Exploring the impact of long COVID

By Tiffany J. Nhan

In a new paper in Health and Social Work, Nancy J. Smyth, PhD, professor and associate dean for faculty development in the University at Buffalo School of Social Work, explores the post-viral effects of COVID-19. 

With lead author Susan A. Taylor, PhD, professor in the Sacramento State School of Social Work, Smyth discusses the long-term implications of long COVID on health, society and community life. The authors call for increased attention and collaboration among health professionals to improve health messaging, fill in gaps in the public’s understanding of long COVID and study the ongoing impacts of the virus. 

Here, Smyth expands upon her paper to provide information on how COVID-19 and long COVID continue to affect our society and how we can mitigate those effects moving forward. This interview has been edited for length and clarity.

The politicization of COVID really divided the country's realities so that we're no longer united in public health. Part of the misinformation about COVID that people believe now is that it’s basically like the flu or a cold, but even mild COVID infections can result in damage to people's bodies.

We have pretty solid research that suggests that COVID damages the immune system and the brain, and creates a variety of systemic problems, like higher risk of heart problems, stroke and diabetes. We are also seeing significant levels of long COVID in children and other complications after COVID infections, such as an increase in diabetes and multisystem inflammatory syndrome. We're in a position where we have increased national risk because of this, and vaccinations do not prevent it, although they do help reduce the risk. However, people who are vaccinated are getting long COVID and post-COVID complications, and many don't even make the connection to COVID because there's been no messaging about this. The dialogue has stopped because of politics, not science, and culturally, people understandably want this pandemic to be over — and since they are no longer hearing about it, they assume it is.

The more infections people get, the more long COVID and post-COVID consequences we will get in the population. There are people who are now working under capacity or have a disability because of COVID. The best approach, at this point, is to focus on long COVID and how to protect and support people with long COVID, which means reducing repeat infections. 

In addition we need to do a better job recognizing long COVID; recent research suggests that it may be significantly underdiagnosed. There’s been minimal messaging about this from government officials, so that means the work falls to public advocacy groups to speak up repeatedly and educate people.

In a recent study, researchers recruited healthy young people and infected them with the SARS-CoV-2 virus, which causes COVID. All except one developed mild COVID infections; the study then took repeated measures of the effects over time. They found that over time and up to a year later all participants experienced a reduction in cognitive functioning, memory issues and executive function issues, and yet none of them reported having cognitive problems. Imagine an entire population with large numbers of people who have had mild COVID infections and have cognitive problems, but don't know that they have cognitive problems. What are the implications of that for workplaces, for driving, for all the decisions that we make in our society? 

Everything we know about preventing the spread of COVID applies to preventing long COVID because getting reinfected with COVID increases your chance of developing long COVID: Test before you go to events so you don't infect others, and take responsibility to test when you feel like you might have a cold or allergies, because if you've had COVID, when you get it again it may look very mild. Mask when you’re in crowded indoor spaces (especially when local wastewater testing indicates virus levels are high) because there’s a good chance there are infected people in that space. The SARS-CoV-2 virus thrives in poorly ventilated spaces and spreads through the air like smoke spreads through a room. In other words, you don’t need to be next to someone who is infected for the virus to reach you. Use HEPA-filter air purifiers in indoor spaces to clean the air, and open windows whenever possible.

I also recommend people link with one of the advocacy groups mentioned in our article. Encourage people to ask themselves: “How are you since you’ve had COVID? Is your body back to normal? And if not, what have you noticed?”

A study by George Washington University, published in 2023, found that one third of the faculty, students and staff were suffering from long COVID. The biggest issue for universities in the transmission of respiratory diseases, including COVID, is the air quality and ventilation in classrooms. When you have a room filled with people in a meeting or class, it gets filled with carbon dioxide (which we all exhale), unless there's good ventilation. So what does that mean? The CDC has said the risk of spreading COVID and other respiratory illnesses is higher if the carbon dioxide levels are higher because that tells you the ventilation isn’t adequate. And now we have research indicating that the SARS-CoV-2 virus also thrives on carbon dioxide.

Universities can start by promoting public health and the health of our students, faculty and staff overall. That would be a great strategy because, honestly, parents want to send their kids to a campus that focuses on health and wellness with structural things that actually make a difference. Rather than addressing long COVID strictly as a long COVID strategy, we can target it as a larger public health strategy for the health and wellness of a workplace, college and community.