Britain turns a blind eye to long Covid. That is not the way to prevent it from destroying lives and livelihoods | Devi Sridhar

TRest me, no one, not even in public health or medicine, wants to talk or think about Covid-19. The trauma of those pandemic years is seared into our minds. But whether we want to deal with it or not, Covid-19 is still affecting us all and is circulating at quite high levels in Britain this month. Although community surveys are no longer carried out by the Office for National Statistics to estimate the total number of cases, hospital data from England indicates that the weekly hospitalization rate for Covid-19 is 4.64 per 100,000 people, while the northeast region is 8.91.

These figures only include people admitted to hospital and do not reflect those suffering at home or visiting GPs. While we have been mostly fixated on death rates during the pandemic, the longer legacy concerns people who had and cleared the infection but are still suffering – what is commonly called long Covid.

This chronic condition still raises many questions. We are still learning about its overall prevalence in the population (estimated at 5.5% of those infected in Britain in one study, and 15% in another study from the US), and ongoing research into the underlying biology and immunology behind the symptoms, including attempts to identify markers for diagnosis, and promising treatments are being developed. Patients have had to fight firstly to have their condition recognized as ‘real’ (rather than a figment of their imagination or a sign of mental weakness), and secondly for medical services that could provide support and care.

Recent concerns about economic inactivity (i.e. people who may be in the labor market or looking for work but are not) are linked to the growing percentage of those who are unable to function due to the long Covid-19 crisis. A study in the Lancet in August 2021, it was estimated that 22% of people with long Covid-19 were unable to work, and 45% had reduced hours. A 2023 study from the US surveyed more than 15,000 people with previous Covid-19 infection and found that 40% of people reporting symptoms were unemployed. The authors, looking at the issue from an economic perspective, noted that “acute Covid is a pandemic; For a long time, Covid could be a mass disabling event.”

Fortunately, research is also emerging to understand the condition and how to prevent it. From a recent study in the New England Journal of Medicine discovered that vaccination greatly reduces the risk of serious problems with long Covid. The authors used health records of approximately 440,000 military veterans infected with Sars-CoV-2 in the US to look at the impact of vaccination on reducing long-term symptoms associated with the disease.

The study found that the incidence of experiencing symptoms one year after infection decreased during the pandemic from 10.42 cases per 100 people for unvaccinated individuals in the pre-Delta period, to 3.5 cases per 100 people for vaccinated persons in the Omicron period. They estimate that roughly 72% of the reduction in long Covid-19s was due to the vaccines, while 28% was linked to changing variants. The authors emphasize the importance of vaccination in reducing persistent Covid symptoms, but say that even with vaccination and in the Omicron era, a significant number of people suffer from long-term Covid-19 after infection.

Where does this leave us? Currently, Covid is circulating at a high level in Britain. While vaccination rates were high in 2021 and 2022, they have fallen in recent years due to limited criteria for who can get one. Very few groups Eligible for an autumn booster are: adults aged 65 and over, care home residents, frontline NHS and social workers, as well as people in high-risk groups. The general population can get the Covid-19 vaccine, but it is pricey, costing almost £100 per dose at Boots, for example. Compare this to the private cost of a flu jab of just under £22.

Given the limited NHS budget, decisions need to be made about: cost-benefit basis on whether rolling out vaccines to the wider population (at a cost of £25 per dose to the government), or subsidizing the private cost of jabs, is worth the potential benefit. This benefit was assessed by looking at what it would cost the NHS to hospitalize people, and what the savings could be with vaccination. Given this new study, it is worth also looking at the benefits in terms of savings to the economy by keeping people in good health and in the labor market, and by reducing the costs of those seeking NHS services for long Covid-19.

In the US, Canada And AustraliaCovid boosters are free for everyone, regardless of immigration or insurance status. France It seems likely that it will continue its free booster policy this fall. Looking at the policies of other countries, Britain is the outlier in continuing to limit free boosters to certain groups.

As we look ahead to winter, I hope that research groups will begin to publish revised estimates of the costs and benefits of offering the Covid booster free of charge, or at the lower cost of £25 for which the government can purchase injections, to everyone. those who want them. The calculations should take into account the long Covid-19 period so that the costs of not vaccinating in terms of illness and missing work are truly reflected, even if this does not lead to a hospital admission. Avoiding the impact of disease at a population level is not only good for the individual, but also for the NHS and the wider economy.