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Human Rights Research Center
Sep 128 min read

Long COVID, Longer Recovery: The Lasting Effects of the COVID-19 Pandemic on Low-Income Countries

Author: Aleris Law

September 12, 2024


Introduction


In 2015, all Member States of the United Nations (UN) adopted the 2030 Agenda for Sustainable Development as a call to action to end poverty and promote peace and prosperity. The Agenda is roadmapped by 17 Sustainable Development Goals (SDGs), each focused on a different social, economic, or environmental issue our planet faces. Although early efforts produced some results, progress began to falter. 2020 signified the beginning of the Decade of Action - an accelerating timeline to pursue sustainable solutions to the world’s biggest challenges - but was also marked by the COVID-19 pandemic, significantly slowing progress towards the SDGs. This effect was especially amplified in lower-income countries (LICs), who bear the brunt of the impact. 

The full extent of the pandemic and long COVID’s impact on everyone are still being assessed. Although most sectors were affected, one report found that SDGs 1 (eradicating poverty), 3 (good health and well-being), 4 (quality education), 9 (industry, innovation, and infrastructure), and 11 (sustainable cities and communities) were hit the hardest.


Direct Impacts of COVID-19


All UN member countries were impacted by COVID-19, with 62% experiencing medium to high impacts, but regions including Latin American and the Caribbean, Sub-Saharan Africa, South Asia, the Middle East, and North Africa were impacted more heavily. Mainly due to economic lockdown, many countries faced an increase in extreme poverty, slowing progress towards SDG 1 (the rate of which was already declining pre-COVID). The UN reported that about 41% of LICs experienced a higher poverty rate in 2021 compared to 2020, whereas only 13% of upper middle-income countries experienced an increase. By 2022, extreme poverty had returned to pre-pandemic levels in most countries, but not LICs.


The overall impact of COVID-19 on the workforce was expected to be minor since COVID more heavily affected those of or near retirement age. However, lockdowns and containment measures resulted in disproportionate job losses for informal workers, especially those from LICs where rates of informal employment run high. In least-developed countries (LDCs), informal employment stood at 89.1% in 2023, with no improvement since 2015. Women and youth in particular face higher unemployment rates regardless of region. As of 2023, Northern Africa and Western Asia, followed by Central and Southern Asia, have the highest rates of young people not in education, employment, or training (NEET), with NEET rates of 28.5% and 27.4%, respectively. These individuals are at risk for social exclusion, as their income is below the poverty line, and they lack the skills to improve their economic situation. NEET status is associated with a higher suicide risk, criminal behaviour, and unemployment experience.


Reduced education rates can be attributed directly to COVID-19 lockdowns. A 2023 report of 104 countries found that learning losses due to COVID-related school closures were documented in 4 out of every 5 countries. An assessment from the Organisation for Economic Co-operation and Development (OECD) found that mathematics scores fell by 15 points and reading scores fell by 10 points, both breaking the record for declines in previous years. LICs with lack of infrastructure to mitigate COVID-19 were impacted harder with fewer than 10% of LICs reporting having sufficient soap, clean water, masks, and sanitation and hygiene facilities to assure the safety of all learners and staff, compared to 96% in HICs.


Regarding health-related SDGs, loss of progress due to COVID-19 is estimated to be about 16.5% for LICs, compared with 3% for higher-income countries (HICs). Low- and middle-income countries (LMICs) were impacted harder in indicators of infectious diseases, violence and injuries, reproductive health, and environmental risks. COVID-19 impacted access to diagnosis and treatment not only for itself, but for other dangerous diseases such as HIV/AIDs, tuberculosis (TB), malaria, and other neglected tropical diseases (NTDs). Progress towards universal health coverage (UHC) slowed as well, with financial hardship remaining a significant challenge. Around 1 billion people spent, out-of-pocket, over 10% of their household budget on health. Although COVID-19 has already provided the push towards an increase in official development assistance for basic health, which doubled from $10.2 billion in 2015 to $20.4 in 2021, almost 40% of the total was supplied by Germany, the United States, and the Global Fund and Gavi (Global Alliance for Vaccines and Immunization).


Long COVID


Long COVID is a condition that follows a severe COVID-19 infection. Studies currently suggest that anywhere between 10% to 45% of those infected experience long COVID, though it is likely that the percentage is much higher due to undocumented cases. Symptoms and conditions experienced by long COVID patients such as cardiovascular disease, type 2 diabetes, chronic fatigue syndrome (CFS), and postural orthostatic tachycardia syndrome (POTS), can last for years, and in some cases, are expected to be lifelong. In addition to immune dysregulation, vascular issues, and organ damage, long COVID has also been found to impact neurological and cognitive systems, with memory loss and cognitive impairment impacting daily life and ability to work. 

Currently, there are few studies focused on the burden of long COVID on low- and middle-income countries (LMICs). A review from 2022 found that only 15 out of 59 registered trials on long COVID therapeutics enrolled patients from LMICs, a limitation on the generalizability of the results of those studies. However, conducting research on long COVID in LMICs may be challenging due to lack of research infrastructure and detection services. 


In addition, just understanding the scope of long COVID’s impact will not be enough to help populations recover. The availability, accessibility, and affordability of developing therapies must also be taken into consideration. LMICs may not have the capacity for rehabilitation services due to underserved and under-resourced health systems and the burdens of other diseases such as HIV/AIDs, tuberculosis (TB), and malaria. In fact, the projected global shortage of health workers by 2030 is expected to be 10 million. Sub-Saharan Africa in particular is in a dangerous position, with only an average of 2.3 doctors and 12.6 nursing and midwifery personnel per 10,000 population. With limited access to healthcare, higher risk individuals will be the most likely to experience long COVID more severely, possibly resulting in chronic disability and making it difficult, if not impossible, to return to full-time work. In many LMICs, lack of social protection measures and grants will continue to exacerbate the health and economic inequalities resulting from long COVID.


What’s Next?


All humans have the right to the highest attainable standard of physical and mental health. Countries are obligated to protect the rights of their people and develop legislation, policies, and strategies to provide access to quality care and address the root causes of health disparities. However, lack of resources severely slows progress towards these goals – this is evident in how COVID-19 disproportionately affected low-income countries during and even after the pandemic.

To address health inequities between countries of different income levels and ensure everyone has the right to health, international cooperation will be necessary to strengthen infrastructure in LICs such as support detection and rehabilitation services to address the care needs of patients with long COVID. Additional research, especially from and including LICs, will be needed to completely understand the characteristics and impacts of long COVID not only on the population but on progress towards SDGs. It will be crucial for us to not only invest in recovery, but to prepare for the future, so that LMICs will not continue to be impacted disproportionately by future pandemics and global progress towards the SDGs continues to improve.


 

Glossary


  • 2030 Agenda for Sustainable Development: A plan of action proposed by the United Nations in 2015 to improve areas of critical importance for humanity and the planet.

  • Comorbid: The condition of having two or more diseases at the same time.

  • Containment measures: Interventions implemented by governments to reduce the spread and severity of COVID-19 outbreaks such as school and workplace closures, stay-at-home orders, and travel restrictions.

  • COVID-19: A contagious disease caused by the SARS-CoV-2 virus. It often causes respiratory symptoms similar to a cold or flu and can affect other body systems.

  • Decade of Action: The period (2020-2030). in which action towards sustainable solutions and the 2030 Agenda for Sustainable Development is being accelerated.

  • Economic lockdown: Refers to the COVID-19 pandemic recession, in which all countries experienced reduced economic activities, with countries reliant on tourism, travel, hospitality, and entertainment hit the hardest.

  • Immune dysregulation: An immune response to the body’s own tissues, cells or molecules or against a foreign molecule that is normally ignored by the immune system.

  • Informal employment: Work without a contract, legal protection or social security. It is often characterized by inadequate social protection, low productivity, and low quality.

  • International cooperation: The collaboration between countries to improve quality of and access to infrastructure.

  • Least-Developed Country (LDC): A country with severe structural impediments to sustainable development.

  • Long COVID: A chronic condition that develops after a COVID-19 infection, with a wide range of symptoms and comorbid conditions.

  • Low-Income Country (LIC): A country with a GNI per capita (determined by the World Bank) of $1,145 or less in 2023.

  • Not in Education, Employment, or Training (NEET): Youth who are not attending educational part- or full-time educational activities, employed, or in training.

  • Organisation for Economic Co-operation and Development (OECD): An international organization that advises governments on policy to address social, economic and environmental challenges.

  • Pandemic: An infectious disease outbreak that has spread across a wide geographical area and affects a significant proportion of the world’s population.

  • Postural orthostatic tachycardia syndrome (POTS): an autonomic nervous system disorder with symptoms including excessively fast heart rate and symptoms of lightheadedness upon standing.

  • Sustainable Development Goal (SDG): A specific area targeted by the 2030 Agenda for Sustainable Development. There are 17 total goals, and a report is developed each year to track global progress towards achieving them by 2030.

  • United Nations (UN) Member States: A member of the United Nations that “accept[s] the obligations contained in the United Nations Charter and, in the judgment of the Organization, are able to carry out these obligations”.

  • Vascular issues: Issues related to the arteries and veins. COVID-19 is known to cause vascular inflammation and increases in arterial stiffness, reducing the heart’s ability to pump blood.


 

Sources


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