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Covid-19 has killed more than 6 million people worldwide but will also leave a lasting scar on hundreds of millions who have survived. The disease can trigger cardiovascular, gastrointestinal and neurological symptoms; it can affect the skin, kidneys, liver, the endocrine organs and the eyes. Moreover, the damage to the body may linger long after the initial sickness. Much about this phenomenon of “long covid” is still unclear, but evidence is accumulating that populations will be struggling for years to come.

What is long covid? Although there are no hard-and-fast definitions, it broadly means symptoms that persist beyond four weeks since the initial infection and that are hard to explain in any other fashion. Some of the most common are fatigue and memory problems, but others can include difficulty breathing, cough, chest pain, heart palpitations, headache, dizziness, change in smell or taste, depression, anxiety and diarrhea. More than two years into the pandemic, scientists are trying to understand who gets long covid and how the infection can cause lasting harm.

It is becoming more clear that long covid cuts a wide swath. A new survey for the Journal of Infectious Diseases examined about 50 articles and studies covering nearly 1.7 million patients worldwide who were infected with the coronavirus. Overall, the authors found the global prevalence of long covid symptoms was 43 percent of those who had been infected, higher for those who had been hospitalized than those not. They said that based on a World Health Organization estimate of 470 million people having been infected, their estimate could mean about 200 million people currently experience or have previously experienced long-term health-related consequences of the disease. The U.S. Government Accountability Office said recently that between 7.7 million and 23 million Americans might have suffered from long covid so far.

Another insight has come from the creation in October 2021 of a diagnostic code for those identified as suffering from long covid. Studying the private health-care claims of 75,252 patients labeled with the code, the nonprofit group FAIR Health found that a surprisingly large share of them, three-quarters, had not been hospitalized for the virus but still showed symptoms of long covid. Moreover, long covid seemed to strike women more often, at 59.8 percent of the group compared with 40.2 percent for men. Yet another study published in the British medical journal BMJ found that one dose, and even more so two doses of vaccine, reduced the risks of long covid in Britain.

The policy implications of long covid are immense and just starting to come into view. Not only will health-care systems need to be prepared, but it could also send shock waves through the labor force as workers seek time off to deal with their maladies, or go on disability. It could also lead to a mental health crisis as people struggle to cope with their conditions. Long covid is going to mean a long haul.

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