Public Health

Long COVID: What we do and don't know after 3 years of the pandemic with Andrea Garcia, JD, MPH


 AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.

AMA Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, summarizes what we've learned—and what unknowns still linger as the COVID pandemic crosses the three-year mark. American Medical Association CXO Todd Unger hosts.

Learn more at the AMA COVID-19 resource center.


  • Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association

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Unger: Hello and welcome to the AMA Update video and podcast. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago. Welcome back, Andrea.

Garcia: Thanks. Good to be here.

Unger: Andrea, I know it's hard to believe, but this past Saturday marked the three-year anniversary of the World Health Organization declaring the COVID outbreak a pandemic. As we finally begin to move out of the acute phase, are we able to get some perspective at this point?

Garcia: Well, that's right, March 11, 2020, really did mark that beginning of the pandemic for many Americans. And it was the day the WHO declared COVID a pandemic. And here in the U.S., if you recall, it was also the day the National Basketball Association suspended its season. And that was after a player had tested positive for the virus, which I think hit home for a lot of people.

At that time, there were only 118,000 cases of COVID being reported worldwide. And the U.S. really only had a small portion of those, though, as you recall, testing in those early days was really limited. But trying to take stock of it all as we look back is difficult. Of course, on one hand, we had rapid innovation like mRNA vaccines and therapeutics, new care models that expanded access to health care. We also more clearly saw, I think, the inequities that plague our health system.

We had severe labor shortages. Hospitals and physicians experienced unprecedented strain. And we know people delayed care and, in some cases, got sicker than they would have otherwise. I think we also have had to wrestle with the emergence of long COVID, those unexplained symptoms that impact people long after their acute infection has resolved.

Unger: Andrea, as we look around to the media, what kind of headlines are we seeing that capture this kind of perspective we're talking about with a three-year lens?

Garcia: Yeah, so a lot of the news outlets are certainly mentioning March 11 and its significance. And the Associated Press led its coverage this week with a headline that asks an interesting question, and that was, has the COVID-19 virus won? I think that's a question a lot of us are still pondering, especially as the virus continues to spread, the global death toll near 7 million.

And if we break that down, that daily average, the pandemic is killing 900 to 1,000 people a day worldwide. And those are the ones we know about. That true number, as we talk about often here, is likely higher.

We're ending the public health emergency here in the U.S. on May 11. But given these numbers globally, the WHO has said it's not ready to end its own declaration. Even here in the U.S., daily hospitalizations and deaths are below the worst peaks that we've seen, but they haven't dropped to those low levels that we reached in the summer of 2021 after vaccines but prior to the Delta wave.

Unger: I guess we're not in the last-of-us territory, but those are some stark statistics that you just gave. What do you see as the most pressing challenge now as we move forward?

Garcia: Well, one major challenge is certainly going to be continuing to do what we do here every week, and that is tracking and discussing the data. Many of those data sources that were stood up during the pandemic are shutting down. For example, I think the one that was really the gold standard of data during the pandemic was the Johns Hopkins tracker. That shut down this past Friday.

And I think kudos to them because that was a fantastic team that filled a huge void in making data more accessible. But part of the issue is that sources for real-time data have drastically declined in the U.S. We're only seeing New York, Arkansas, Puerto Rico still publish those cases and deaths on a daily basis.

Unger: What about the CDC? I know that's been the main data source that we've relied on for these updates.

Garcia: Yeah, CDC collects a variety of information from states, hospitals and labs, including the number of reported cases, hospitalizations and deaths, and, of course, which strains of the virus are circulating across the country. But for many of those counts, there's less data available now and it's been less timely. And we know it's been more than a year since CDC moved away from case counts and testing, and that was partly because of the rise in home tests that we noticed aren't in those official count.

So the focus is on hospitalizations, which are reported daily, although that could change certainly with the declaration changing. But the reporting continues. It's just less reliant on those daily reports and are shifting more towards death certificates, which can take days to weeks to come in. And U.S. officials really are adjusting to the circumstances and trying to move to something that resembles more along the lines of how we do surveillance for flu.

Unger: Well, before all those numbers go away, we do have statistics for this week. Andrea, are we still on the same downward trajectory that we've been on for some time now?

Garcia: We are. So if we look at The New York Times data reported, cases, hospitalizations and deaths have all decreased nationally. We're seeing an average of just slightly less than 30,000 COVID cases being reported daily. About 24,000 people are hospitalized with COVID. Those numbers are about a 13% decrease from two weeks ago. And we're seeing an average of nearly 400 deaths per day.

Unger: So the numbers, certainly on the death side, still high, but otherwise, there is good news here.

Garcia: Yeah, particularly with hospitalizations, which have been falling steadily for weeks and they're at the lowest rate since May. And in some states like Hawaii and Nevada, hospitalizations are lower than they have been in nearly two years. I think the other good sign is test positivity. That's fallen significantly in the past couple of weeks. It's hovering right around 7.6%. And that's a promising sign that these declines in other areas are unlikely to change course in the immediate future.

Unger: Andrea, we've talked a lot so far about the data being a challenge going forward. But another challenge we'll continue to deal with for some time is long COVID. Do we have any idea about how many people it's impacted? It must be pretty difficult to track because it can show up very differently in each person.

Garcia: Yeah, that's right. And Becker's Hospital Review did a pretty comprehensive review of where we stand globally at this three-year mark, and it included long COVID in that coverage. And as you said, it is difficult to track because it does manifest differently in different people. But in many places, data on long COVID are absent, especially in low-income and middle-income countries.

If we look at the research, the estimates are about 10% of those infections result in long COVID. And as many as 79% of people who experience the condition say it's become a factor that's limited them in their daily lives and sometimes that's a significant limitation.

Studies will likely take place for many years to help us better understand how to diagnose and treat long COVID. For now, researchers have really zeroed in on seven key symptoms to define long COVID. Those are things like fatigue, chest pain, shortness of breath, palpitations. And it's estimated about 65 million people worldwide had suffered from long COVID since the pandemic began.

Unger: Andrea, what do you think the best approach is for decreasing what is a big knowledge gap at this point?

Garcia: Well, in a recent article in The Lancet, it said that a global coordinated effort is going to be essential to improving our understanding of the cause, pathogenesis and clinical diagnosis and treatment for long COVID. It said, and I believe rightfully so, that without specific treatments for long COVID, we're going to need to continue to focus on prevention, so keeping COVID cases low, ensuring vaccination as well as patient-centered multidisciplinary care.

The article also pointed out that we do have the ability to work together. And we saw this during the acute phases of the pandemic. We worked together in unprecedented ways. We saw collaboration between government, international organizations and pharmaceutical companies. Long COVID, as well as post-acute infection syndromes, have not received anywhere near the same level of attention or resources and that's going to need to change. We're going to need better diagnostic care and better clinical resources for these patients going forward.

Unger: Absolutely. And we'll certainly continue to cover that as the research progresses. Andrea, has there been any other big news this week that we need to know?

Garcia: I think just that we continue to see a relaxing of those requirements and testing sites shutting down as we inch closer to that emergency declaration ending on May 11. And I think an example of that is last Friday, U.S. officials relaxed that COVID testing requirement on travelers from China.

The CDC had issued a statement offering more details on that move, explaining that air passengers won't need to show a negative COVID test result or documentation of recovery from COVID prior to boarding a flight to the U.S. And that requirement, as you know, was put in place a couple of months ago when China ended its zero-COVID policies, which sparked a surge of cases and deaths in that country.

Unger: Now, you also mentioned testing centers closing. I know there's a huge one right around the corner from me that's now looking pretty empty. Anything we need to know on that front?

Garcia: No, just that those COVID call centers, those testing sites, those drive-thru testing sites are closing. I know many people are looking to move on from the pandemic. And that combined with the public health emergency ending, plus the availability of at-home tests, is really driving those closures. And I think just a reminder that people are still eligible to receive those eight free tests a month. Be sure to get those before May 11.

Unger: Well, that's a good reminder. And that wraps up today's episode. Andrea, thanks so much for being here today. We'll be back soon with another AMA Update. And you can find all our videos and podcasts at Thanks for joining us today. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.