.
Xiao Wu, Christina Mullikin
New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences University
Abstract
Long COVID refers to the continuation or development of lingering or new symptoms three months after the initial coronavirus infection. The most common symptoms are fatigue, and shortness of breath. Research has shown that approximately 10-30% of people who have had COVID-19 have these symptoms. Long COVID has impacted socioeconomic and healthcare systems in the United States (U.S.) and all over the world in many ways. The pathological changes and treatment guidelines for Long COVID are still not clear. Many states have integrated complementary and alternative medicine (CAM) in their health care services. CAM treatments have improved patients’ symptoms and boosted their immunity. With effort and support from healthcare providers and policies, CAM has the potential to shed light on the patients who suffer from long COVID.
Introduction
History repeats itself! When the COVID- 19 virus swept around the world, the parallels with the 1918 flu pandemic were obvious. It was estimated that 675,000 Americans lost their lives in the 1918 pandemic (Taubenberger & Morens, 2008). As of this writing COVID-19 has taken more than 1.1 million lives in the U.S. (CDC, 2023), and, while waves of COVID-19 have already affected the majority of countries, the impacts of COVID-19 are still evolving with the problems of ‘Long COVID’ or ‘post-COVID-19’ .
Long COVID or post-COVID-19 refers to the continuation or development of lingering or new symptoms three months after the initial infection (Shah et al, 2021). The most common symptoms are fatigue and shortness of breath. Other symptoms may include cognitive challenges and difficulty concentrating, depression, headaches, sleep problems, smell and taste dysfunctions, joint or muscle pain, gastrointestinal, and cardiac issues (Yong, 2021). Research has shown approximately 10-20% of people who have had COVID-19 have these symptoms (Cheung et al, 2020) (Mao et al, 2020). The chances of long COVID increases to more than 30% in patients who require hospitalization during the course of the initial illness. Long COVID is far more common than many think, as it affects people’s ability to resume normal life activities. Previously healthy people may become disabled. The COVID-19 pandemic and Long COVID have placed a substantial strain on the healthcare systems in the United States, and the rest of the world.
Long COVID and Healthcare Inequities
The COVID-19 pandemic has highlighted and exacerbated the health inequities that already existed in the U.S. The beginning of the COVID-19 pandemic demonstrated the healthcare disparities in certain racial/ethnic and socioeconomic status (SES) groups. For example, women of color and with children faced the challenges of financial and job insecurity with a higher rate of morbidity of COVID-19 (Aleksanyan & Weinman, 2022) (Kalinowski et al, 2022). People of low SES were more likely to live in overcrowded communities which makes it challenging to follow social distancing guidelines. The infectious disease easily spreads. Without secure jobs and healthcare, they tended to have worse outcomes from COVID-19 infections, which makes the development of Long COVID more likely (Patel et al., 2020).
The rates of long COVID are higher in women (Perlis.et al.,2022), Black and Latinx populations (Berger. et al., 2021). Many social determinants of health such as SES, physical environment, and occupation can have strong effects on the progression of COVID-19. Long COVID has a negative shift in the social determinants of health (Russo et al., 2021). Effective interventions are needed to treat patients so as to reduce the negative health impacts of structural racism in health systems, and health policies and programs on racial and ethnic minorities and populations experiencing social disadvantage.
Long COVID and the Healthcare system
The COVID-19 pandemic has pushed the healthcare system to its limits, straining both global health security (GHS) and universal health coverage (UHC) type systems (Lal et al., 2021). GHS aims to strengthen the national and international capacity of preventing, detecting and responding to public health threats, especially infectious diseases. UHC focuses on providing health security and universal access to comprehensive and quality care without financial burden (Wenham et al, 2019).
The pandemic began in early 2020, constituting an unprecedented challenge to healthcare, socio-economic and political systems worldwide.
Despite the U.S. receiving top ratings for the pandemic in the GHS Index, the country suffered high rates of healthcare worker burnout, exhaustion and trauma, supply shortages, and resource maldistribution (Lal et al., 2021). Despite the U.S. being the most advanced country in medicine and having the highest Gross Domestic Product (GDP), it is also the current number one country for the COVID-19 cases and deaths per capita. Meanwhile, The U.K., with a well-developed UHC, showed the UHC’s limitations during the historic pandemic, not acting quickly to ensure an effective National Health Service response (Wenham, 2020). Because of the fragmented health systems in the COVID-19 pandemic, long COVID was reported with a prevalence of 10% to 15% in the U.K. a similar rate to the U.S. (Castro et al., 2022). However, countries with integrated health systems of GHS and UHC, such as South Korea and Taiwan, effectively controlled and prevented the COVID-19 pandemic (Normile, 2020).
Long COVID and Health Care Access as well as Insurance Coverage
Long COVID includes a wide range of medical problems that can last weeks, months, or years, significantly impacting one’s life and work (Fugazzaro et al., 2022), (Walle-Hansen et al., 2022). Medical management and healthcare support can improve the quality of life for these patients.
Healthcare access is the ability of an individual to obtain health care when needed. In the U.S., access is restricted to people who either have insurance coverage from employers or sponsored by governmental healthcare programs, such as Medicare, Medicaid, and the Affordable Care Act (ACA). In general, if one already has health insurance, it will continuously cover their health care for long COVID. For employer-sponsored health insurance, if one is too sick to work, they cannot maintain their coverage. Fortunately, there are provisions that protect people’s continued access to health care benefits and coverage in this situation through the Family and Medical Leave Act (FMLA), which provides leave or disability benefits for those who are eligible (Kröönström. et al., 2022).
In some special conditions, for example, when one’s current insurance might not cover all of expenses related to the treatment of long COVID, the ACA guarantees the right to appeal. There is no guarantee that your insurance plan will fully or partially cover your prescribed medications for the treatment of long COVID.
Long COVID and integrative approaches for patient care
Studies have indicated that the long COVID may be a looming public health crisis (Phillips & Williams, 2021). As health care practitioners, what can we do to help patients. The pathology of long COVID is not understood, nor is how long it takes for patients to recover from the condition. By involving broad healthcare perspectives, some patients have formed online groups to share information and support each other. Many states have integrated complementary and alternative medicine (CAM) in the health care services (Kim et al, 2022) (Roth et al, 2021). CAM and acupuncture interventions have improved symptoms and boosted immunity.
In our clinic, we have encountered patients with Long COVID symptoms including headaches, insomnia, and irritable bowel syndromes, etc. With acupuncture and Chinese herbal medicine treatments, we have helped many patients recover. As we understand, patients with health insurance coverage have less financial stress and have better outcomes.
As we discussed, minorities including women, Black and Hispanic populations, have been disproportionately affected in the pandemic. For the complex clinical needs of these patients, health systems and practitioners need to make more efforts.
Summary
Long COVID is a chronic illness affecting the physical and mental health of millions of Americans. It is also a pervasive economic burden which may continue for decades. The World Health Organization, health policy makers, and healthcare providers have worked together to face the challenges. As Wall Street Journal described, “Treating people with long COVID comes with a cost that will fall to some extent on patients and their families and to some extent on society” (Krause, 2022). We believe that we can manage Long COVID well as we have finally controlled the surges of the COVID-19 pandemic.
公共衛生的新挑戰-Long Covid和未來展望
吳曉，穆利金.克里斯蒂娜
新英格蘭鍼灸學院，馬薩諸塞州藥學與健康科學學院
摘要
目前已是後新冠時代，或稱長新冠時代。長新冠是指 首次感染冠狀病毒三個月後，持續或新發展的, 揮之不去的症狀。最常見的症狀是疲勞和呼吸短促。研究表明，約10-30%的新冠感染患者有這些症狀。新冠疫情及長新冠，對美國乃至全世界的社會經濟和衛生保健系統，造成了前所未有的壓力和衝擊。迄今爲止，長新冠的病理變化和治療指南尚不清楚。許多國家已經將補充和替代醫學(CAM)納入其保健服務，應用包括針灸及替代醫學的干預，改善了患者的症狀，提高了患者的免疫力。未來在醫療政策支持下，通過義務工作者的努力，為長新冠患者的醫治帶來一道曙光。
介紹
歷史總會重演！當冠狀病毒席捲美國和世界各地時，1918年流感大流行又一次從歷史的角落被提到桌面上來。不幸的是，據估計，約有67.5萬美國人在1918年的 流感中喪生(Taubenberger & Morens，2008)，而現在，COVID- 19迄今已奪走了超過1099866名美國人的生命(CDC，2023)。儘管現今新冠疫情高峯期已經 過去，但新冠疫情的影響仍在繼續，並進入了另一個階段，即長新冠或后新冠階段。
長新冠 或後新冠是指在初次冠狀病毒感染三個月後，持續或新發生的揮之不去或新癥狀(Shah. et al.，2021)。最常見的癥狀是疲勞和呼吸急促。其他持續癥狀可能包括認知障礙和注意力不集中、抑鬱、頭痛、睡眠問題、嗅覺和味覺功能障礙、關節或肌肉疼痛、胃腸道和心臟問題(Yong，2021)。研究表明，大約 10-20% 的新冠 患者有這些癥狀(Cheung. et al.， 2020 )(Mao. et al.，2020)。在住院治療的患者中，長新冠的機會增加到30%以上。長新冠比人們想象的要常見得多，它影響了人們恢復正常生活活動的能力, 從前的健康者可能會成爲殘疾人。新冠病毒大流行和長新冠，影響了美國及全世界的社會經濟和衛生保健 系統，在許多方面給衛生系統造成了前所未有的壓力。
長新冠與醫療衛生不平等
新冠疫情的爆發，凸顯並加劇了美國已經存在的公共衛生不平等。在疫情爆發之初，某些種族/民族和 社會經濟困難的地區，疫情發生和蔓延很快。根據 Aleksanyan和Kalinowski的研究，特別是在有色人種女性和有孩子的女性受到很大衝擊，因為她們面臨 經濟和工作不穩定的挑戰，也不能很及時接種疫苗，所以冠狀病毒感染的發病率更高(Aleksanyan & Weinman，2022)，(Kalinowski et al，2022年)。同時，社會經濟狀態處於劣勢的群體，更多的生活在擁擠的社區，不能保持有效的社交距，所以傳染病很容易在這些社區傳播。如果沒有穩定的 工作和醫療服務，他們的健康保健就較差，發展為長新冠的可能性就更大(Patel等，2020年)。
長新冠的發率，在女性(Perlis. et al., 2022)，黑人和拉丁裔人口中發病率較高(Berger. et al.,2021). )。社會經濟地位、生活環境和職業等許多健康的社會決定因素，對新冠疫情的發展有很大影響。顯而易見的是，長新冠的發生，與健康的社會決定因素呈現負方向影響(Russo. et al.，2021)。所以，為了預防長新冠，需要有效的干預措施來治療急性期病人，並減少衛生系統的負面健康影響，減少不合理的衛生政策和方針, 對少數民族羣體及社會弱勢羣體的影響。
長新冠與衛生系統
新冠疫情突然爆發，將所有衛生系統推向了極限， 無論是作爲全球衛生安全(GHS)還是全民健康覆蓋(UHC)的衛生系統均受影響。(Lal et al., 2021)。全球衛生安全系統旨在加強國家和國際預 防、發現和應對公共衛生威脅，特別是傳染性疾病。另一方面，全民健康覆蓋系統的目標是提供健康保障，並在沒有經濟負擔的情況下，讓市民普遍獲得全面和優質的護理服務(Wenhamet al，2019)。
疫情從2020年初開始，在全世界迅速蔓延，每個人都無法避免地面臨着前所未有的挑戰，當然衛生保健、社會經濟和政治系統也都被推向疫情漩渦的中心。儘管美國在全球衛生安全指數(GHS Index)評比中，獲得了流行病的最高評級，但美國經歷了新冠疫情危機，衛生保健工作者筋疲力盡、身心疲憊，倍受創傷，衛生保健供應短缺和資源分配也明顯不均(Lal et al.,，2021)。美國是世界上醫學最發達的國家，也是全球國內生產總值(GDP)排名第一的國家，但是到目前為止，美國卻是世界上新冠病例和死亡人數最多的國家。與此同時，英國擁有發達的全民 健康覆蓋系統，但在歷史性的大流行期間，顯示了全民健康覆蓋的侷限性，國家沒有迅速採取行動，以確保國家衛生服務的有效響應(Wenham，2020)，當新冠疫情大流行到來時，其衛生系統顯得支離破碎， 應對不力，以致英國長新冠流行率爲10%- 15% (Castro et al., 2022)。然而，與英美相比，韓國和臺 灣等擁有全球衛生安全和全民健康覆蓋一體化衛生系統的國家，疫情期間有效地控制和預防了新冠病毒病大流行(Normile., 2020)。
長新冠與醫療保障和醫療保險
長新冠患者在長達數週、數月或數年的歲月裡，其長新冠症狀及其在治療中遇到的問題，嚴重影響患者的日常生活和工作(Fugazzaro et al，2022), 但是醫療支持是改善患者的生活質量的重要保障。
醫療保險的獲取，是市民在需要時，能獲得醫療保健支持。在美國，有僱主保險或由政府醫療保健計劃， 例如聯邦醫療保險紅卡、聯邦醫療保險百卡和平價醫 療法案(ACA)。一般來說，如果病人已經擁有健康保險，將持續涵蓋病人的長新冠醫療保健和治療。 如果病人長新冠病情較重而無法工作，可能因為不能 繼續工作而無法維持保險，在這種情況下，有一些政策可以保護人們繼續獲得醫療保健福利和保險，即《家庭和醫療休假法》(FMLA)，如果病人符合享有該法案的條件，即可享有此保健福利，當然病人也可以根據病情，申請殘疾福利(Krönström. et al.，2022 )。
在一些特殊情況下，例如，病人擁有的醫療保險可能無法支付長新冠費用，這時可以申請平價醫療法案(ACA), 這可能幫助病人解決所需藥物部分或全部費用。
長新冠整合醫學治療方法
據報導，長新冠可能是下一個公共衛生災難(Phillips & Williams，2021)。作爲一個醫療衛生 從業者，我們能做些什麼來幫助病人？目前為止，長新冠病理過程尚不清楚。所以，在面對長新冠病人時，常採用綜合醫療護理，例如由患者形成在線 小組，以分享信息和相互支持。美國許多州已將補充和替代醫學(CAM) 納入保健服務。(Kimet al, 2022)(Roth et al, 2021年)。鍼灸，中藥，以及更多補充替代醫學的干預，將改善了患者的症狀，提高患者的免疫力。
在臨床工作中，我們也會見到長新冠的病例，如頭 痛，失眠，腸易激症候群等。通過鍼灸，有時加入草藥，我們已經幫助許多患者恢復了正常的生活和工作。據我們所知，有醫療保險覆蓋的患者，財務壓力較小，能夠更好完成整個療程的治療，獲得更好的療效。
正如我們所討論的，少數民族，包括婦女，黑人和拉丁裔人口，在這場疫情中受到了更大的衝擊，對這些患者會有更多更複雜的臨牀需求，衛生系統和醫務從業人員需要付出更多的努力。
小結
長新冠是一種慢性疾病，影響着數百萬人的身心健康，也將會導致普遍的經濟負擔，這樣的情形可能 持續幾十年。世界衛生組織(WHO)、衛生政策制定者和衛生保健從業者共同努力，應對這場嚴峻挑戰。正如《華爾街日報》所描述的，“治療長新冠患者的成本，將在一定程度上落在患者和他們的家庭身上，並在很大程度上需要社會承擔” (Krause，2022)。相信未來我們能夠很好地應對長新冠，如同我們已經做到的—成功地控制了新冠的大流行和暴發。
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