Written by Dr Tim Trodd
We are now in the 5th wave of Covid in Hong Kong. It may be interesting to consider the challenges posed by Long Covid and its impact on individuals, families, businesses, and Hong Kong’s society as a whole. Long Covid, that is persistent symptoms after acute Covid disease, is a common and disabling condition. It is a multisystem inflammatory process that can result in a multitude of symptoms and increase the risk factors for many diseases.
For comparison I have looked at the UK, which has a similar public health system to Hong Kong and around 10 times the population (68m v 7.6m). The UK is now reaching the stage where Covid is mild and endemic and is in an a position to look back upon the epidemic phase. The Office for National Statistics in the UK collects data on Long Covid symptoms.
The February 2022 report estimated that 1.3 million people in the UK are living with Long Covid symptoms, that is 2% of the population. Of those 63% reported that the symptoms effected their day-to-day activities with 18% effected “a lot”. Fatigue is the most common symptom reported (50%), followed by shortness of breath (37%). The prevalence of self-reported long COVID was greatest in people aged 35 to 69 years, females, people living in more deprived areas, those working in health care, social care, or teaching and education, and those with another activity-limiting health condition or disability. So Hong Kong may expect around 150,000 people to experience Long Covid symptoms.
We know that the rate of Long Covid increases with disease severity. This will be relatively good for Hong Kong as we have high vaccination rates in the bulk of our population and most people are going to catch the Omicron variant, which causes less severe disease. Therefore, we would expect lower rates of Long Covid compared to the UK, which experienced waves of disease prior to vaccination and with more severe variants such as Delta. However, Hong Kong does face some special challenges, lockdowns and the economic effects of the 2 years of Covid have disproportionately affected the poor and, with the biggest single determinate of ill-health being poverty, we can expect a large impact on the 1.65 million Hong Kong residents 3 living in poverty.
In addition to Long Covid, there will be other healthcare challenges. The sheer load of work and difficulty maintaining healthcare services, for instance due to staff shortages and need for infection control measures, will make it hard to maintain acute care services. There are bound to be delays in screening and preventative services which will lead to delayed diagnosis and disease progression. Research has shown that persistent inflammation following Covid may lead to as much as a 50% increase in acute illness such as stroke and heart attack.
As individuals and parents we can take steps to lessen the impact of this on ourselves and families. A healthy lifestyle with a healthy diet and plenty of exercise will improve all health parameters. Consider nutritional supplements, such as probiotics, Vitamin D and Zinc and Selenium. Regular health checks will help to identify risk factors for ill-health and find problems early. Long Covid itself requires a holistic approach and measures to decrease inflammation.
Corporations of all sizes will benefit from providing services to maintain the physical and psychological health of their employees in these times. Particularly setting up channels to allow easy and anonymous access for employees to health services, we find that they are often reluctant to seek help through HR.
When Covid in Hong Kong finally reaches the endemic phase there will still be many healthcare challenges to be addressed. Taking a proactive and positive approach will lessen the impact on ourselves, our families and our businesses.
Long Covid & Cardiovascular Disease
Long Covid is a common and often disabling condition. The underlying cause appears to be multi-system inflammation which persists after the acute infection. A recent paper 1 has investigated the long-term effects on the cardiovascular system and found there to be an increase a wide range of cardiovascular diseases.
The research in the USA studied a very large database of more than. 5 million patients. The risks of major cardiovascular events such as stroke (50%), heart attack (60%) and Pulmonary Embolism (90%) were greatly increased in the year following acute Covid. In keeping with other studies into Long Covid the risk increased with the severity of the initial illness.
They conclude that governments and health systems around the world should be prepared to deal with a rise in the burden of cardiovascular diseases. Because of the chronic nature of these conditions, they will likely have long-lasting consequences for patients and health systems and also have broad implications on economic productivity and life expectancy.
As individuals it is important to remember that a healthy lifestyle will decrease the risks of severe Covid, Long Covid and cardiovascular disease. Vaccines also protect against severe Covid and Long Covid. Regular check ups will identify risks for cardiovascular disease, including inflammation, to allow for prevention and timely treatment.
1. Trodd, Tim (Dr.). Why does Long Covid increase the risk of Cardiovascular Disease? - OT&P Knowledgebase. Retrieved March 29, 2022, from https://www.otandp.com/knowledge-base/why-does-long-covid-increase-the-risk-of-cardiovascular-disease
2. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK : 3 February 2022. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK - Office for National Statistics. (n.d.). Retrieved March 29, 2022, from https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/3february2022
3. Hong Kong poverty rate jumps to historic high. RTHK. (n.d.). Retrieved March 29, 2022, from https://news.rthk.hk/rthk/en/component/k2/1619222-20211110.htm