By David Tuller, DrPH
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Last week, the journal Annals of Clinical Microbiology and Antimicrobials published the results of a major effort to collate international expertise on Long Covid. The article–“Long COVID clinical evaluation, research and impact on society: a global expert consensus”—was produced under the auspices of the Long COVID Advisory Group of the World Health Network, a global collaborative.
Earlier today, I spoke with Andrew Ewing, the document’s lead and corresponding author and a professor of chemistry and microbiology at the University of Gothenburg, Sweden, and David Joffe, a co-author and a respiratory and sleep physician in Sydney, Australia. Below, I have posted information from the World Health Network’s press release, which calls the situation “a wake-up call for governments and health systems,” followed by the interview.
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From the release…
A landmark international study has confirmed what millions of patients and advocates have been saying for years: Long COVID is real, it is debilitating, and the global response must be drastically scaled up. The Delphi study, involving over 150 experts across medicine, research, and patient advocacy, represents a first-of-its-kind consensus on the priorities, gaps, and urgent needs surrounding Long COVID.
Conducted through a rigorous process designed to build agreement across diverse disciplines, the study identified ten critical areas requiring immediate action. Together, they paint a stark picture of a growing public health crisis that continues to be underrecognized and underfunded.
1. Educating Frontline Providers Is Non-Negotiable
There was unanimous agreement that healthcare workers must be trained to recognize Long COVID—not just as post-viral fatigue, but as a complex, multi-system condition involving neurological, immune, and organ dysfunction.
2. A Universal Definition Is Essential
The lack of a single, standardized definition of Long COVID is hampering progress. Without a clear clinical framework, patients face inconsistent care, researchers struggle to study the disease, and policy lags behind reality.
3. Long COVID Is Not “Just Tiredness”
Experts confirmed what many patients already know: Long COVID includes serious complications such as immune dysregulation, neurological injury, and organ damage—even when conventional tests appear “normal.”
4. It’s an Invisible Disability
Many Long COVID sufferers experience disabling symptoms that don’t show up on routine tests. These invisible impairments are often misunderstood, dismissed, or overlooked entirely.
5. Current Diagnostics Fall Short
The expert panel highlighted the limitations of standard lab work. Advanced diagnostics—including tilt-table testing, cardiopulmonary exercise testing (CPET), microclot analysis, and mitochondrial markers—are needed to uncover hidden dysfunction.
6. A Syndrome of Syndromes
There is clear consensus that Long COVID is not one disease, but a cluster of overlapping conditions such as dysautonomia (including POTS), mast cell activation syndrome (MCAS), ME/CFS, and mitochondrial dysfunction. Each of these demands nuanced care.
7. Children Are Also at Risk
Despite persistent myths, COVID-19 is not benign in children. Experts emphasized the need for long-term studies on how SARS-CoV-2 affects developing immune systems, brains, and hormonal balance. Repeat infections may result in lasting cognitive and physical harm.
8. Clean Indoor Air Is a Prevention Strategy
Long COVID is, to an extent, preventable. Reducing airborne transmission of the virus through improved ventilation and air purification—particularly in schools and workplaces—is essential public health infrastructure.
9. We Need Global Investment, Now
From diagnostics and treatments to workplace accommodations, Long COVID requires coordinated international funding. The current lack of leadership and investment represents a growing risk to global health.
10. The Economic Fallout Is Massive
Long COVID is not just a medical issue—it’s a socioeconomic one. Healthcare systems are overwhelmed, labor participation is falling, and inequality is rising. Continued inaction, the study warns, is a policy failure with long-term consequences.
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