“Ease the restrictions, let the majority get back to their normal lives, but continue to shield the vulnerable.” It is common to hear such arguments hinting at the possibility of achieving herd immunity, and they usually invite heated debate. But what if we cannot determine exactly who the ‘healthy’ and ‘vulnerable’ people are?

According to data collected by the COVID Symptom Study since the start of the pandemic, 5% of people who contract COVID-19 are likely to suffer from the symptoms for more than 8 weeks. These persistent symptoms include fatigue, breathlessness, headache, insomnia, chest pains, and intermittent fevers. While ‘long COVID’ is more likely to affect older than younger people, 10% of 18- to 49-year-olds who contract the virus suffer from long-term complications.

What does all this mean for our approaches to managing the virus? Certainly, the government should pay greater attention to long COVID. In a crisis full of unknown variables, it pays to stay alert for new curveballs to avoid being caught off guard in the future. Since long COVID has, over the recent months, significantly impacted those who are of working age, the government needs to actively enforce measures meant to keep workplaces COVID-secure. Managing long COVID successfully can help to alleviate potential economic impacts too: by maintaining the health and productivity of workers, future economic recovery can proceed more smoothly.

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But at this point, resources are already stretched thin – the beleaguered test-and-trace system, meant to be ‘world beating’, has struggled to keep up with the rate of spread. The government also needs to prevent hospital beds and ventilators from running out over the winter. Indeed, the second nationwide lockdown across England, which began on 5 November, is likely in response to new estimates that the death toll in winter could exceed the earlier predicted ‘worst-case scenario’ of 85,000. The focus of the government now is to protect the NHS, while also buying time to scale up the test-and-trace system to meet demand. With these pressing matters occupying much of the government’s attention, the issue of long COVID is unlikely to be high up in their list of priorities – despite calls from organizations like Long Covid SOS and the Long Covid Support Group to pay greater heed to the issue.

What can we do then, at the individual level? Certainly, the public should be cognizant of the effects of long COVID. There might initially have been low public awareness of long-term implications because it took time for such cases to be documented; however, there is now sufficient evidence of long COVID that it can no longer be ignored. Ideally, awareness of long-term complications that occur even in younger people should remind those who perceive themselves as invulnerable that the virus can be far more severe than the common cold.

However, such depressing stories in the media will also add to public distress, at a time when mental health is already taking a hit in response to the second lockdown. It may be more demoralizing than beneficial for long COVID to settle into the public consciousness. Nonetheless, in such a crisis, awareness should always be prioritized: it is far better that people recognize the severity of a crisis and take individual precautions, rather than ignore the full extent of risks and pay dearly down the road. Information shared should therefore always be factual, well-researched, and should not be spread with the intention of fearmongering. While there have been instances of individuals coming forward to share their experiences of long COVID on social media, official communication by the government and mainstream media should always be based on the research findings of credible scientific institutions, rather than sensational, unverified anecdotes.

Still, the greatest hurdle is perhaps the growing fatigue towards pandemic restrictions that will prevent scientific advice from being taken seriously. Behavioural economists have documented how hyperbolic discounting creates preferences for smaller rewards in the present, as opposed to larger rewards that can only be reaped in the future. Having been deprived of many opportunities for socialisation and recreation over the past few months, it will be difficult to convince individuals – particularly the young – to continue prioritising their health risks over their personal liberties.

It is clear that the COVID-19 pandemic will not ‘end’ in a straightforward manner anytime in the near future. Even when an effective vaccine has been found, it takes time for it to be produced and distributed at a sufficiently large scale. What we can expect instead is for restrictions to be periodically loosened and tightened in the coming year, in response to changing levels of spread. It will be a long winter, a long 2021, and a long nightmare for patients whose symptoms just won’t go away.

Original image: https://pixabay.com/fr/illustrations/maux-de-t%C3%AAte-migraine-m%C3%A9decine-3660963/