TEL AVIV – When Belgian Ann Li got sick with COVID in March 2020, she did not know that the disease would follow her for years.

“Even though I’m standing here in front of you looking seemingly healthy, I still suffer the consequences of the initial infection,” she told the audience of a panel devoted to Long COVID during the 72nd session of the WHO Regional Committee for Europe, meeting in Tel Aviv, Israel.

Li currently chairs Long COVID Europe, a European network of Long COVID patient associations. According to new data released during the session, she is one of some 17 million individuals in the WHO European Region who have experienced COVID symptoms for at least three months in the first two years of the coronavirus pandemic.

The study was conducted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine on behalf of the WHO Europe. 

It found that women are twice as likely as men to suffer from long COVID. Among patients who required hospitalization, one in three women and one in five men were likely to develop long COVID.

“IHME’s research shows nearly 145 million people around the world in the first two years of the pandemic suffered from any of three symptom clusters of long COVID: fatigue with bodily pain and mood swings, cognitive problems, and shortness of breath,” according to Dr Christopher Murray, Director of IHME. 

“Knowing how many people are affected and for how long is important for health systems and government agencies to develop rehabilitative and support services,” he added.

Limited knowledge 

Discussing how to tackle the health crisis posed by the condition was one of the reasons behind the meeting, said Dr Natasha Azzopardi-Muscat, WHO Europe Director of the Division of Country Health Policies and Systems.

“Our knowledge of this condition is limited but it appears that 10 to 20% of people recovering from COVID-19 go on to develop mid and long-term symptoms,” Azzopardi-Muscat said. 

“Today we are here to discuss together what are the concrete actions that we can take on all fronts to minimize the health, social and economic consequences of this debilitating condition,” she stressed.

For the past year and a half, the European Commission’s Expert Panel on Health – which includes 15 scientists and health system experts – has been working on reviewing the state of the art and providing an analysis of the research and health system requirements on the matter. 

As Dr Dionne Kringos, vice-director of the Amsterdam Public Health Research Institute and a member of the expert panel explained, the panel has come up with several recommendations.

“First of all, we need to agree on common and global definitions for clinical use, as well as for surveys and research, which are updated periodically as evidence emerges,” she remarked. “Secondly, it’s important to agree on diagnostic and prognostic criteria for the post-COVID condition, its phenotype, and its emerging subtypes.”

Assessing the needs of patients and understanding how they can re-enter the workforce is also going to be crucial, Kringos noted. Other points mentioned in the proposed strategy include ensuring that knowledge is promptly shared and incorporated into health systems and that healthcare workers are properly trained.

Lack of research-based interventions 

The current lack of guidelines and research-based interventions to treat long COVID is a source of deep frustration, several panellists agreed.

“Despite this progress, my feeling as a clinician is prone to frustration,” said Dr Gemma Torrell, a general practitioner working at a primary care center on the outskirts of Barcelona. “In my country, regional guidelines have been published in participation with patients but implementation has been erratic. As a consequence, people with long COVID often feel disappointed because doctors are reluctant about the legal existence of the condition.”

“We face the same challenges,” echoed Dr Zachi Grossman, President of the Israel Pediatric Association. 

“There is not enough awareness both among parents and pediatricians about long COVID in children,” he said. “There is no organized guidance for teens. The whole area of diagnosis is not complete.”

New WHO initiative

WHO Europe announced a partnership with Long COVID Europe to focus on recognition of the condition and knowledge sharing, research and reporting, and rehabilitation.

“For these goals to be achieved, we need all countries in the WHO European Region to recognize that long COVID is a serious problem, with serious consequences and requires a serious response to stop the lives of those affected from getting any worse – and not just on a physical health level,” said Dr Hans Kluge, WHO Europe Regional Director.

“We are hearing stories of so many individual tragedies, of people in financial crisis, facing relationship problems, losing their jobs, and falling into depression,” he added.

“Many health workers who risked their lives on the frontlines of the pandemic now have this chronic and debilitating condition as a result of infection acquired in the workplace. They, and millions of others, need our support.”