Summaries in English and Dutch 10 303 symptomatology, and that differences in humeral immunity is unlikely to fully explain long COVID. Wider literature reports that any effect of vaccination is likely to be modest and insufficient for therapeutic use of vaccination on a population scale. As such, the pressing need for the development of treatments for long COVID remains. Finally, Chapter 9 summarizes and discusses the key findings of this thesis in the context of constantly-evolving literature. I first outline the complex interplay of pre-pandemic and COVID-19-related factors that underly why individuals with a lower socio-economic status (SES) and with a migration background may have been at higher risk of both SARS-CoV-2 infection and consequent severe disease, both in the Netherlands and in other high-income countries (HICs). I emphasize that governmental organizations and public health officials should urgently work together to understand and then combat the drivers of these disparities. Next, I discuss that long COVID is a highly heterogenous condition that is challenging to define across diverse populations. The condition is likely to represent multiple pathologies that are only beginning to be understood. This presents a challenge when endeavoring to encompass the condition in one universal definition. I consequently stress the importance of investing in ongoing research to develop effective treatments, and underline that in the meantime, prevention of SARS-CoV-2 infection (for instance, through COVID-19 vaccination) and addressing modifiable risk factors (such as obesity), is our best strategy for mitigating the burden of long COVID. The final part of Chapter 9 examines the challenges facing public health officials, epidemiologists and researchers when interpreting data collected during the pandemic. I discuss possible ways to strengthen surveillance data of infectious diseases in the Netherlands (many of which are already in motion) and globally. Moreover, I point out that utilizing existing population-based observational studies during a crisis can help to rapidly generate crucial information. Next, the biases inherent in long COVID research are discussed. For instance, more needs to be done to ensure inclusivity of long COVID research, with a focus on sex-stratified studies, inclusion of minority populations and low-resource settings in research programmes. Continued investment in long COVID research is essential to ensure that both prevention and treatments are effective and equitable. This thesis provides important insights into the epidemiology and long-term effects of COVID-19. Nonetheless, there are still many unanswered questions. Continued research is needed to understand the underlying mechanisms and determinants of long COVID, as well as the development of effective treatment strategies. Additionally, efforts must be made to address the socio-economic and cultural inequalities that have been identified in this thesis and elsewhere. Only by taking these steps can we hope to be better prepared for a next pandemic.
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