October 7, 2022

How the COVID-19 pandemic may leave a long-term imprint on our health

At the start of another school year, I’ve been thinking about the differences between 2021 and 2022. Last year, many schools had mask mandates, testing programs and quarantine rules (SN: 3/15/22). This year, masking is optional and testing and quarantines are out (SN: 8/19/22). 

We’ve shed measures that stop the spread of the coronavirus and help prevent excessive disruptions to in-person learning. Without them, and with the absence of nearly any controls in place elsewhere in society, we’re inviting the virus to keep spreading, to find new ways to thwart immunity and to continue to derail plans and routines. And it’s not just a risk to our day-to-day lives, but to our future health. As much as we want to put the pandemic in the rearview mirror, evidence continues to emerge that the coronavirus’s impact will be a recurring, unwelcome feature of many tomorrows. 

Scientists predict COVID-19 cases will rise this fall and winter in the United States, as more of life heads indoors during colder weather. The Biden Administration has said there could be 100 million new cases. We have a new aid in the face of a possible surge: a revamped COVID-19 shot targeting the omicron variant, from both Pfizer (for 12 years and up) and Moderna (for 18 years and up), is now available (SN: 9/2/22). Meant as a booster shot, the tweaked vaccine is the original version with added protection against the BA.4 and BA.5 variants. The BA.5 variant is dominant in the United States, accounting for 89 percent of cases at the beginning of September.

Public health officials would like to get as many boosters in arms as possible this fall to temper a rise in cases. We know the original vaccine has done an outstanding job protecting people from severe illness and death. The vaccine has also helped reduced transmission, although this benefit can wane quickly. Overall, the COVID-19 vaccine is a crucial tool to protect public health. But it alone can’t shoulder the entire burden of keeping the virus at bay. Controlling the coronavirus takes a team approach, the vaccine together with masks, ventilation improvements and crowd control (SN: 4/4/22).

Without these additional measures, people will keep getting sick. Claire Taylor, a physician in the United Kingdom, tweeted about her experience having COVID-19 three times this year, in March, June and August, as the omicron family of variants moved through her country. “How can it be sustainable, sensible, bearable even, to get a virus that floors you in the same way multiple times a year?” she wrote.

It doesn’t seem sustainable, sensible or bearable. Not with what the virus can do in the midst of infection, and not with the harms that can linger after an infection subsides. Adults, for example, can face health issues throughout the body after a bout of COVID-19. A study of health records from the U.S. Department of Veterans Affairs reported that, compared with those who haven’t had COVID-19, those who have — whether hospitalized or not — face higher risks of a variety of cardiovascular diseases beyond the initial 30 days post-infection. Other research has found an increased risk of neurological and psychiatric illnesses for two years after a SARS-CoV-2 infection, compared with other respiratory infections.

On top of the risks from COVID-19 itself is the expected health effects of the pandemic’s disruptions to medical care. A study of a large health care system in Massachusetts found a drop in expected hospitalizations for urgent heart issues during the first year of the pandemic. Breast and ovarian cancer screenings in the United States decreased in 2020 compared with 2018. These delayed and lost health care opportunities may reverberate for years.

And then there is long COVID. Each surge of infections adds to the pool of people suffering from a range of debilitating symptoms that they just can’t shake, from extreme fatigue to brain fog to shortness of breath (SN: 9/1/22). Because it takes time to identify people who develop long COVID, we don’t yet know the toll from the omicron surge earlier this year. But the spike in cases was so large, “I suspect there will be millions of people who acquire long COVID after omicron infection,” immunobiologist Akiko Iwasaki told Liz Szabo of Kaiser Health News on August 26.

Long COVID can leave people unable to work, which is a threat to their ability to support themselves and maintain health insurance, as well as a looming crisis for the economy. There are already an estimated 16.3 million working-age Americans, meaning those 18 to 65 years old, who have long COVID; 2 million to 4 million of them are out of work because of their illness, a new Brookings Metro report finds. The annual cost of the wages lost is around $170 billion and may be as high as $230 billion.

There are also health impacts from grieving the loss of so many lives during the pandemic (SN: 10/27/21). Already 1 million people have died worldwide this year from COVID-19; close to 6.5 million in total have lost their lives to the disease during the pandemic.

Those deaths have included a devastating number of children’s parents and caregivers. Approximately 7.5 million children have lost one or both parents to COVID-19 as of May 2022, researchers report in JAMA Pediatrics on September 6. An estimated 10.5 million children have become orphans or lost caregivers. These deaths put children’s education, health and well-being at risk, deficits that cannot be overcome without dedicated societal support (SN: 2/24/22). 

Like adults, children who’ve had COVID-19 are at higher risk for various health issues compared with children who haven’t had the illness, including heart inflammation and blood clots, researchers reported in Morbidity and Mortality Weekly Report on August 5. Children also develop long COVID. And kids and teens have suffered mental health harms from the pandemic, with many experiencing increased anxiety and depression. The subsequent demand for mental health services hasn’t been met.

We’re just beginning to learn about other health issues that could stem from the virus or the circumstances of the pandemic. A recent U.S. study found an alarming rise in youth-onset type 2 diabetes during the first year of the pandemic compared with the average of the prior two years. New cases jumped by 77 percent in 2020. It’s not clear if the increase is due to COVID-19 infection, shifts in diet or activity or stressors from the pandemic, but the rise has strained existing health services for children with diabetes, the researchers wrote.

The pandemic has also disrupted vital health services for children around the world. A study of 18 low- and lower-middle–income countries found a decline in doctor visits and the delivery of maternal and child health care from March 2020 to June 2021. The lost care is estimated to have led to more than 110,000 excess deaths among children under 5 and more than 3,000 excess deaths among mothers, a threat to recent progress in reducing child and maternal mortality, researchers report August 30 in PLOS Medicine. The pandemic has also interfered with vaccination campaigns, leaving children worldwide vulnerable to vaccine-preventable diseases.

Even newborns may face worsened health as a result of the pandemic. Research on prenatal exposures to maternal infection during the 1918 influenza pandemic has found health issues much later in life for the babies born, including higher rates of cardiovascular disease, kidney disease and diabetes.

In a piece on why studies across the life span of children born to mothers who’ve had COVID-19 are needed, the authors discuss the hypothesis that maternal infections during different trimesters may put the fetal organs developing at the time at risk. For example, the heart develops in the first trimester, the kidneys in the third, so infections in those periods could mean a higher risk later in life of cardiovascular disease or kidney disease, respectively. 

This is just a preview of the pandemic’s reach; we’re going to continue to learn of ways COVID-19 will shape our health and our lives going forward. It’s enough to keep me in a mask, and though reasons for donning one undoubtedly vary, I’m far from alone: 31 percent of Americans are masking most or all of the time, while 26 percent are some of the time, according to a poll from late August by The Economist/YouGov.

Considering what we know so far, and with an expected rise in COVID-19 cases on the horizon, reinstating masking and implementing other control measures indoors in the coming months seems prudent. It’s a guard against infections now and may contribute to a healthier tomorrow.