Cape Town — Long Covid, which is when symptoms persist beyond the acute phase after a person is infected with SARS-CoV-2 that causes Covid-19, is emerging as a major global health challenge. Meta-analyses – a scientific method used to combine the results of many different studies that have looked at the same question – estimate that the combined global prevalence of Long Covid is around 36% among individuals who tested positive for Covid-19.
The World Health Organization suggests lower numbers globally (6-20%), but some studies show nearly half of Covid-19 patients experience long-term symptoms.
The incidence varies substantially by study and geographic region:
Europe: 39%
Asia: 35%
North America: 30%
South America: up to 51%
But where is Africa in these global statistics?
Unfortunately, Africa is largely missing from most international research. The global 36% figure comes from a large study that looked at 442 smaller studies worldwide, but very few of those studies were from African countries. This means we don’t have a complete picture of how Long Covid affects people across the continent.
However, the few studies that have been done specifically in Africa suggest that between 42% and 49% of Covid-19 survivors in Africa experience Long Covid symptoms.
Long Covid often manifests as a wide spectrum of symptoms, like fatigue, shortness of breath, cognitive dysfunction (brain fog), muscular pain, and mental health issues.
Studies show the prevalence does not decline substantially even after one or two years after being infected with the virus that causes Covid-19.
There are also several factors increasing the risk of experiencing Long Covid symptoms, including advanced age, female sex, pre-existing health conditions such as diabetes or hypertension, and the severity of the initial Covid-19 infection.
The Latest Scientific Research
Researchers have shifted the understanding of Long Covid from being strictly a post-viral fatigue syndrome to a complex, multi-system disorder.
Some key advances include:
Microclots and Blood Vessel Conditions: Research led by Professor Resia Pretorius and her colleagues in South Africa has been pivotal. Studies found insoluble microclots present in the blood plasma of all individuals with Long Covid examined to date. These microclots, containing molecules that inhibit the body’s ability to break down clots (e.g., alpha-2 antiplasmin, fibrinogen), may restrict blood flow and oxygen delivery to tissues, potentially explaining many symptoms, from fatigue to cognitive impairment. These discoveries are now being replicated internationally and are a leading theory for Long Covid pathology.
Endothelial Senescence a.k.a. Zombie Cells: A new direction in research suggests that certain viruses, including SARS-CoV-2, may induce a “zombie-like” senescence (the process of aging and declining function in cells) in the endothelial cells lining blood vessels. These cells stop functioning properly, release inflammatory molecules, encourage clots, and evade the body’s natural process of identifying, attacking, and removing unwanted or harmful things from the body, contributing to Long Covid and similar syndromes like ME/CFS. Trials are underway to pinpoint and target such cells for potential therapies.
Overlap with ME/CFS and Autoimmune Responses: Nearly half of those suffering from ongoing post-COVID symptoms meet the criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). There is growing evidence that Long Covid works in similar ways to other illnesses that happen after viral infections. This includes problems with the immune system not working properly, ongoing inflammation in the body, and possibly virus particles that remain stuck in body tissues like the gut.
Finding Better Treatments: Scientists are working to find specific markers in blood tests and identify different types of Long Covid that could help doctors diagnose the condition and create treatments suited to individuals. However, there are currently no proven diagnostic tests or standard treatments that work for everyone with Long Covid. Doctors are only able to treat individual symptoms.
How Africa is Currently Affected
The continent faces unique and severe challenges with Long Covid.
Prevalence and Impact
Nearly half of Covid-19 survivors in Africa experience at least one Long Covid symptom, with major studies showing a cumulative incidence of around 48,6%. This rate is as high as or higher than most global estimates.
The most commonly reported symptoms are debilitating fatigue (35–41%), breathlessness, cognitive impairment/brain fog, and psychiatric conditions, affecting quality of life and economic productivity. Up to a quarter of patients report mental health disturbances like anxiety and post-traumatic stress disorder (PTSD).
Many people, especially in low-resource settings, remain undiagnosed or misdiagnosed, and true prevalence is likely undercounted due to underreporting and limited access to care.
Healthcare Access and Policy
Public healthcare systems across Africa are already strained. There is a severe shortage of clinical resources, with most Long Covid diagnosis and management occurring in better-resourced, urban, and private facilities.
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In South Africa, with its high rates of tuberculosis (TB) and HIV, Long Covid is overlooked in favor of TB, reports The Sick Times, especially among the poor, Black population. Many symptoms overlap, and cultural, financial, and institutional barriers prevent effective Long Covid care and research access.
Only a small fraction of available healthcare and research funding targets Long Covid, compared with high-profile diseases like TB. The disease is frequently dismissed by medical professionals, resulting in widespread gaslighting and misclassification of persistent symptoms.
Local Research Leadership
South African scientists, notably from Stellenbosch University, are at the forefront of global research into the mechanisms of Long Covid, including the role of microclots and cellular senescence, which are already steering treatment research internationally. However, much of this work relies on international donors and private endowments rather than substantial government support.
There is an urgent call across the continent for increased research funding, the establishment of Long Covid clinics, and greater integration of patient advocacy to shift both policy and clinical practice.
Major gaps in public health responses need to be addressed, particularly support for those living with Long Covid in African contexts where primary healthcare remains a challenge.