Covid and life expectancy : why we have yet to see the full impact of the pandemic on Healthcare?

The major goal of healthcare is extending not only the life span of people in society but also their quality of life. Therefore, we track both mortality (death) and morbidity (impact on health) when considering the impact of any disease. One of the main statistics used for tracking the improvement of a population’s general health is life expectancy rates, which should steadily improve as the healthcare provided improves. This has largely been true for the last 20 or so years. However, recent evidence demonstrates that the coronavirus pandemic has caused a significant setback in life-expectancy rates in many countries. In this article, our team explores the reasons of this setback and the solutions to overcome this situation.

How has life expectancy changed since COVID-19?

COVID-19’s mortality rates have been widely publicized, as the 1% mortality rate seen in confirmed cases is much less than feared at the beginning of the pandemic, but excess mortality statistics prove that the effective death toll has been much higher. In a recent study of life expectancy rates in 29 countries, Western Europe has largely seen a return to pre-pandemic life expectancy rates but many countries including Eastern Europe and the US have not seen such a return, as in 2021, registered COVID-19 deaths still account for most of the life expectancy losses seen^[1] . In the US, the life expectancy was 78.8 years, which declined in 2020 to 77 years, but is now estimated at 76.4 years in 2021, the lowest rate since 1996, suggesting that the coronavirus pandemic has significantly impacted the overall health of the American population, as death rates have increased across all age groups. Pandemic control measures and high vaccination rates have allowed other countries to bounce back. However, more than 300,000 cases have been reported daily worldwide in 2022 suggesting that the rate of COVID-19 infections is not slowing down and indicates it is likely to continue impacting the world’s overall health for a while to come.

COVID lingers longer than the average respiratory infection

In the US, more than 18 million people have long COVID.

Additionally, there has been a lot of coverage, as the pandemic has progressed, on the number of people who suffer from long COVID, or as labeled by the WHO, “Post-COVID condition.” These are patients that after contracting the initial infection, continue to have COVID-19-related symptoms that can last for weeks to months after the initial infection and in severe cases can lead to disability.

In the US, more than 18 million people have long COVID[2]. Based on several recent studies from the UK, up to 33% of adults who contract COVID-19 experience long COVID symptoms[3]. In children, 11–17-year-old, 14% report post-COVID conditions[4]. The older the patient the more likely they are to experience post-COVID syndrome, a 3.5% increase per decade[3]. The same study indicates that women are 50% more likely to suffer from long term effects of COVID-19 than men.

Long COVID’s underlying causes are still poorly understood and effective treatment strategies are being developed as information surfaces.

What is the difference between long COVID and COVID-induced morbidity?

Even if only 10% of those infected end up with irreversible damage, population life expectancy estimates and overall health will be significantly impacted globally.

Long term effects of COVID can vary widely between patients and cover many organ systems, including general symptoms such as lingering fatigue and fever, to respiratory symptoms, including shortness of breath and chest pain, similar to the initial infection, but can also include neurological symptoms such as headaches and “brain fog” and digestive issues such as stomach pain and diarrhea. In COVID-19 patients who experienced severe illness resulting in hospitalization, many of them may also develop post-intensive care syndrome or PICS, with persisting muscle weakness impaired judgment, and even symptoms of post-traumatic stress disorder (PTSD). Mechanistically, long COVID symptoms stem from unresolved infections, immune dysregulation, induced auto-immunity, and autonomic nervous system damage, based on current research . There is, however, no way of predicting the likelihood or length of post COVID symptoms based on the severity of the primary infection, though some correlation between lack of primary vaccination and long COVID incidence exists. The persistence of symptoms also does not speak to the long-term and potentially irreversible damage COVID-19 infection does to organ systems stemming from both the infection and the inflammatory response induced to combat the infection. This damage drives long-term COVID morbidity, which results in COVID-19-induced chronic diseases, permanently altering a person’s ability to be as healthy post-COVID as they were before.

The largest impact of the coronavirus COVID-19 pandemic is likely on the horizon, not in the rearview mirror.

More than confirmed 650 million COVID-19 cases have been reported during the first two years of the pandemic, with some people being infected multiple times[5]. Even if only 10% of those infected end up with irreversible damage, population life expectancy estimates and overall health will be significantly impacted globally, resulting in a higher percentage of the population with chronic health problems, and increased healthcare costs over their lifetimes. Thus, the largest impact of the coronavirus pandemic is likely on the horizon, not in the rearview mirror.

Creating the necessary urgency to find long COVID and COVID-induced morbidity solutions

Recognition and exploration of long term effects of COVID was delayed as the impact of long COVID to patients’ health and quality of life is unique to COVID-19 and not found as a consequence of other respiratory pathogens. Research is underway to understand the disease as are clinical trials for the repurposing of other treatments to combat the known COVID symptoms, such as an ADHD med Gaunfacine, which may resolve long COVID associated “brain fog”. It will be some time before we understand the root causes of long COVID and how to treat it or even prevent it effectively. COVID-induced morbidities are also unique consequences of this virus. Our collective health will only continue to decline unless we muster a collective effort to find solutions.

As the world is still recovering from coronavirus pandemic, it is difficult to pay attention to less immediate threats. But the long aftermath of COVID-induced morbidity poses a significant threat to health and deserves the same sense of urgency as COVID-19 as COVID-induced morbidity will impair far more people than those who died of the infection. Is the world prepared for the potentially massive wave of COVID-induced morbidity? How ready are healthcare systems to deal with the increased costs and need for care? Alcimed closely follows the evolution of the situation and the rapid developments in the field and is ready to support you on these topics! Don’t hesitate to contact our team!

[1] Schöley et al. (2022). Life expectancy changes since COVID-19. Nature Human Behaviour, 6(12), 1649‑1659. https://doi.org/10.1038/s41562-022-01450-3
[2] Robertson et al. (2022). The epidemiology of long COVID in US adults two years after the start of the US SARS-CoV-2 pandemic. MedRxiv. https://doi.org/10.1101/2022.09.12.22279862
[3] Up to one in three people who have had COVID-19 report long COVID symptoms. (s. d.). NIHR. https://www.nihr.ac.uk/news/up-to-one-in-three-people-who-have-had-covid-19-report-long-covid-symptoms/27979
[4] First findings from world’s largest study on long COVID in children and young people. (s. d.). NIHR. https://www.nihr.ac.uk/news/first-findings-from-worlds-largest-study-on-long-covid-in-children-and-young-people/28572
[5] Mathieu, E. (2020, 5 mars). Coronavirus (COVID-19) Cases. Our World in Data. https://ourworldindata.org/covid-cases

About the author,

Danna, Grande Exploratrice en virologie au sein de l’équipe Santé d’Alcimed aux Etats-Unis