To Prevent Long COVID, Prevent All COVID

We are facing an uncertain COVID future. We’ve all heard about people catching COVID-19 and developing chronic, often debilitating symptoms they just can’t shake.

While recovery from COVID can often take weeks, when symptoms – commonly fatigue, breathing difficulties, a distorted sense of smell or taste, muscle or joint pain – persist for more than three months and can’t be explained by another cause, that’s when “long COVID” status kicks in.

It’s an emerging public health concern that isn’t widely understood. Which is why, as Chair of our County’s Health and Hospital Committee, I convened a special hearing in late October, bringing together public health and medical experts to discuss the scientific and clinical aspects of long COVID, as well as current treatment practices. 

Our County was a public health leader during the early acute phases of the pandemic, and I want to ensure that we’re well positioned to address the long-term COVID-related health needs of our community – starting with providing folks the information they need.

My key takeaway: Don’t catch COVID in the first place. You don’t have to have a severe case to become a long-hauler.

The most important thing is prevention, prevention, prevention, and getting vaccinated,” said hearing panelist Dr. Hector Fabio Bonilla, Clinical Associate Professor and Co-Director of the Post-Acute COVID-19 Syndrome (PACS) Clinic at Stanford Medicine.  

Vaccination can also help decrease the chances of getting long COVID after a breakthrough infection by about 50%, said Dr. Supriya Narasimhan, Chief of Infectious Diseases Division and Hospital Epidemiologist at Santa Clara Valley Medical Center

The projected number of long COVID cases is disconcerting, with estimates that the syndrome will hit 10%-20% of those who survive their initial infection.

We’re talking about 15 to 25 million people in the United States,” Dr. Brian Block, Assistant Professor in the UCSF Division of Pulmonary, Allergy, Critical Care and Sleep Medicine and Associate Director of the Medical ICU, told us.

Equally sobering is the “who” of long COVID.

UCSF set up it’s long COVID clinic expecting to take care of people who had been hospitalized with severe symptoms, most often older adults and those with preexisting conditions such as obesity and diabetes. Block was surprised, however, by the number of young people coming in without those risk factors.

“Whereas the mortality has mostly been in older adults, the group that seems most at risk to have the long-haul symptoms are younger, working age adults,” he said. “We could be facing a wave of people with decades of reduced quality of life and productivity.”

Indeed, we learned from Emily Hough, a fellow at Brown University School of Public Health, about one study that showed 40-45% of people who have had long COVID needing some kind of adaption to return to work or school; 20% struggle to return to work at all.

The long COVID clinics at both Stanford and UCSF have a multi-disciplinary approach. Specialists in infectious disease, pulmonology cardiology, neurology, and psychology collaborate to address a multitude of symptoms – and to rule out the many alternative causes, including cancer, blood clots, anemia, and hypothyroidism.

In the County’s health system, the number of long COVID cases is still small enough for patients to be cared for by their primary providers, with referrals to specialists as warranted – for now.

County health administrators advised us that in the near future it will likely be advantageous to have our own multi-specialty clinic for long COVID patients, and that when the time comes, such a facility could be up and running in 3-4 weeks.

That’s good news in terms of our County’s capacity to pivot rapidly and meet the needs of the public. But my hope is that you never need such specialty care.

With that in mind, I’d like to give Dr. Narasimhan the last word: “To prevent long COVID, you have to prevent all COVID. That starts with masking, with personal protection to minimize exposure, and with vaccination.”

Watch a video recording of the full Santa Clara County Health and Hospital hearing on long COVID.

Joe Simitian
Santa Clara County Board of Supervisors

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