(Image: AAP/Mick Tsikas)

Is long COVID still a thing? The virus seems to have got milder as it has mutated, but what about long COVID, the reported persistence of mysterious symptoms even after the acute infection has passed? Is that still something worth worrying about?

To the casual observer it certainly seems like no-one is worried. I went to a conference the other day and two of the around 1,000 people there wore masks. Is that justified, or are we sleepwalking into trouble?

The science on long COVID is concerning. A major paper released the other day argued that not only is long COVID real, your chances are worse in a subsequent infection. The study — on millions of health records from the UK and Spain — was a bit ambiguous on whether a first infection can cause a lot of persistent symptoms (lasting more than 90 days). All it found for sure was a high risk of an altered sense of smell or taste, fatigue (but only among the British sample), and breathing problems (for the Spanish not the Brits). 

People who’d had just one infection reported many long-lasting symptoms at the same rate as people who tested negative — i.e. people who’d had a negative test were likely to report long-lasting symptoms too. In fact, the COVID-infected people were less likely to report some symptoms, such as anxiety. But when it came to a second infection, the story was very different, with a huge rise in the risk of persistent symptoms: “Persistent symptoms were more common after reinfection than following a first infection.”

Given most of us have had an infection or two, further hits may be risky.

Is long COVID real?

Viruses that leave long-lasting problems are not new. Think polio. HIV too. And now we understand the link from the Epstein-Barr virus to multiple sclerosis, we know a virus must be involved in MS too. ME/CFS, also known as chronic fatigue syndrome, is another illness with a post-viral origin.

Viruses can hang out in reservoirs in the body, places where the immune system can’t touch them. They have a trick called latency, where they basically hibernate. Normally a virus needs to replicate to survive, but it can go quiet like a seed in the desert waiting for the right moment to come back to life. Shingles is a latent virus that comes back to life.

So don’t be sceptical about whether long COVID is real. It is. The good news is research shows some people get better so it need not be lifelong. However, for others, it is severe and debilitating.

The data

In the US there is a signal that hints long COVID may be quite a problem. It measures the number of people reporting a disability very regularly and in the past few years it has shown a major rise. 

This is circumstantial evidence — there’s no way to prove these people have long COVID. But it is interesting. You’d need to have a better theory of what could be causing a rise in disability to disprove it. Mental ill health is one such idea. 

Most of the disabled people in the chart above are still in the labour force but some are disabled and not looking to work. The US economy is humming and drawing many people into work. The number of people not in the labour force is plunging. But that is not true of people with disabilities. There’s a rise in them out of the labour force, as the next chart shows. That represents a big trend change, especially for women.

Don’t get me wrong — people with disabilities are joining the workforce in the US in big numbers too, and this is consistent with a lot of people with mild disabilities needing to work in a cost-of-living crisis. Either way we see signs of a growing population of those with a disability, including a rise in those so disabled they can’t work, which you might not expect when employers are so hungry for staff.

The Australian data

This got me wondering: what can we see in the Australian data? We don’t have a monthly survey asking people if they are disabled (the Bureau of Statistics does ask in the five-yearly census) but we do have a labour force survey that asks people who aren’t in the labour force why. Among the responses people can choose is being permanently incapacitated.

Usually you’d expect the rate of people who can’t work to fall when unemployment is low and vacancies are high. So if that is rising now, it could be a sign of long COVID hitting some people. 

Here’s what we find. The next chart shows a rise in people declaring they can’t work because of permanent incapacitation. 

It’s not proof of long COVID, but it is what we’d expect to see if long COVID was taking people out. The wrinkle in the theory is the rise is a little later than you might expect if long COVID were the main cause — it pops up in late 2023. Unless of course COVID has been quietly ravaging our population this year.

It’s a small sample, but it is a clue that a blasé attitude to COVID could, for some people, be a problem. The risk is there — not high enough to be tearing the population apart, but probably not at zero either. I don’t think we should sneer at anyone who wants to mask up or avoid crowds — not until we get a lot more data.

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