Neighbor Tuesday: Long COVID - A global look

Almost all studies on long COVID have been in rich countries. Almost all clinical trials on long COVID treatments are in rich countries.

And, it’s not because there isn’t a need in lower-income countries. We know that the pandemic had a major impact in lower-income countries. Nearly 60% of global excess deaths occurred in lower-income countries. ‘Excess deaths’ means those that were above the expected number of deaths. So, these are deaths that are from all causes and a result of disrupted health systems, COVID, and the pandemic. In other words, a large number of them were preventable. An unfathomable 14.9 million excess deaths happened during the pandemic, almost 3 times higher than deaths from COVID. And, 60% were in lower-income countries with already fragmented and under-staffed health systems.

Why am I bringing this up?

Because without investment in the health systems that were hit the hardest or needed bolstering before the pandemic, what will change? Moving forward, those countries and areas will be building back up and that will take a long time unless we do something.

Moving forward, we have also done a terrible job at squashing out COVID. There’s still lots of COVID circulating with new variants popping up. Remember that the lower the amount of COVID infections, the lower the risk of variants. And, that matters because of the real fear that one of those variants could evade our vaccines. In other words, we run the risk of our current vaccines not working if we let COVID just run rampant.

The other result of letting COVID go rampant is more people living with long COVID. We know from previous studies that women 30-50 years of age (hello fellow friends!) with no underlying conditions are at the highest risk of long COVID. Ugh, yall! I think at this point in the pandemic, we all know someone who is living with the devastating effects of long COVID, including navigating health systems that are not set up to treat long COVID yet. Long COVID is not to be messed around with. COVID is not the flu, and long COVID is one of the reasons why. We do not have ‘long flu’. But we do have a devastating long COVID that affects 10-30% of those who have been sick with COVID.

Now, think with me of living in an area with poor health care access or without treatment widely available for common ailments, much less for long COVID. That’s what the majority of the world outside of richer countries lives with. One study in South Africa found that 39% of patients who had COVID had persistent symptoms at least 6 months after. And, that’s in South Africa where they have better detection and surveillance infrastructure that many low-income countries. But not many therapeutics available for long COVID.

I want to link this story about two women, Megan and Muthoni, from India and Kenya, respectively, that have never fully recovered from COVID. Or hear from Emilia from Bolivia, an 18 real old who is now blind in her right eye from long COVID. The poignant title of the article, ‘No One is Talking About It: The Cruelty of Long COVID in the Global South’, encourages us to continue paying attention and advocating for our neighbors.

Another thing we can do is advocate for global vaccine equity.

There’s growing evidence that vaccination protects people from developing long COVID. (Here’s another great article about that.) So, we need more people getting vaccinated! (And, maybe this is a gentle encouragement to get your booster!) That protects people from severe disease and also from long COVID.

Unfortunately, there’s still a vast inequity in vaccine access globally with lower-income countries being vaccinated at half the rate of higher-income countries. So, protection provided through COVID vaccines against severe disease and long COVID is lower in lower-income countries that higher-income countries.

But, the biggest point I want to bring up is about money.

In low-income countries, people have to pay for healthcare out-of-pocket, up to 40%. Think with me of how much you make on an average month - and then take 40% to pay for simple healthcare costs like testing for COVID or treating a COVID infection. That’s reality for lots of families in the world. Most of my research deals with those expenses and how to protect families from poverty due to healthcare costs. Unfortunately, lots and lots of families in low-income areas drop into poverty because of a health emergency, like COVID, and are unable to climb back out. With a chronic disability like long COVID that needs lots of ongoing treatment, the risk of poverty is even higher.

That’s where we can come in as neighbors.

Most of us can’t give millions of dollars to countries to help families pay for healthcare. If you can, let me connect you with the United Nations. =) Here’s the thing though - I don’t think that’s the full answer. Yes, we can give money. And, Also. I think the answer to protecting families from out-of-pocket expenses that bankrupt them is a global redistribution of wealth. I don’t think we need more money - I think we need more equity. We need richer governments, like the US, to not only help their lower-income citizens more, they can also help other countries build up their health systems. I know, I know, this is complicated and requires a semester-long-class to disentangle more of that statement. But, I think it starts with leadership.

So, how can we love our neighbors globally? How can we help them not have to make a decision between providing healthcare to one child or feeding the rest of the family?

We can vote. In the US, 2024 is coming up as an election year. I want to ask us to consider widening our scope of how we vote. Maybe we could consider how our vote matters globally to our neighbors. My upcoming book talks about this more in-depth, BTW, and hopefully helps disentangle that more for you.

I know most of you reading this already want to love your neighbors and are doing it in incredible ways. Today, this Neighbor Tuesday, I want to join you and say ‘solidarity’ and leave you with the beautiful picture of Mt. Kilimanjaro in Tanzania.

Kilimanjaro | Height, Map, Country, & Facts | Britannica

-Emily