Long COVID

Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is often defined as the presence of persistent, recurring or de novo symptoms that cannot be attributed to other diagnoses and that persist more than 12 weeks after an initial SARS-CoV-2 infection.¹ However, this definition is not universally adopted with others considering long COVID to occur as early as 4 or 8 weeks post-infection.^1,2 Accordingly, long COVID has been associated with >200 different symptoms (including fatigue, brain fog, shortness of breath and chest pain) and estimates of long COVID range from <5 to >80% depending on the study design and patient cohort.^3,4

We have now reached a stage in the COVID-19 pandemic where the risk of acute COVID-19 has been significantly reduced by the availability of vaccination, anti-virals and prior infection. Indeed, the World Health Organization (WHO) has recently declared that COVID-19 is no longer a global emergency, signifying our transition into the next phase of pandemic. However, the sheer number of individuals infected with SARS-CoV-2 (>765 million at the time of writing) has raised questions as to whether we now face a future where a significant proportion of the community will be living with the long-term deleterious consequences of SARS-CoV-2 infection. This also raises questions as to the future burden on the healthcare system and how we can adapt the relevant health services to meet this need.

To address these and other concerns regarding long COVID, the House Standing Committee on Health, Aged Care and Sports launched an inquiry into long COVID and repeated SARS-COV-2 infections. The Australian Academy of Science in partnership with the Australian Academy of Health and Medical Sciences organised a roundtable discussion⁵ on 17 February 2023 at Parliament House to inform this inquiry by bringing together a variety of different experts including fundamental biomedical researchers, epidemiologists, clinicians, social scientists and most importantly, people with lived experience of long COVID. I was privileged to be invited by ASM to attend this roundtable event as an ASM member, a virologist and someone actively engaged in long COVID research.

The panel discussed a wide variety of issues around long COVID including whether the current definition of long COVID proposed by the WHO (the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation) is the most appropriate for use in Australia. Although a consistent definition of long COVID may appear to be a trivial matter, it is actually essential for prevalence estimates, patient diagnosis and most importantly the provision of treatment. However, as emphasised by the inquiry, there remain significant knowledge gaps in the long COVID field beyond just the definition. These include the impact of repeat infections, vaccinations and treatments given during the acute phase of the disease on the development of long COVID. For individuals living with long COVID, and their healthcare providers, effective treatments are similarly complex and there is a clear need for evidence-based models of care and support. There is also a paucity of information on the prevalence and impact of long COVID in First Nations communities as well as other priority populations. Perhaps these knowledge gaps are not surprising, given that we have only had SARS-CoV-2 in the human population for just over 3 years. However, these knowledge gaps significantly impair our ability to prevent long COVID and support those with the disease. There was a strong consensus among the panel members that education and engagement about long COVID are essential as we navigate this next stage of this pandemic. There is also a clear need for a national strategy on data collection and research to ensure that all States and Territories work together to address the issue of long COVID.

The day the report of this inquiry (entitled ‘Sick and tired: casting a long shadow’) was released (24 April), the federal Health minister announced the commitment of A$50 million from the Medical Research Future Fund for research into long COVID.⁶ How this funding is to be committed across the various research and healthcare needs surrounding long COVID remains to be determined. However, it is hoped that commitments such as these, coupled with lessons from the lived experience of people with long COVID, will lead to improved patient outcomes and a better understand of this new, but potentially debilitating, disease.

Data availability

Data sharing is not applicable as no new data were generated or analysed during this study.

Conflicts of interest

K. R. Short is a consultant for Sanofi, Roche and NovoNordisk. The opinions and data presented in this manuscript are of the author and are independent of these relationships.

Declaration of funding

K. R. Short is funded by the NHMRC Investigator Grant (2007919).