19 January 2023

We Are Fucked

Before there was Covid-19, there was SARS 20 years ago.

SARS was a Coronavirus very similar to Covid-19, but it had faster symptom onset, and was less contagious, so the world public health system managed to contain it fairly quickly.

It was similar in more ways than one.  We now have Long-Covid, and we have people today who still suffering from Long-SARS.

Given the percentages of Long-Covid, the disability numbers down the road are likely to be very grim: 

In 2002–03, a Severe Acute Respiratory Syndrome (SARS) coronavirus caused a pandemic. It was described as a novel virus, meaning that it seemed to be unrelated to other viruses directly. Worldwide there were approximately 8000 cases and over 800 deaths. Toronto (Ontario, Canada) had the largest outbreak outside of Asia, with 251 cases and 41 deaths, with health care workers making up 43% of the cases.


The World Health Organisation (WHO) has recorded about 500 million Covid-19 cases and 6 million deaths globally, up to mid-April 2022 [2]. How many people have suffered from Long Covid [also called post acute sequelae of COVID-19 (PASC)]? We have both too much evidence and insufficient evidence. There are many, many articles published. There is incomplete agreement as to criteria for inclusion, symptoms, severity of symptoms and length of time symptoms have persisted. There is the question of what proof of Covid is required (is a self-reported test adequate?) and whether the study setting is in the community or whether it is post hospitalization. In the UK, the official register provides a prevalence of ongoing post-Covid symptoms at about 8% of cases (1.8 million people [3] post 22.3 million cases [4]). A recent Lancet preprint [5] (i.e. preliminary, not yet accepted for publication and without peer review) systematic review and meta-analysis including 196 studies and 120,970 participants showed that long COVID may affect more than half of the patients, after a median of 6 months from the diagnosis. It is expected that with time, the exact numbers will become more clear. However, it is now already clear that the numbers are very significant. To deal with those staggering numbers of people with ongoing Long Covid symptoms, innumerable rehabilitation programs have sprung up. However, since Long Covid is new, there is no knowledge as to what:

  • Makes a good rehab program for this population;

  • What is cost-effective;

  • What services are needed and helpful;

  • What are the short-term and long-term outcomes with and without rehabilitation?

These questions cannot yet be answered. However, if as seems likely, Long Covid is similar to the long-term outcomes post SARS, then predictions can be made. Since the term ‘Long Covid’ seems to have taken hold, I will retrospectively refer to the collective symptoms post 2003 as ‘Long SARS’. It should be noted that all the Long SARS patients in my experience were ‘severe’, as all our patients were very sick, hospitalized and many went through the ICU. The literature on Long Covid includes all levels of severity from asymptomatic to fatal. Severity of illness has not yet been established as a risk for Long Covid but it remains as a possibility.


It is clear that Long SARS (post SARS ongoing symptomatology) exists, persists (apparently permanently) and can be devastatingly life-changing for some. Sufficient similarities exist between Long SARS and Long Covid (PASC) in symptoms, findings and course over time (so far) that one can predict that it is very highly likely that some Long Covid disability will persist permanently. For those interested in rehabilitation, it is once more noted that the peer group support was very highly valued by the patients. Those wishing to treat Long Covid remotely (such as with telehealth) should consider this. All of the foregoing information is provided as a personal opinion to help guide treatment and counseling, so as to provide hope but not false hope for those affected by Long Covid.

Long SARS is often permanent.

SARS and Covid are not the same.  SARS was much more virulent, with a mortality rate about 5 times that of Covid, and it would not be unreasonable to assume that the occurrence of long term disability would be less likely with Covid-19 as well.

On the other hand, Covid-19 has infected something on the order of ½ million times more people than SARS, so the aggregate numbers are likely to dwarf what was seen with SARS.

I could be wrong about this, I am not a doctor, nor am I a public health professional, I am an engineer, dammit,* so these are musings largely unsupported by anything beyond my inclination to see patterns and my experience working in healthcare and designing medical equipment.

Still, the societal impact of hundreds of millions of people worldwide having a long term disability, along with higher mortality rates from things like heart disease, kidney failure, and diabetes looks to be an enormous challenge in the long term.

*I love it when I get to go all Dr. McCoy!


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