Long COVID: the elephant in the room
長COVID：豈能視而不見
On April 1, 2022, the UK government ended free universal COVID-19 testing, as part of the Living with COVID-19 plan. The legal requirement to isolate if positive has also been scrapped in England under this plan, and all other public health restrictions have now been removed.
2022年04月01日，英國政府宣布結束免費COVID-19普測，作為與COVID-19共存計劃的一部分。根據這一計劃，英國也已取消隔離陽性患者這一法律要求，而且目前已取消所有其他公共衛生限制。
The Living with COVID-19 strategy portrays the restrictions from the past 2 years as 「necessary」 but as also coming with a 「huge toll on wellbeing and economic output」, and states that the 「next phase of the COVID-19 response is to enable the country to manage COVID-19 like other respiratory illnesses, while minimising mortality and retaining the ability to respond if a new variant emerges with more dangerous properties than the Omicron variant」.
「與COVID-19共存」策略將過去2年期間實施的限制描述為「必要」，但限制也「使健康和經濟遭受巨大損失」，並指出「COVID-19應對策略的下一階段是使國家能夠像管理其他呼吸系統疾病一樣管理COVID-19，同時最大限度地降低死亡率，並保留在出現比Omicron變異株更具危險特性的變異株時做出應對的能力」。
At a time when SARS-CoV-2 infections remain at record levels in the UK due to the omicron (B.1.1.529) sublineage variant BA.2 (about one in 13 people were estimated to be infected in the week ending March 26, 2022), and hospitalisation and mortality rates are rising again, removal of all public health restrictions is problematic, if not highly unethical. The new policies will also disproportionally affect the clinically vulnerable and those who are in situations of precarious employment, further increasing disparities. Adding to this exceptionally bleak picture, there is now irrefutable evidence pointing to a high incidence and large burden of long COVID, with devastating effects on quality of life and on the economy already visible. As of Jan 31, 2022, according to data from the Office for National Statistics, 1·5 million people in the UK (2·4% of the population) reported experiencing long COVID symptoms, with 65% of those reporting a negative impact on their day-to-day activities. In the USA and UK, millions are taking long-term absence from the workforce due to long COVID.
在英國，由於omicron（B.1.1.529）亞系變異株BA.2，SARS-CoV-2的感染率仍然處於創紀錄的水平（在截至2022年3月26日的一周內，估計每13人中就有一人被感染），住院率和死亡率再次上升，此時取消所有公共衛生限制，如果並非非常不道德，也會帶來問題。新政策還將不成比例地影響臨床上易感和就業方面不穩定的人群，進一步增加差距。令這一異常黯淡的境況雪上加霜的是，現有無可辯駁的證據表明，長COVID的發病率高，疾病負擔大，對生活質量和經濟的破壞性影響已經可見。根據國家統計局的數據，截至2022年01月31日，英國有150萬人（占人口的2.4%）報告出現長COVID症狀，其中65%報告對其的日常活動產生負面影響。在美國和英國，由於長COVID，數百萬人長期無法工作。
The adverse health effects from long COVID range from fatigue and difficulty concentrating, to neurological and neuropsychiatric symptoms, respiratory and cardiovascular problems, and metabolic disease. Earlier in the pandemic, the discourse largely centred on acute illness, and perhaps rightly so. However, long COVID has now clearly emerged as a public health concern that will not only disrupt health care of people living with non-communicable diseases (NCDs) but likely also increase the burden of NCDs.
長COVID對健康造成的不良影響介於疲勞和注意力不集中，至神經和神經精神症狀、呼吸和心血管問題以及代謝性疾病。在全球大流行的早期，討論主要集中在急性病方面，這也許是正確的。然而，長COVID現在已明確成為一個公共衛生問題，不僅將打亂非傳染性疾病 (NCD) 患者的醫療保健，還很可能增加NCD的負擔。
The Lancet Diabetes & Endocrinology has, on many occasions, editorialised on the alarming increasing rates of poor metabolic health worldwide, and, in August, 2020, we published a large population study showing increased risk of death from COVID-19 in people with type 1 and type 2 diabetes. In this issue of the journal, Yan Xie and Ziyad Al-Aly report significantly increased risk of diabetes in the post-acute phase (>30 days) of COVID-19 in a cohort of US veterans, including those who had had mild infections and for whom no previous risk factors for diabetes were known. Publication of this study follows the release of data from the US Centre for Disease Control and Prevention showing that people younger than 18 years were more likely to receive a new diabetes diagnosis in the post-acute phase of COVID-19 than those without it or with pre-pandemic respiratory infections. However, a number of other studies did not report similar associations. A cohort from Scotland shared on the preprint server medRxiv, found that incidence of type 1 diabetes in children (aged 0–14 years) during 2020–21 was 20% higher than the 7-year average, but these findings were attributed to other causes and not a direct effect of SARS-CoV-2.
《柳葉刀糖尿病與內分泌學》在很多情況下就全球代謝健康狀況不佳發生率以驚人的速度增加發表了社論，2020年8月，我們發表了一項大型人群研究，顯示1型和2型糖尿病患者死於COVID-19的風險增加。在本期雜誌上，Yan Xie和Ziyad Al-Aly報告，一個由美國退伍軍人組成的隊列中，COVID-19急性期後（> 30天）患糖尿病的風險顯著增加，包括那些曾有輕度感染且既往無糖尿病風險因素的人。美國疾病控制和預防中心發布的數據顯示，年齡小於18歲的人群比未感染COVID-19或在全球大流行前具有呼吸道感染的人群更可能在COVID-19急性期後新診斷為患有糖尿病。但是，許多其他研究未報告相似的相關性。來自蘇格蘭的一個隊列在預印本伺服器 medRxiv 上分享，他們發現2020年-2021年期間兒童（0-14歲）1型糖尿病的發病率比7年平均值高20%，但這些結果歸因於其他原因，而並非 SARS-CoV-2造成的直接影響。
Large and well controlled epidemiological studies with reasonably long follow-up (>1 year) will be key to further clarify the association between COVID-19, newonset diabetes, and metabolic complications, and assess potential causal relationships. Epidemiological efforts should also be examined in the context of comprehensive clinical data, such as data from CoviDIAB, a global clinical registry launched in June, 2020, to determine the presentation and course of COVID-19–related diabetes. The contributions of basic and translational research to our understanding of COVID-19 and its prevention have been remarkable and should continue to complement and inform clinical research. Selfless and open collaboration within the international scientific community will be fundamental. If the link between COVID-19 and newonset diabetes holds true, even a small increase in the global prevalence of diabetes could have disastrous consequences.
進行隨訪時間合理且較長（> 1年）的大型對照充分流行病學研究將是進一步闡明COVID-19、新發糖尿病和代謝併發症之間的相關性，並評估潛在因果關係的關鍵。還應在綜合臨床數據的背景下檢查流行病學工作，例如CoviDIAB的數據，CoviDIAB是2020年6月啟動的全球臨床登記研究，以確定COVID-19相關糖尿病的表徵和病程。基礎和轉化研究對我們理解 COVID-19 及其預防做出了顯著貢獻，應繼續補充和告知臨床研究信息。國際科學界內部開展無私和公開合作將是根本。如果 COVID-19 和新發糖尿病之間相關這一論斷成立，即使全球糖尿病患病率小幅增加也可能產生災難性後果。
In a world where the new mantra is to learn to live with COVID-19, long COVID cannot be ignored. Any strategy to learn to live with COVID-19 must also aim for a fair, thriving, and healthy post-pandemic world—that is what return to normalcy should look like.
在全世界逐漸將學會與COVID-19共存作為新口頭禪的背景下，長COVID不容忽視。任何與COVID-19共存策略也必須旨在建立一個公平、繁榮且健康的大流行後世界—這也是恢復正常該有的狀態。