you were to just lump everyone together, and put them into a clinical trial, you would probably find that none of the treatments work. It’s got to be more targeted. We need pragmatic but targeted trials, where we can look at multiple treatments but at the same time tease out these different groups.

It’s a huge piece of work and getting it off the ground quickly is going to be difficult, because there just isn’t the same political impetus. We’re back to the same governance structure we had before, which is very slow. That’s going to be a challenge, delivering those trials at the speed that people want and deserve.

Dr Waasila Jassat, public health specialist, Johannesburg, South Africa: ‘There are devastating stories of going from pillar to post’

In South Africa, like in other lower-middle-income countries, we struggle with health services. Even pre-pandemic, we had so many inequities in terms of health access and service delivery which have only widened and worsened.

There are very few health services that have been developed for long Covid. For some people, it’s just going to be reassurance, it’s just going to be over-the-counter medicine or GP management for the symptoms. But some people need specialist referral and they need medical specialists, rehabilitation specialists, mental health providers, sometimes oxygen. We don’t have any kind of planning for those multidisciplinary services. There are devastating stories of going from pillar to post, going to doctors, not being taken seriously, not finding any help. So where we can, we try and refer them to sympathetic clinicians in the areas, but there’s a huge gap.

There is also the problem of the public health sector that just doesn’t have the capacity. We’ve been overwhelmed with huge waves and it’s impacted our routine health services; immunisation is down, HIV testing and treatment is down, TB testing is down. We haven’t been able to deliver routine health services,…