Three years after the pandemic reared its head, millions of former patients say they are still feeling the effects of the disease. A lack of data on their experiences impedes the ability for government to understand the long-term effects Covid is having on the workforce.

Epidemiologist Awang Bulgiba Awang Mahmud notes that Covid-19 is one of the few known infectious diseases whose effects are experienced long after infection.

“The damage caused by the SARS-CoV2 virus does not end with the eradication of the virus from the body. In fact, it seems to set off a chain of events long after apparent recovery from the acute infection,” he said via email.

Millions are suffering from long Covid

The Brookings Institute released a report in August 2022, estimating up to four million people worldwide are no longer able to work due to health issues arising from Covid-19. And the US Department of Health and Human Services suggests up to 23 million Americans alone suffer from long Covid.

The Department of Statistics Malaysia recorded the number of inactive unemployed – which includes those who would have looked for work if they had not been ill – increasing by 2,300 to 110,700 in October 2022 from 108,400 in September 2022.

Others in this category include those who did not look for work because they believed no work was available or that they were not qualified for it, as well as those who are waiting for the result of job applications.

However, important to note is Covid-19’s impact is not just restricted to the inability to work, it is also tied in to people’s inability to work well. Several cases have been found to highlight this.

One of them is a 53-year-old oil and gas company executive who has not been able to return to work fully due to long Covid symptoms. Another case involves a medical professional with a family history of heart disease who has had to undergo angioplasty at the age of 34 and be on heart medication for life. Prior to his Covid-19 infection, he was a runner and hiker.

Studies have shown that former Covid-19 patients are now more likely to develop and possibly die from non-communicable diseases (NCDs), including cardiovascular disorders and diabetes, compared to those who have never been infected.

A recent British Medical Journal study tracked 54,000 people in the UK for four-and-a-half months and found that those whose Covid-19 infection was mild were still 10 times more likely to die of any cause during the four months.

Data collection on long Covid cases lacking

As such, a more robust system for gathering data is therefore required to futureproof the Malaysian healthcare system and economy from the burden of long Covid and future pandemics.

Calculating the cost of long Covid on the economy requires data such as the number of such cases, the severity of the affliction, the number of work days lost due to illness, loss of quality of life and the medical cost of treating the illness, according to Harvard economist David Culter.

Health and economic experts say there is currently not enough data in Malaysia, partly due to difficulty in diagnosing whether the symptoms are part of long Covid or something else.

Health economist professor Maznah Dahlui currently runs several studies tracking the health status of former Covid-19 patients and healthcare workers at Universiti Malaya Medical Centre (UMMC).

She said so far, researchers have found a majority of previously healthy people have not developed long Covid symptoms. Long Covid was more common among those who had to be hospitalised and the elderly, she added.

Nonetheless, she acknowledged Covid-19 infection may cause some new symptoms or exacerbate health conditions after recovery, saying Malaysia was not prepared for the post-pandemic burden on the healthcare system.

“We are having this double disease burden. We are still struggling with communicable diseases like tuberculosis, dengue, malaria and yet we are (getting) more non-communicable diseases (NCDs) like diabetes, mostly lifestyle diseases related to obesity,” she said.

Healthcare budget needs to increase

She added the government needs to increase the healthcare budget from the current 2% of the gross domestic product (GDP) and invest more in preventative healthcare.

Maznah, who is also a public health specialist at UMMC, said Malaysia’s healthcare services and delivery systems are generally good but financial coverage of healthcare, particularly medication, is still lacking.

“Right now, even if you don’t have money you can get access to healthcare services – just pay RM1 – but you need to pay out of pocket for some drugs, especially cancer drugs, and people can get poor by paying for it. It’s a catastrophic healthcare expenditure,” she said.

As medical costs continue to balloon, she argued Malaysia should implement a national health insurance or social health insurance scheme to complement healthcare by paying for medication and others.

In the meantime, Awang Bulgiba called on the health authorities to think of a permanent structure for Covid-19 vaccination to provide boosters and new vaccines when necessary.

“Right now, the thinking is still ad hoc but the planning for such vaccinations should already be made,” he said.

And concerning the labour force, many employees with health problems post-Covid-19 will benefit from the Employment Act amendments – coming into effect soon – that will allow for flexible working arrangements moving forward.