Since 2020, the condition known as long COVID-19 has become a widespread disability affecting the health and quality of life of millions of people across the globe and costing economies billions of dollars in reduced productivity of employees and an overall drop in the work force.

The intense scientific effort that long COVID sparked has resulted in more than 24,000 scientific publications, making it the most researched health condition in any four years of recorded human history.

Long COVID is a term that describes the constellation of long-term health effects caused by infection with the SARS-CoV-2 virus. These range from persistent respiratory symptoms, such as shortness of breath, to debilitating fatigue or brain fog that limits people’s ability to work, and conditions such as heart failure and diabetes, which are known to last a lifetime.

I am a physician scientist, and I have been deeply immersed in studying long COVID since the early days of the pandemic. I have testified before the U.S. Senate as an expert witness on long COVID, have published extensively on it and was named as one of Time’s 100 most influential people in health in 2024 for my research in this area.

Over the first half of 2024, a flurry of reports and scientific papers on long COVID added clarity to this complex condition. These include, in particular, insights into how COVID-19 can still wreak havoc in many organs years after the initial viral infection, as well as emerging evidence on viral persistence and immune dysfunction that last for months or years after initial infection.

How long COVID affects the body

A new study that my colleagues and I published in the New England Journal of Medicine on July 17, 2024, shows that the risk of long COVID declined over the course of the pandemic. In 2020, when the ancestral strain of SARS-CoV-2 was dominant and vaccines were not available, about 10.4% of adults who got COVID-19 developed long COVID. By early 2022, when the omicron family of variants predominated, that rate declined to 7.7% among unvaccinated adults and 3.5% of vaccinated adults. In other words, unvaccinated people were more than twice as likely to develop long COVID.

While researchers like me do not yet have concrete numbers for the current rate in mid-2024 due to the time it takes for long COVID cases to be reflected in the data, the flow of new patients into long COVID clinics has been on par with 2022.

We found that the decline was the result of two key drivers: availability of vaccines and changes in the characteristics of the virus – which made the virus less prone to cause severe acute infections and may have reduced its ability to persist in the human body long enough to cause chronic disease.

Despite the decline in risk of developing long COVID, even a 3.5% risk is substantial. New and repeat COVID-19 infections translate into millions of new long COVID cases that add to an already staggering number of people suffering from this condition.

Estimates for the first year of the pandemic suggests that at least 65 million people globally have had long COVID. Along with a group of other leading scientists, my team will soon publish updated estimates of the global burden of long COVID and its impact on the global economy through 2023.

In addition, a major new report by the National Academies of Sciences Engineering and Medicine details all the health effects that constitute long COVID. The report was commissioned by the Social Security Administration to understand the implications of long COVID on its disability benefits.

It concludes that long COVID is a complex chronic condition that can result in more than 200 health effects across multiple body systems. These include new onset or worsening:

• heart disease
• neurologic problems such as cognitive impairment, strokes and dysautonomia. This is a category of disorders that affect the body’s autonomic nervous system – nerves that regulate most of the body’s vital mechanisms such as blood pressure, heart rate and temperature.
• post-exertional malaise, a state of severe exhaustion that may happen after even minor activity — often leaving the patient unable to function for hours, days or weeks
• gastrointestinal disorders
• kidney disease
• metabolic disorders such as diabetes and hyperlipidemia, or a rise in bad cholesterol
• immune dysfunction

Long COVID can affect people across the lifespan from children to older adults and across race and ethnicity and baseline health status. Importantly, more than 90% of people with long COVID had mild COVID-19 infections.

The National Academies report also concluded that long COVID can result in the inability to return to work or school; poor quality of life; diminished ability to perform activities of daily living; and decreased physical and cognitive function for months or years after the initial infection.

The report points out that many health effects of long COVID, such as post-exertional malaise and chronic fatigue, cognitive impairment and autonomic dysfunction, are not currently captured in the Social Security Administration’s Listing of Impairments, yet may significantly affect an individual’s ability to participate in work or school.

A long road ahead

What’s more, health problems resulting from COVID-19 can last years after the initial infection.

A large study published in early 2024 showed that even people who had a mild SARS-CoV-2 infection still experienced new health problems related to COVID-19 in the third year after the initial infection.

Such findings parallel other research showing that the virus persists in various organ systems for months or years after COVID-19 infection. And research is showing that immune responses to the infection are still evident two to three years after a mild infection. Together, these studies may explain why a SARS-CoV-2 infection years ago could still cause new health problems long after the initial infection.

Important progress is also being made in understanding the pathways by which long COVID wreaks havoc on the body. Two preliminary studies from the U.S. and the Netherlands show that when researchers transfer auto-antibodies – antibodies generated by a person’s immune system that are directed at their own tissues and organs – from people with long COVID into healthy mice, the animals start to experience long COVID-like symptoms such as muscle weakness and poor balance.

These studies suggest that an abnormal immune response thought to be responsible for the generation of these auto-antibodies may underlie long COVID and that removing these auto-antibodies may hold promise as potential treatments.

An ongoing threat

Despite overwhelming evidence of the wide-ranging risks of COVID-19, a great deal of messaging suggests that it is no longer a threat to the public. Although there is no empirical evidence to back this up, this misinformation has permeated the public narrative.

The data, however, tells a different story.

COVID-19 infections continue to outnumber flu cases and lead to more hospitalization and death than the flu. COVID-19 also leads to more serious long-term health problems. Trivializing COVID-19 as an inconsequential cold or equating it with the flu does not align with reality.

Ziyad Al-Aly, Chief of Research and Development, VA St. Louis Health Care System. Clinical Epidemiologist, Washington University in St. Louis

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Nutrition Facts label, that black and white information box found on nearly every packaged food product in the U.S. since 1994, has recently become an icon for consumer transparency.

From Apple’s “Privacy Nutrition Labels” that disclose how smartphone apps handle user data, to a “Garment Facts” label that standardizes ethical disclosures on clothing, policy advocates across industries invoke “Nutrition Facts” as a model for empowering consumers and enabling socially responsible markets. They argue that intuitive information fixes could solve a wide range of market-driven social ills.

Yet this familiar, everyday product label actually has a complicated legacy.

I study food regulation and diet culture and became interested in the Nutrition Facts label while researching the history of Food and Drug Administration policies on food standards and labeling. In 1990, Congress passed the Nutrition Labeling and Education Act, mandating nutrition labels on all packaged foods to help address growing concerns about rising rates of chronic illnesses linked to unhealthy diets. The FDA introduced its “Nutrition Facts” panel in 1993 as a public health tool that empowered consumers to make healthier choices.

The most obvious purpose of the Nutrition Facts label is for consumers to learn the nutritional properties of a food. In practice, however, this label has done much more than simply inform shoppers. It also encodes a wide range of political and technical compromises about how to translate food into nutrients that meet the diverse needs of the American public.

Where do “% Daily Values” come from?

The daily value, or DV, percentages on the label don’t all come from the same source. This is a reflection of differing public health targets for the label.

Recommended values for micronutrients like vitamins are based on Recommended Dietary Allowances, or RDAs, from the National Academies of Sciences Engineering and Medicine. Vitamin RDAs were developed out of historical concerns with undernourishment and meeting minimum needs.

Daily value percentages for macronutrients – carbs, fats and proteins – are based on U.S. Department of Agriculture Dietary Guidelines. DVs for macronutrients registered a new concern about overeating and a focus on “negative nutrition” encouraging maximum intake levels.

DVs reflect two fundamentally different causes for concern. The numbers for micronutrients represent a floor: the basic minimum vitamin needs a child should meet to avoid malnutrition. The numbers for macronutrients, on the other hand, are a ceiling: a target maximum limit that adults should avoid surpassing if they want to prevent future health problems caused by eating too much high sodium or fatty food.

Why 2,000 calories?

The FDA almost used 2,350 calories as the baseline for calculating daily values, because it was the recommended population-adjusted average caloric need for Americans ages four and older. But after pushback from health groups concerned the higher baseline would encourage overconsumption, the FDA settled on 2,000 calories.

FDA officials felt this figure was less likely to be “misconstrued as an individualized goal since a round number has less implied specificity.” This means 2,000 calories is not actually a target for most American consumers reading the label. Instead, it is an example of the public health preoccupation with collective risk – what one scientist called “treating sick populations not sick individuals.”

By choosing a round number that was easy to do math with, and a calorie count below the average American’s, FDA officials were favoring practicality and utility over accuracy and objectivity. Advocating for the lower 2,000 calorie baseline, they reasoned, would offset Americans’ tendency to overeat and do more good than harm for the population overall.

Who determines serving sizes?

According to the Nutrition Labeling and Education Act of 1990, serving sizes should reflect “an amount customarily used.”

In practice, this involves routine negotiations between the FDA, U.S. Department of Agriculture – which also sets serving sizes for dietary guidance tools like the MyPlate – and food manufacturers. Each conducts research on consumer expectations and food consumption data, taking into consideration how a food is prepared and “typically eaten.”

Serving sizes are also determined by product packaging. For example, a soda can is generally considered a single-serving container and therefore just one serving, regardless of how many fluid ounces it contains.

What’s in a name?

The label was almost called “Nutrition Values” or “Nutrition Guide” to highlight that Daily Values were recommendations. Then FDA Deputy Commissioner Mike Taylor proposed “Nutrition Facts” to sound more legally neutral and scientifically objective.

The new design – a staid, black Helvetica text against a white background, using indented subgroups and hairlines for readability – and the authoritative boldface title helped establish “Nutrition Facts” as an easily recognized government brand.

This led to imitators in other policy arenas: first “Drug Facts” for over-the-counter medicines, then consumer protection initiatives in various tech industries, such as Federal Communications Commission “Broadband Facts” and “AI Nutrition Facts.”

The Nutrition Facts panel has remained largely consistent since the 1990s, despite some updates like adding lines for trans fats in 2002 and for added sugars in 2016 to reflect evolving public health priorities.

New ways to calculate the facts

Establishing the Nutrition Facts label required building an entirely new technical infrastructure for nutrition information. Translating the diverse American diet into a consistent set of standardized nutrients necessitated new measures, testing procedures and standard references.

A key player in developing that technical infrastructure was the Association of Official Analytical Chemists. In the early 1990s, an AOAC Task Force developed a food triangle matrix dividing foods into categories based on their proportions of carbs, fats and protein. The intention was to determine appropriate ways to measure nutritional properties like the amount of calories or sugars, as the food’s physical properties would affect how well each test worked.

Legacy of the Nutrition Facts label

Today, public-private collaborations have taken this translation of foods into simplified nutrient profiles further by making nutrition facts plug-and-play. The USDA FoodData Central provides a comprehensive database of nutrient profiles for individual ingredients that manufacturers use to calculate Nutrition Facts for new packaged foods. This database also powers many diet and nutrition apps.

The analytic tools developed for the Nutrition Facts label helped create the basic information infrastructure for today’s digital diet platforms. But critics argue these databases reinforce an overly reductionist view of food as simply the sum of its nutrients, ignoring how the different forms a food takes – such as its moisture, fibrous materials or porous structures – affect the way the body metabolizes nutrients.

Indeed, many nutrition researchers concerned about the negative health effects of ultra-processed foods now talk of a food matrix to emphasize precisely the opposite of what the AOAC sought with its food triangle: a need for a holistic understanding of how food shapes health.

Surprisingly, the Nutrition Facts label’s greatest impact may have been driving the food industry to reformulate products to achieve appealing nutrient profiles – even if consumers weren’t closely reading the labels. While envisioned as an education tool, I believe the Nutrition Facts label in practice has worked more like a market infrastructure, reshaping the food supply to meet shifting dietary trends and public health goals long before consumers find those foods at the supermarket.

Xaq Frohlich, Associate Professor of History of Technology, Auburn University

This article is republished from The Conversation under a Creative Commons license. Read the original article.