Apparently, in some people COVID-19 is not like the seasonal flu, a ‘one time shot’ disease that everyone recovers fully from without missing a step. Contrary to what former President Trump said last year about COVID-19 to downplay the threat, it is indeed a disease to be feared, precisely because we now understand it can ‘dominate’ the body and may not let go in a few days, a few weeks, a few months or even a lifetime.
Depending on severity of the initial illness, COVID-19 may result in a myriad of serious and debilitating chronic conditions. For example, there is growing evidence the disease may have long term neurological and psychiatric effects (1, 2). Although it is still not clear who are most susceptible to suffer from persistent sequelae post infection (long COVID), it is a phenomenon observed in many other viral infections. Neither do we fully understand who is most at risk, but severity of the illness seems to predispose to protracted symptoms.
In the past, we have confronted similar situations where an incident have caused the release of environmental toxins that has caused acute and/or chronic disease among the exposed. For example, soldiers and civilians exposed to ‘Agent Orange’ during the Vietnam war. The first Persian Gulf war resulted in many soldiers suffering from what became known as ‘Gulf War Syndrome’. And after 9/11, first responders and many others were exposed to dust containing chemicals from the collapse of the Twin Towers that triggered serious respiratory illness and cancers. Many died as a result. But these cases of exposure to environmental toxins numbered only in the hundreds or thousands. COVID-19 may eventually cause chronic illness among millions.
We are already suffering from an epidemic of ‘intentional injuries’ which include drug addiction and overdose deaths (3), suicides, violence and mass shootings. In 2020, 88, 000 predominately young people between the ages of 16-44 died of opioid overdose, a 37% increase over the previous year. These are ‘behavioral diseases’ that primarily affect individuals in the prime of their lives.
Therefore, COVID-19 along with the other public health crises we are experiencing could eventually impact the nation’s workforce and the economy — reducing productivity and global competitiveness.
How do we address these problems?
The number of COVID-19 cases continues to grow exponentially, with the potential of millions suffering long term effects leading to declining quality of life or worse, permanent physical or neurological disability. The first step in combatting COVID-19 is prevention with an effective vaccine. But it will take at least 2 years (2022) until everyone in the United States is vaccinated, unless distribution is accelerated. Until then, we must continue with the next best option, public heath measures, including the use of masks. Wearing masks has proven to be nearly as effective as a vaccine.
In conclusion, we must provide health care security through an expansion of affordable quality healthcare, including mental health care, to all citizens, without exception and without regard to ability to pay. Universal access to healthcare will ensure that those experiencing chronic illness whether from COVID-19 or health crises as described above will be diagnosed and treated early. It is an urgent national health security emergency.
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00084-5/fulltext