Before Daniela Alves caught Covid-19 in March, the 31-year-old Londoner regularly worked overtime to accelerate her career as a mobile app designer. Now, she struggles with client meetings, and says persistent fatigue has halved her productivity.

“I was a beast before, but now things are different,” Alves says over Zoom, pausing frequently to catch her breath or cough. “I can’t physically do it, and I’m approaching life differently.”

Alves said she needed three months off work even after experiencing a “mild” infection that didn’t require hospitalization. Covid-19’s lingering effects count her among an expanding population of so-called long-haulers -- survivors left with debilitating conditions who represent another insidious dimension of the pandemic.

“Anybody who needed to be hospitalized or needed intensive care support will suffer disability afterwards.”

It’s now known that SARS-CoV-2 will leave a portion of the more than 23 million people it’s infected with a litany of physical, cognitive and psychological impairments, like scarred lungs, post-viral fatigue and chronic heart damage. What’s still emerging is the extent to which the enduring disability will weigh on health systems and the labor force. That burden may continue the pandemic’s economic legacy for generations, adding to its unprecedented global cost -- predicted by Australian National University scholars to reach as much $35.3 trillion through 2025 as countries try to stop the virus’s spread.

“The bottom line is that the physical, long-term health consequences are very serious for people’s welfare, and in economic terms,” said Hannes Schwandt, an assistant professor of education and social policy who studies well-being and economic outcomes at Northwestern University in Evanston, Illinois. “But, we don’t know enough about it yet.”

While it’s unclear how many survivors become long-haulers, a Covid-19 symptom study in the U.K. with more than 4 million participants found 1 in 10 people are sick for a least three weeks. People with mild cases of the disease are more likely to have a variety of “strange” symptoms that come and go over a longer period, according to Tim Spector, professor of genetic epidemiology at King’s College London, who is leading the study.

‘Weirder It Gets’
“The more we learn about coronavirus, the weirder it gets,” he said.

The still-evolving clinical picture, dearth of patient follow-up, and incomplete data on the number of people afflicted by Covid-19 make it difficult to predict the pandemic’s long-term health and economic consequences, according to Christopher J. Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.

“There’s enough out there to suggest it’s appreciable, and this is something we’re becoming interested in trying to measure,” said Murray, who has studied the global burden of disease for almost 30 years.

That information will be critical for anticipating and funding future health-care needs, said Thomas File, president of the Infectious Diseases Society of America.

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