Long Covid is one of the most controversial topics remaining about the pandemic. Depending on who you ask, it is either a real and current threat to the health of the globe, or a relatively minor issue that we should pay little attention to in the future. It is hard to weigh in on the topic without passionate advocates taking issue with the things that you say, which is true of quite a lot of the conversations we have had over the course of the pandemic.

A recent study from Queensland has injected further discord into this already complicated space. The press release about the study says that, in a large observational study, people who had tested positive for Covid-19 when the Omicron variant was spreading were no more likely to report ongoing symptoms or serious problems in their daily life than either people who tested negative or those who tested positive for influenza. This follows similar previous work by the same team showing almost identical results. According to Dr John Gerrard, one of the authors of the paper and Queensland’s chief health officer, the findings call into question the entire conceptualisation of long Covid, arguing that it may be “time to stop using terms like ‘long Covid’”.

This has caused a number of articles arguing that long Covid is causing unnecessary fear, because of little difference between long-term symptoms caused by Covid-19 and other common viral infections.

The first issue here is that it’s hard to know what to make of the research. The results being reported are an early news release about a presentation that is going to happen at the European Congress of Clinical Microbiology and Infectious Diseases in April. In other words, we have no idea how robust this paper is, nor how useful the data may be. The fact that there are so many news stories about this unpublished, unpresented finding is itself something of a problem.

However, the reports on these findings are consistent with a range of other papers that have been published on Covid-19 in the last few years. We know that the risk of long Covid is strongly related to how severe initial infections are. In 2020, when Covid-19 was many times more problematic than flu, long Covid was fairly common, but after successful vaccination campaigns, effective new medications and wide-scale infection, the risk from a Covid-19 infection has gone down substantially. The risk of getting long Covid from an infection is now somewhere around 10times less common than it was in 2020. Given the decrease in severity of Covid-19, it’s not unlikely that rates of long-lasting symptoms are similar between Covid-19 and influenza in 2024. As I’ve been saying for years, much of this comes down to how we define long Covid, and how we know which long-term symptoms are actually caused by Covid-19.

In other words, you could reasonably argue that Dr Gerrard is correct. The problem, however, is that a lot of people were infected in 2020 and 2021, before we had vaccines and treatments to reduce the severity of the disease. There is no question that a large group of people are still suffering serious problems from their initial Covid-19 infection, many of them years after first getting sick. Australia doesn’t have a national estimate of how many, but data from the UK suggests that about 0.5% of the country might fall into this group. While it’s not a big percentage, that is still a lot of people – a similar rate in Australia would mean about 100,000 Aussies suffering similarly. These people have been left largely without hope, because we still don’t really know why they have long Covid, and have no effective interventions to treat their disease.

And herein lies the problem with long Covid discussions. There are two separate conversations going on at the same time. We can talk about the future, which seems a bit brighter – long Covid rates are down drastically, and people who get infected with Covid-19 now are about as likely to experience serious, long-lasting issues as people who got the flu in 2019. But we also have to acknowledge the large number of people seriously injured by Covid-19 in the early stages of the pandemic who may never recover their health.

There may be nothing unique about long Covid in the future – even without this new report the evidence is strong that Covid-19 is now quite similar in risk to influenza per infection – and perhaps we should start talking more about post-viral conditions as a category rather than focusing on those symptoms caused by Covid-19 alone. But if we do, it is important that we do not leave behind the numerous people suffering seemingly endless problems caused by Covid-19 years ago.