Open Society

Long COVID represents the constellation of post-acute and long-term health effects caused by SARS-CoV-2 infection; it is a complex, multisystem disorder that can affect nearly every organ system and can be severely disabling. The cumulative global incidence of long COVID is around 400 million individuals, which is estimated to have an annual economic impact of approximately $1 trillion—equivalent to about 1% of the global economy. Several mechanistic pathways are implicated in long COVID, including viral persistence, immune dysregulation, mitochondrial dysfunction, complement dysregulation, endothelial inflammation and microbiome dysbiosis. Long COVID can have devastating impacts on individual lives and, due to its complexity and prevalence, it also has major ramifications for health systems and economies, even threatening progress toward achieving the Sustainable Development Goals. Addressing the challenge of long COVID requires an ambitious and coordinated—but so far absent—global research and policy response strategy. In this interdisciplinary review, we provide a synthesis of the state of scientific evidence on long COVID, assess the impacts of long COVID on human health, health systems, the economy and global health metrics, and provide a forward-looking research and policy roadmap.

Long COVID is a complex, multisystem disorder that affects nearly every organ system, including the cardiovascular system4, the nervous system5,6,7,8, the endocrine system9,10,11, the immune system12,13, the reproductive system14 and the gastrointestinal system15. It affects people across the age spectrum (from children16,17,18 to older adults19,20), people of different race and ethnicities, sex and gender, and baseline health status21. Cardinal manifestations include brain fog (or cognitive dysfunction)7, fatigue, dysautonomia (which commonly manifests as postural orthostatic tachycardia syndrome (POTS))22 and post-exertional malaise23. Many of the health effects seen in long COVID are shared across several infection-associated chronic conditions, also called post-acute infection syndromes23,24,25,26.

Stimming acts as the mixing process that stirs all of these ingredients together. The cake represents this soon-to-be-finished article. By repeatedly listening to a fragment of a film trailer, I have been able to transform various sources of inspiration into motivational energy. With this energy, in spite of a life now filled largely with despair, I am making something out of nothing. Some might say I am using my tragedy as a source of energy.

The phrase “What does not kill me makes me stronger” comes to mind. My autism was neglected so late into adulthood that, at age 42, my potential for a prosperous future was all but ruined. Nothing can repair the damage to my life, not to mention the psychological trauma. By embracing natural autistic stimming, I used what would otherwise be shunned as strange to make myself stronger. I am going to need it…

Under Walz’s leadership, in May of last year, Minnesota became the first state to dedicate funding to Long Covid and associated conditions, including myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome. Billy Hanlon, the Minnesota ME/CFS Alliance‘s director of advocacy and outreach, says that Walz was instrumental in pushing for the legislation.

“Just as COVID-19 is not going away,” Walz wrote in his 2023 funding proposal, “Long COVID is not going away.”