Dato’ Dr Amar-Singh HSS

THE Covid-19 pandemic ‘marathon’ is not over, even if we wish it to be. There seems to be a relaxed outlook by many, with a drop in mask usage and increased unprotected social gatherings. We have lost all momentum to fix indoor ventilation significantly and vaccination of young children has sadly faltered. Communication by health authorities has been limited on current emerging data and science on our Covid-19 risks.

While we work to restart the economy, restore our children’s education loss and support those who have lost jobs or are having food security issues, we must be mindful of the situation. This brief article is to summarise current understanding from research and data on the situation and highlight the three pandemics that are occurring. Note: I have not referenced many studies in this article to facilitate reading. But the comments made are all based on current available data from reliable sources.

First pandemic: Covid-19

The Covid-19 pandemic continues to evolve. Even with effective vaccines, fresh waves of new Covid-19 variants of concern are to be expected; some of these may evade the protection that immunisation offers. Recent studies show that natural infection by recent variants (Omicron) do not confer additional immunity. No one can predict with certainty what will happen in the next few years. The positive case numbers reported are no longer our focus but Long Covid and long-term health damage from Covid is what we should be monitoring.

Second pandemic: Widespread mental health issues

Prior to the Covid-19 pandemic, it was recognised that we were facing a growing rise in psychosocial issues, a mental health pandemic. The Covid-19 crisis has exacerbated this, with worsening societal inequalities. Many have lost support services, experienced social isolation, faced mental health challenges, and had finances negatively impacted. There has been an increase in domestic violence and abuse, increase in challenging behaviours, increased anxiety and stress; especially in persons with disabilities and those with chronic health conditions. This is just the beginning. Data suggests that the Covid-19 pandemic is exacerbating the mental health pandemic and that the full impact of this pandemic is yet to emerge: suicides have increased, as have anxiety and post-traumatic stress disorders (PTSD).

Third pandemic: Potential mass disability event

Of concern is the lack of awareness by society of this third pandemic. The impact of Long Covid and long-term health damage from Covid is serious, and the growing body of evidence demands our attention.

A May 2022 report on Long Covid posted on the US CDC MMWR website showing data that: “one in five Covid-19 survivors aged 18–64 years and one in four survivors aged ≥65 years experienced at least one incident condition (persistent symptoms or organ dysfunction) that might be attributable to previous Covid-19”. This means that 1 in 5 adults aged over 18 years who had a previous Covid-19 illness went on to have a second health condition such as: Neurologic and mental health conditions; Cardiovascular conditions; Respiratory conditions; Kidney failure; Musculoskeletal conditions; Blood clots and vascular issues.

The concern is that, while Long Covid is higher in those admitted to hospital, those with asymptomatic and mild infections are also at risk. While Covid-19 vaccines have been excellent at reducing our risk of hospitalisation, latest studies show that vaccination reduces the risk of Long Covid by only 15 per cent. Data is emerging that reinfection with Covid-19 may not be without risk and may worsen health outcomes.

Of equal concern is the long-term health damage from Covid-19, even in persons who did not experience Long Covid. Studies have shown brain shrinkage in adults compared with before pandemic (even mild infections), other end organ damage and suggest a premature aging risk. The latest study from Denmark presented this month, using large population datasets and Covid-19 testing, showed that those infected were at higher risk of developing neurodegenerative disorders (increased risk of Alzheimer’s disease, Parkinson’s disease, ischaemic stroke and intracerebral haemorrhage).

The Covid-19 pandemic is now being spoken of by some scientists and clinicians as a potential ‘mass disabling event’.

A suggested response

1.    It is vital for the health authorities to offer ongoing and clear communication, to the general public, regarding the evolving science and data on Long Covid and the long-term health damage from Covid-19. This will enable the public to take personal risk reduction measures.

2.    The authorities must continue to make concerted efforts to limit the spread of the virus and minimise reinfection as a means to reduce the long-term burden of disability. The routine use of quality masks (KF 94/N95) and significantly improved ventilation systems in ALL indoor spaces is vital.

3.    The authorities should offer screening to all individuals who have had a Covid-19 infection, to look for secondary conditions (e.g., cardiac, neurological, endocrine).

4.    Our nation must partner with those in the forefront of developing therapeutic options to treat people with Long Covid. This science and research need to be accelerated.

5.    The authorities need to significantly strengthen existing mental health services in the Ministry of Health as well as those offered by Civil Society Organisations. We need to hasten support for individuals affected by the exacerbated mental health pandemic.

6.    We need effective mechanisms to map persons and families (disaggregated data, including those with disabilities) whose lives have been adversely affected by the pandemic. Mechanisms to ensure financial security for these families is crucial in the face of a pandemic and war associated recession.

The narrative of ‘living with Covid’ with limited communication on the long-term health damage from Covid-19 has made many complacent. We need to be conversant with the latest science and evidence and live accordingly.

Dato’ Dr Amar-Singh HSS

Consultant Paediatrician