Update on COVID-19 and Long Covid

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3 mins

Mike Wilson | 31 October 2024

3 mins

Recent months have seen further successive waves of Covid-19 across many countries, including the UK, US, Canada and Australia. This includes a relatively large wave in July and August, which has since subsided. Several Olympic athletes withdrew from events due to infections, or later admitted to having Covid. This wave caused age-standardised mortality rates in the UK for 2024 to diverge from those of 2019 (see the yellow line in the diagram below), which is the best year on record^[1].

Since that time, it has become clear that the remainder of this year more closely tracks 2019 than 2022 (red line), in which the whole second half of the year saw relatively poor mortality. This is fairly good news, and we expect mortality has broadly recovered to around pre-pandemic levels everywhere, though note that no improvements over a period of five years is a poor outcome compared to long-term trends. The effects of the tail end of the pandemic contribute to this, as do relatively weak improvement rates more generally.

The variants of COVID-19 involved in recent waves appear of similar severity to those prevalent throughout the last two years, as do those which have emerged more recently. Mortality impacts in the general population are especially noticeable on a baseline of typically low summer mortality in the northern hemisphere but are far smaller than during 2020-2022.

In England, useful data emerged estimating the current risks associated with an infection. Between November 2023 and March 2024 the Winter Coronavirus Infection Study tested a sample of the population to determine COVID-19 incidence and prevalence and also recorded hospitalisations and mortality associated with the virus. The risks associated with COVID-19 remain highly age-dependent and are shown below. These have fallen roughly 90% since early in the pandemic and are now broadly comparable to death rates from influenza. COVID-19 still infects people around three times more regularly than ‘flu, so retains a higher overall burden on health.^[2]

We can also use this source to estimate the current threat of a COVID 19 infection leading to a case of Long Covid. The above report includes weekly estimates of COVID-19 incidence (peaking at around 1 in 200 people per week in early December), and a separate source surveys people to ask them if they have Long Covid and, if so, how long they have had it and how severe it is.^[3]

Using the numbers of people who said, in February 2024, that they had had Long Covid for between 4 and 11 weeks, and overlaying these on prevalence a few months earlier, we can roughly estimate that the risk of a case of COVID-19 leading to a form of Long Covid affecting daily activities ‘a lot’ was between 0.1% and 0.2% during the UK’s 2023/24 winter. Including all people affected either ‘a little’ or ‘a lot’ the risk is around 0.5%, or 1 in 200 people. 4 to 11 weeks represents relatively short-duration illness, and we would expect a material proportion of these people to make a full recovery.

The net effect is that the total number of people experiencing Long Covid is no longer increasing. In the UK it has remained at around 2 million since 2022. Similar data in the US shows roughly flat prevalence over the same period.^[4]Many of these people have long-term conditions, showing no signs of improvement in a period of over three years. However, increasingly this appears to be a cohort of people impacted in 2020-21, and not a (significantly) growing pool of people.