In February 2003, Sars – the first Sars – hit Toronto, carried back from Hong Kong by an elderly woman who’d been to a wedding. The outbreak was the largest and deadliest outside Asia, with 241 infections and 41 deaths over the next few months. The city wanted to move on quickly: in July, Toronto announced it was open again for business with a 500,000-capacity outdoor concert – widely known as ‘Sars-stock’ – headlined by Rush and the Rolling Stones. Sars faded from the news soon afterwards. But many patients continued to suffer from fatigue, headaches, and respiratory and cognitive difficulties, for months or years after their initial infections.
A team at St John’s Rehab Hospital followed up with fifty patients reporting post-Sars symptoms. John Patcai, the hospital’s chief of staff, has made the comparison between long Sars and long Covid. The window he offers is small and narrow: as interest in Sars dwindled so did funding, and after a few years the group stopped their battery of physiological tests, continuing to record only the patients’ psychological state and self-reported complaints.
Some of the data was published last year, and may help with understanding of specific symptoms such as cognitive impairment, but Patcai’s reflections on the experience also offer a warning. After nearly a decade of follow-up, ‘none of our fifty patients got their old life back with time and treatment,’ he has said. ‘Not one reported that they were fully recovered and back to all their pre-Sars activities.’
This doesn’t mean that everyone affected by long Covid should despair: many have recovered over time. But it does give precedent for a similar condition, from a closely related virus, lasting for years. And it suggests that the idea this will all somehow go away on its own is misguided and dangerous. Scientists are still working to find reliable diagnosis markers for long Covid – something in the blood, organs or immune system that signals the lingering presence of disease. But there is a clear set of similar symptoms in patients across the world, and the numbers are staggering.
A recent bulletin from the ONS suggests that two million people in the UK consider themselves to have long Covid, and a fifth of them report symptoms lasting more than two years. Scientific studies have shown long-term damage to the heart, kidneys and lungs after serious Covid infections, andchanges in brain structure even in mild cases.
All this would be concerning even if Covid were – as we once hoped – a one-time shock of disease, a cresting wave that would crash and then recede for ever as immunity took hold. But the long-term effects of Covid haven’t been fully reckoned with in light of another surprising discovery about the virus: that the waves keep rising, and we can be infected multiple times – even several times in the same year. Reinfections were not well tracked early in the pandemic, but they are so widespread as to be obvious now. A nurse made the news for three reinfections, and there are reports of people developing infections twice in one month.
The era of smooth waves and daily death counts is over; instead we have prolonged, choppy swells that never quite ebb. Vaccines drastically cut the likelihood of hospitalisation and death, and at first they cut the risk of being infected at all; but while the protection from severe disease held, recent variants have chipped away at the more basic defences. And new research suggests that Omicron, unlike older variants, often does not leave us with strong immunity against further infections. We are still unlikely to die of Covid, but we catch it quite easily. More people were infected during the first two months of the Omicron wave than the previous two years combined.
Since control measures have largely been abandoned, we urgently need to know not only what the long-term effects of Covid are, but whether they are cumulative over multiple infections. We know that vaccination cuts the general risk of long Covid by about half, but not what other treatments might blunt its advance. There are several academic studies addressing these concerns, but not enough to give fast answers.
After making drastic and unprecedented interventions in the name of public health in the early phase of the pandemic, governments have now largely abdicated responsibility. Boris Johnson said in February that the UK was ‘moving from government restrictions to personal responsibility’, and other countries have since followed suit. Few people want the return of legal restrictions, and it was never feasible to impose them in perpetuity. Most of us have – for better or worse – worked out a personal approach to Covid safety. But we can’t make informed decisions if we don’t know what ‘living with Covid’ actually means. A cynic might think that those in power aren’t looking for answers because they don’t want to know.