For months, governmental officials around the world have appeared to want to forgo discussing the specter of long COVID. As a new review makes clear, that is wishful thinking—and the latest COVID variants may well kick long COVID into overdrive, a scenario that researchers and experts have been warning about for some time.

“I think they (government agencies) are itching to pretend that COVID is over and that long COVID does not exist,” says Ziyad Al-Aly, director of the Clinical Epidemiology Center at Veterans Affairs St. Louis Health Care System and lead author of the review. “It is much more pleasant to pretend as if emergency department visits and hospitalizations haven’t been rising sharply this summer.”

In a Nature Medicine review this week, Al-Aly and several other top researchers lay out a difficult truth: Long COVID has already affected an estimated 400 million people worldwide, a number the authors say is likely conservative, at an economic cost of about $1 trillion annually—equivalent to 1% of the global economy.

Moreover, the risk of a person being hit with long COVID rises with repeated infections of the virus itself, and recent COVID activity has experts watching closely. As review co-author Eric Topol noted in a recent blog post, the current COVID incursion is ramping up quickly, with one modeler estimating 900,000 new infections per day in the U.S. alone.