During a CBS “60 Minutes” interview that aired Sunday, President Joe Biden said the SARS CoV-2 pandemic was over. Perhaps the most remarkable thing about his words is that many people will believe them, or worse, reinforce them in the most literal sense.
After all, our country was already at a point where there could be great disagreement about whether the almost 65,000 preventable Covid-related deaths so far since April 30 — around the time when deaths from the massive rise in the BA1 omicron variant waned — could mean the pandemic is over.
If Biden was referring to the emergency phase of the pandemic being over, his statement is correct in some respects — at least for the time being.
If Biden was referring to the emergency phase of the pandemic being over, his statement is correct in some respects — at least for the time being. This is largely because the health care system is not currently overrun with Covid patients, vaccines are widely available (including for children), there are substantial levels of hybrid immunity (for now) and we have highly effective prophylactics and treatments for those who are vulnerable to a serious outcome.
However, we are still dealing with a crisis. Even though Biden also said that “we still have a problem with Covid”, saying the pandemic is over makes it unclear what the extent of the remaining Covid problem is and what exactly needs to be done about it.
One glaring issue that persists and that Biden’s comments were grossly wrong is post-acute consequences of SARS CoV-2 infection, commonly known as long-term Covid. According to June data from the Centers for Disease Control and Prevention, it affects about 20% of the millions of people in the US who have had Covid.
Even with his long Covid plan, the administration has made no major policies or efforts to reduce the future public health burden of the condition. When you consider how debilitating long Covid can be – fatigue, brain fog, dizziness, chest pain, shortness of breath are just some of the symptoms – it’s clear why it’s critical to portray it as an economic crisis and a public health crisis. to grab . In August, a report from the Brookings Institution suggested that up to 4 million people may be unemployed due to persistent symptoms. Others who are currently working and who have had Covid for a long time or who eventually develop it may have to become disabled at some point.
The magnitude of the long-standing Covid problem may be greater than most people realize.
For major public health problems, especially new ones that are poorly understood in terms of burden, causes and risk factors, it is critical not only to collect data, but also to establish a so-called public health surveillance system. the CDC defines public health surveillance as the “ongoing, systematic collection, analysis and interpretation of health-related data essential to the planning, implementation and evaluation of public health practice, closely integrated with the timely dissemination of this data to those responsible for prevention and control.”
In a major development this month, researchers from the Regenstrief Institute and Indiana University’s medical and public health schools announced a five-year $9 Million Grant from the CDC to mine statewide electronic health records to estimate the incidence and prevalence of long-term Covid in Indiana.
However, we do not yet have a national population-representative surveillance system for long-term Covid in the US. For a condition like this, such a system cannot rely solely on data from people who have access to the health care system. The UK’s Office for National Statistics (US) has had a model-long Covid surveillance system since February 2021. The data from September 2022 shows that no less than 3.1% of the entire UK population may currently have Covid for a long time. The office conducts routine population-representative surveys asking those who have had the virus: “Would you describe yourself as someone with ‘prolonged COVID’, that is, if you are still experiencing symptoms more than 4 weeks after you first got it? COVID-19 that are not explained by anything else?”
To shed more light on the magnitude of the longstanding Covid problem in the US and who is most affected and most at risk, our team at the City University of New York recently conducted a representative study of a sample of 3,000 American adults. We asked a question similar to the ONS to make a comparison, and we found that 7.3% of American adults (about 18.5 million people) were likely to have had Covid for a long time in early July 2022, which is a staggering and sobering number.
Why is the current prevalence of persistent symptoms in the US higher than that in the UK, given relatively similar pandemic experiences? It may be due to higher and earlier uptake of vaccines and boosters in UK vs US It could also be that there were fewer infections in the UK and better coverage of vaccines and boosters among those we’ve since learned are at higher risk for long-term Covid (eg. women and people with comorbidities).
Indeed, an increasing body of evidence, consistent with our recent study, suggests that: being informed about vaccines reduces the risk of developing long-term Covid after a breakthrough infection. This is huge and welcome news. But if the US leader says the pandemic is over, motivation for people here to get a vaccine or booster will continue to decline. Have booster levels remained low compared to levels in the UK and have risen slowly in the past months. Without diagnosis or treatments for long-term Covid, preventing it is all the more important.
The CDC still uses the term “fully vaccinated” to describe people who have received two doses of an mRNA vaccine when it should refer to them as undervaccinated and vulnerable to a serious Covid outcome, including long-term Covid.
Not unrelated to this issue, the CDC still uses the term “fully vaccinated“ to describe people who have received two doses of an mRNA vaccine when it should refer to them as undervaccinated and vulnerable to a serious Covid outcome, including long-term Covid. Unfortunately, because the president’s statement on the pandemic was also unclear, any important distinction or intended context was lost to the public.
To clarify where we stand on Covid, an active and targeted approach needs to be included to increase vaccination coverage among those most at risk, along with better targeted rapid antiviral treatment for those who become infected. But the US has become passive about promoting vaccines and boosters.
And given the magnitude of prolonged Covid and how little is known about who is most affected and most at risk, the CDC needs a formal national surveillance system to monitor it. The Weekly CDCs and Census Bureaus Household Pulse Exam began collecting data on long Covid in June. As with our study, the survey estimated that: 7.6% of US adults had long Covid symptoms since July 2022. Crucially, public health surveillance goes far beyond the collection and analysis of data and includes the generation and sharing of information for action with everyone who needs to know.
We see this information sharing activity happening clearly in the CDC’s Covid Data Tracker, which displays key Covid-19 surveillance statistics, including daily data on cases, deaths, hospitalizations and vaccination. It would be helpful to display long Covid stats and related trends on the Covid Data Tracker. This could use data from the national Household Pulse Survey, and this survey is large enough to provide very detailed geographic breakdowns for state and local health departments to use. Increasing long Covid tracking in this way could significantly increase the country’s focus and potential for collective programmatic and policy action on this all-important dimension of the pandemic.
While we may be out of the emergency phase of the pandemic – thanks to some amazing scientific advances and a continued absence of new variants of concern – we’re not out of the woods yet. To date, to date, we are still experiencing more than 31,000 preventable Covid-related hospitalizations and nearly 500 preventable Covid-related deaths per day.
When it comes to the future SARS CoV-2 pandemic, the CDC must leverage surveillance to focus on the entire public health threat posed by the virus, including long-term Covid.