Report on Long COVID Healthcare Utilization and its Implications for Sustainable Development Goals

Introduction: Aligning Public Health Research with SDG 3

A recent study provides critical data on the healthcare utilization patterns of adults with long COVID (LC), highlighting challenges and opportunities directly related to the United Nations Sustainable Development Goals (SDGs). The research, which analyzed post-infection healthcare encounters, offers insights that are fundamental to achieving SDG 3 (Good Health and Well-being) by underscoring the long-term health burdens following acute SARS-CoV-2 infection and the subsequent strain on health systems.

Key Research Findings

The secondary analysis of a prospective multicenter study tracked 847 US adults for 180 days post-COVID-19 infection. Participants were categorized as having long COVID (LC) if they reported three or more persistent symptoms at the three-month mark.

• The study included 179 individuals in the LC group and 668 in the non-LC group.
• Both groups demonstrated an overall increase in healthcare visits (office, telehealth, procedures) in the post-infection period compared to the pre-infection period.
• The LC group had a lower likelihood of visiting the emergency department compared to the non-LC group.
• Critically, individuals in the LC group who had been hospitalized previously were nearly three times more likely to experience subsequent hospitalizations within six months post-infection.

Analysis through the Lens of Sustainable Development Goals

The study’s findings have significant implications for several SDGs, extending beyond the immediate scope of public health to encompass economic stability and social equity.

1. SDG 3: Good Health and Well-being
   • The increased rate of re-hospitalization among LC patients signals a significant challenge to ensuring healthy lives and promoting well-being for all.
   • It highlights a critical gap in post-viral care, indicating that current health systems may be ill-equipped to manage chronic post-infectious conditions effectively.
   • The call for enhanced outpatient resources directly supports Target 3.8, which aims to achieve universal health coverage and access to quality essential healthcare services without financial hardship.
2. SDG 10: Reduced Inequalities
   • Chronic conditions like long COVID risk exacerbating existing health and economic inequalities.
   • The need for robust and accessible outpatient support systems is an equity issue. Without them, individuals in vulnerable situations may face disproportionate barriers to recovery, leading to worse health outcomes and greater financial strain, counteracting the goals of Target 10.3 (ensure equal opportunity and reduce inequalities of outcome).
3. SDG 8: Decent Work and Economic Growth
   • The cycle of repeat hospitalizations and chronic illness poses a direct threat to an individual’s ability to maintain employment.
   • This impacts household economic stability and, on a larger scale, national productivity, undermining progress toward Target 8.5 (full and productive employment and decent work for all).
4. SDG 11: Sustainable Cities and Communities
   • The burden of repeat hospitalizations places a significant strain on urban and rural healthcare infrastructure.
   • Developing strong outpatient and community-based support systems is essential for building resilient health infrastructure, a key component of creating sustainable and safe communities as envisioned in Target 11.5 (reduce the impact of disasters on people and infrastructure).

Conclusion and Recommendations for SDG-Aligned Action

The research concludes with a public health imperative to allocate more outpatient resources and support systems to mitigate the need for inpatient admissions among the long COVID population. This recommendation is not only a strategy for improving patient outcomes but is also a crucial action for advancing the Sustainable Development Goals. By investing in comprehensive, accessible, and equitable outpatient care, health systems can better support long-term well-being (SDG 3), reduce health-driven inequalities (SDG 10), and foster more resilient communities and economies (SDG 11 and SDG 8).

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article directly addresses health issues by focusing on the post-infection consequences of a communicable disease, specifically long COVID. It discusses the physical burden on individuals, as evidenced by the need for increased medical care, and the systemic burden on healthcare services. The core theme is understanding and managing a health condition to improve patient outcomes and public health responses, which is central to SDG 3.

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

1. Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
   • The article focuses on long COVID, a long-term consequence of the SARS-CoV-2 infection, which falls under the category of “other communicable diseases.” The research contributes to understanding the full impact and lingering burden of the COVID-19 pandemic, which is a critical aspect of combating the disease.
2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • The study’s primary aim is to compare “healthcare utilization patterns” between long COVID and non-long COVID patients. It explicitly details the use of essential health services such as “inpatient hospitalization, emergency departments visit, office visit, procedure, [and] telehealth visit.” The finding of increased hospitalizations and the call to “allocate more outpatient resources” directly relate to the challenge of providing access to quality healthcare services for this patient group.
3. Target 3.d: Strengthen the capacity of all countries… for early warning, risk reduction and management of national and global health risks.
   • The research itself is an exercise in strengthening the capacity for health risk management. By identifying that long COVID patients are at a nearly “3-fold increased risk of additional hospitalization,” the study provides crucial data for managing the long-term risks associated with the global health crisis of COVID-19. This information helps public health systems anticipate and plan for the needs of this cohort.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

SDG 3: Good Health and Well-being

• Prevalence of long-term symptoms post-communicable disease infection:
  • The article provides a specific metric for identifying long COVID: “if they had three or more post-infectious symptoms at 3 months.” The study found that 179 out of 847 participants (21%) met this criterion. This serves as a direct indicator of the post-acute burden of a communicable disease, relevant to Target 3.3.
• Rate of healthcare service utilization:
  • The article details an “overall increase in visit numbers in all six visit categories in the post-index period.” These categories (inpatient, ED, office, etc.) are direct measures of healthcare utilization. This data serves as a proxy indicator for measuring access to and demand for essential health services under Target 3.8.
• Rate of repeat hospitalizations for specific patient cohorts:
  • A key finding is that long COVID patients “were nearly three times as likely to have additional hospitalizations (OR, 2.6).” This specific odds ratio is a quantifiable indicator of increased demand for intensive healthcare services, which is relevant for measuring progress toward Target 3.8 and for informing risk management strategies under Target 3.d.

4. Table of SDGs, Targets, and Indicators

Source: cidrap.umn.edu