Kashyap Patel MD, Ben Brown, & Fred Ashbury Ph.D. MACE
Post-COVID are we ignoring the harsh reality that may have much worse and deleterious consequences for humanity as a whole? Are we just trying to breathe a sigh of relief and grasp new normalcy to ongoing tempestuous times? Almost four years into the global public health emergency (PHE) from SARS COV-2 (also known as COVID-19) and over 800 million humans across the world (and over 100 million) Americans have been officially reported to have COVID infection. Actual infection numbers may be multiples higher; as may the official death toll, which is close to 7 million.
Post-COVID infection complications (long COVID, also known as Post-Acute Sequelae of COVID (PASC)) sometimes referred to as chronic COVID long haulers) are reported in up to 80% of patients with COVID. PASC has been found in people with only mild initial illness too. Physiological pathways may involve direct consequences of the viral infection along with inflammatory or autoimmune responses in PASC. The severity of PASC varies from mild symptoms involving just fatigue to damage to a variety of organ systems (the lungs, heart, nervous system, kidneys, and liver have all been implicated) as well as mental health impairment. PASC may likely impact 80% of those infected with COVID and can linger on in anywhere between 2.5% to 15% of persons infected; the majority due to inflammation related injury like myocarditis, atrial fibrillation, neuropathy, endocrinopathy, and other tissues.
According to recent statistics, older adults are less likely to have long COVID compared to younger adults. Nearly three times as many adults ages 50-59 currently have long COVID than those age 80 and older. Women are more likely than men to currently have long COVID (9.4% vs. 5.5%). Nearly 9% of Hispanic adults currently have long COVID, higher than non-Hispanic White (7.5%) and Black (6.8%) adults, and over twice the percentage of non-Hispanic Asian adults (3.7%). In the oncology setting, there is a rise in cancer stage migration and a possible link to inflammation-related comorbidities including the possibility of new cancers (either as PASC-need to establish evidence of this link or stress-related inflammation – link already proven) is emerging in the literature. David Cutler, an economist at Harvard University who projected the $3.7 trillion economic cost of long COVID, estimates the individual medical costs of the disease to be about $9,000 a year, on average. With the PHE term expiring in May, many of the PHE-related special subsidies and assistance will likely phase out increasing economic and logistical pressure, PASC will not only have a serious and longer-term impact on patients but also overall on the healthcare delivery system as well as providers. Providers are already facing pressures from multiple sides including a reduction in human resources due to burnout, a less efficient workforce, frequent absenteeism, compassion fatigue due to dealing with more advanced cancer patients with multiple co-morbidities and mental health issues; and, finally, there are fewer patients with insurance coverage. Additionally, we are already noticing a mental health crisis demonstrated by increased episodes of violent behaviors from a multitude of factors post-pandemic. Combining this with many healthcare workers who have left the workforce and many more contemplating leaving the workforce or retiring sooner, it appears that recovery from the pandemic is far from over.
Clearly, in the oncology setting, policy changes, human resource limitations, and restructuring of existing resources will be needed to deal with the longer-term sequelae of covid. We encourage our peers to acknowledge these issues and encourage dialogue to bring about real change quickly.
Fredrick D. Ashbury, PhD
Chief Scientific Officer, VieCure Professor (Adj), Department of Oncology University of Calgary Professor (Adj), DLSPH, University of Toronto
Benjamin Brown
Executive Director, American Society of Pharmacovigilance Co-Chair, Pharmacogenomics, Access & Reimbursement & Coalition Pharmacovigilance
Kashyap Patel, MD
CEO, Carolina Blood and Cancer Care Associates, President, Community Oncology Alliance