COVID-19: WHY DOES SAGE IGNORE LONG COVID?

Some members of SAGE

Hospitalisations and deaths are obviously important factors in considering how to respond to Covid-19.  That has been the focus of SAGE, the Scientific Advisory Group for Emergencies.

In the early weeks of the pandemic, we hadn’t even heard about Long Covid.  Yet we now know that many people are seriously affected by ongoing symptoms.   Shouldn’t SAGE now take Long Covid into account?

Plus, what will the high infection rates forecast mean to us personally?
 

THE EXTENT OF THE LONG COVID PROBLEM

The latest ONS (Office for National Statistics) report suggests that in early June around a million people were experiencing self-reported 'long COVID'. That is "symptoms persisting for more than four weeks after the first suspected coronavirus (COVID-19) infection that were not explained by something else”.

Quoting from the report in terms of longer duration:

• 856,000 (89.0%) first had (or suspected they had) COVID-19 at least 12 weeks previously
• 385,000 (40.0%) at least one year previously

The resulting impact being:

• 178,000 (18.5%) reporting that their ability to undertake their day-to-day activities had been "limited a lot"
• Symptoms adversely affected the day-to-day activities of 634,000 people (65.9%)

These figures are significantly higher than the number of deaths.  Long Covid affects young and old including children.  Even if the numbers above are somewhat over-estimated, Long Covid is clearly a significant problem.

THE SAGE APPROACH

Yet SAGE (Scientific Advisory Group for Emergencies), the main scientific group advising the UK Government, does not formally take Long Covid into account:

• Not part of SAGE's forecast modelling
• Not recorded in the published minutes, although these do not record the discussions.  Such as the last meeting on 9 June which made clear a 4-week delay to step 4 would be worthwhile, which the Government adopted for England.  SAGE clearly has an impact on Government policy.
  

But why does SAGE ignore Long Covid?  Professor Chris Whitty who co-chairs SAGE said on Monday, in answer to a question on Long Covid, that it isn’t well understood.  But we know more than nothing.  Surely the high numbers cannot be ignored?
 

THE LINK BETWEEN CASES AND LONG COVID

The ZOE study

We don’t yet know if the Delta variant cause more or less problems than earlier variants.  Indeed it could be worse, due to the variant’s increased power to infect, if the virus spreads around the body.  

But if we assume Long Covid rates are comparable, then the Kings College ZOE study from last year gives a good indication for those who have symptoms :

• around one in fifty suffering for longer than 12 weeks
• around one in 20 staying ill for 8 weeks
• around one in seven had symptoms lasting for at least 4 weeks

The latest daily confirmed cases are running at 28,773 in the UK, with a doubling time around 9 days. Sajid Javid, the Health Secretary, is talking of soon reaching 100,000 a day.  That would mean around:

• 2,000 extra people a day suffering for longer than 12 weeks
• 5,000 extra people a day staying ill more than 8 weeks
• 14,000 extra people a day with symptoms lasting for at least 4 weeks

After a month or so of high infection rates we would expect to be talking hundreds of thousands more people with prolonged symptoms.  Many of whom will have their lives seriously blighted.

On this scale, imagine the disruption to people’s lives, their livelihoods and their employers.  So why isn’t Long Covid at least being considered by SAGE? 

THE PERSONAL IMPACT

Early data for the Delta variant from Public Health England suggests high vaccine effectiveness against serious disease, as highlighted in yellow:

But as Long Covid is more based on having symptoms, this research suggests results would be expected to be, on average:

• Older adults mainly double-vaccinated with Astra Zeneca would still have around a 1 in 3 chance (33%) of Long Covid compared to being unvaccinated
• Young adults so far single-vaccinated with Pfizer would have around a 2 in 3 chance (64%)
  
• Unvaccinated adults and children have no protection against Long Covid

Of coruse, those who are more susceptible to Covid-19 will have a higher risk of Long Covid.

So as individuals, we still need to take care against contracting COVID-19, whether we are vaccinated or not.
 

IN CONCLUSION

High rates of Covid-19 will inevitably mean a high number of cases of Long Covid.  Vaccination provides limited protection.  Unvaccinated children and adults will continue to be at risk.

We want to get back to normal as quickly as possible.  But surely SAGE and the Government should be more concerned about Long Covid than they are?  To avoid high case rates, and therefore be more careful how quickly to relax all restrictions?