As Americans rightfully celebrate the Biden administration’s announcement of a national push to better understand and treat long COVID, low-resource countries in other parts of the globe risk being left behind. Again.
Health experts such as my colleagues and I are outraged by the unacceptable inequalities between high-income countries and low- and middle-income countries at every stage of the pandemic response — from access to health care and personal protective equipment to vaccines and therapeutics.
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In Africa, where I live and work, 16% of the continent’s population are fully vaccinated, while more than 2 out of 3 Americans, Europeans, and Canadians are vaccinated, and in Europe and North America, vaccines and other essentials are readily available.
As we face the long-term effects of COVID-19, we are on the brink of yet another catastrophic divide: The unequal capacity to provide services to the millions of people estimated to be living with “long COVID” — the ongoing symptoms that can continue for weeks or months though patients are no longer contagious. Little funding, if any, is currently invested to diagnose and treat long COVID in low-resource countries, where health systems do not have adequate personnel or infrastructure to manage existing health challenges, let alone the enduring consequences of COVID-19.
How can we ensure that all people living with long COVID have equitable access to quality health care? We have three recommendations.
1. Collect the data
The full magnitude of the long COVID burden is not yet known. Global health experts only have estimates extrapolated from studies conducted in high-income countries. They tell us that as many as 200 million people, including front-line workers, have experienced ongoing issues, including extreme fatigue, pulmonary and cardiac problems, renal and pancreatic insufficiency, and mental health challenges ranging from depression to psychiatric and neurological illnesses.
Without national-level data for the low-resource countries, designing effective interventions is difficult. Each country must integrate COVID-19 into its national health management information system, and can do so by building on the successful integration of screening for noncommunicable diseases in HIV programs and primary health care settings.
Each country’s COVID-19 national guidelines should encourage health care workers to follow up with patients for one year to monitor and document long COVID in the existing registers at clinics, hospitals, and other service delivery points.
—2. Expand investments in clinical management
At the peak of the initial wave of the pandemic, people were dying in hospital parking lots because of insufficient supplies of medical oxygen or lack of beds in intensive care units.
Medical supplies have made the difference between life and death for hundreds of thousands of people worldwide. We saw it firsthand at FHI 360 when we delivered critical supplies, including medical oxygen, to Indonesia, Haiti, and Nigeria through our USAID-funded EpiC project.
As hospitalizations and deaths decline, it is vital that the global health community expand investment priorities to the infrastructure needed to tackle long COVID: training, diagnostic tools, specialized radiology and imaging equipment, physical therapy, and medications. The current clinical investments remain narrowly focused on respiratory care, failing to account for the broader scope of specialized care that will be required to address COVID-19’s lasting effects.
3. Confront the mental health crisis
COVID-19 has exacerbated the global mental health crisis. The effects in low-resource countries are particularly alarming, considering the limited number of mental health professionals, services, and resources available to support those who need care. Even before the pandemic began, over a quarter of youths in Africa reported experiencing depression and nearly 30% have experienced anxiety, based on a 16-country study. People who have had severe COVID-19 are at higher risk of developing mental health issues such as depression, anxiety and poor sleep.
The absence of services and the stigma around mental health make it even more difficult to document, report and monitor the scale of need.
To address this, we must adopt multipronged, culturally appropriate interventions: create hotlines for mental health support; strengthen referral systems; increase access to services in schools, churches and communities; and integrate mental health services into routine health services. Passage by the U.S. Congress of legislation that would make mental health services an integral part of U.S. foreign assistance programming would be a welcome development.
If we believe COVID-19 ends when a person comes out of quarantine or leaves the hospital, we are gravely mistaken.
And we should not be lulled into complacency by declining COVID-related hospitalizations and deaths. The world was caught ill-prepared for this pandemic, but global health systems could be made ready for its next phases.
By collecting the right data, expanding investment in clinical management and strengthening mental health support, all countries — high-, middle- and low-income — will be prepared to combat long COVID head-on.
About the author
Dr. Otto Nzapfurundi Chabikuli
Dr. Otto Nzapfurundi Chabikuli leads the eastern and southern Africa regional office at FHI 360, a global health and human development nonprofit working in more than 60 countries. Born in the Democratic Republic of Congo, Chabikuli obtained his medical degree and a master’s degree in family medicine from the Medical University of Southern Africa, and a Master of Sciences in Health Systems Management from the London School of Hygiene and Tropical Medicine.
