The danger of long-COVID: why we need to stay vigilant
COVID-19 boredom is setting in among people and it's worrying.
I hear people say "we should just get it and be done with it." But a herd immunity approach is unlikely to work – epidemiologists explain this in a recent Nature article. They say that this tactic would lead to a catastrophic loss of human lives, but without necessarily speeding up society’s return to normal.
Another indifferent response to COVID-19 that I hear is that it only affects the old or previously sick population. But what people don't see is that survivors with mild symptoms – or maybe none at all – can have health problems lasting on average two to three weeks, but in some cases, the effects can persist for months.
An increasing number of people will likely suffer from long-COVID
There is a growing group of COVID-19 survivors who experience lasting symptoms. In the extreme cases, patients suffer from organ damage, with lung and heart damage often being reported, but a range of organs like the liver, kidneys or even the brain could be damaged. Depending on the severity and length of the damage, this could easily lead to adverse health outcomes. In such cases, the virus attacks organs and leaves scarring which can be identified by imaging techniques like computer tomography (CT) scanning.
Generally, those who get hospitalized because of COVID-19 will also experience worse long-term outcomes. That said, there are also COVID-19 survivors with more mild symptoms who have longer-term effects.
A recent study by the COVID Symptom Study app analysed data from 4,182 COVID-19 positive people who logged their symptoms prospectively and had not been hospitalized:
- 13.3% had symptoms lasting more than 28 days, 4.5% for more than 8 weeks, and 2.3% for more than 12 weeks.
- These long-COVID sufferers had symptoms of fatigue, headache, dyspnoea (difficulty breathing) and anosmia (loss of smell).
- These long-lasting symptoms were more likely to appear with increasing age, BMI and female sex.
- COVID-19 patients with more than five symptoms during the first week of illness were more likely to also be affected by long-COVID.
The global scale of COVID-19 suggests there will many survivors with long-term conditions. We can get a feel for what we are talking about by using data from UK COVID-19 confirmed cases on 10 Nov. 2020:
- Total reported deaths: 60,501
- Total COVID-19 confirmed cases: 1,213,363
- Total hospitalized COVID-19 patients: 182,679 (15%)
- Currently hospitalized: 12,949 of which 1,185 are on ventilation (9%)
What conclusions can we draw from the above? About 80% survive the hospital stay (based on other reports), meaning that about 145,000 people who had significant adverse health impacts have already been discharged from hospital. Among that group, a considerable portion may have long-COVID. Studies only started a few months ago and will provide more reliable data in the coming months. One such study looked into care dependency in non-hospitalized COVID-19 patients who had mild symptoms. They found that about three months after the onset of symptoms, a considerable proportion of non-hospitalized patients were to some degree dependent on others for personal care. It is early days but with a rising number of confirmed COVID-19 cases, we need to closely monitor this group of patients.
The impact of long-COVID on insurers
Long-COVID symptoms fall into various groups, including ventilation recovery, organ damage, increased frailty, mental health difficulties, and those with unpredictable post-virus fatigue symptoms. Particularly the long-term organ damage may impact future morbidity and mortality expectations for insurers. Insurers may see claims for additional healthcare, costs for rehabilitation, lost earnings, and care costs for increased frailty.
Our research shows that organ damage from COVID-19 could be severe but is difficult to identify and treat. COVID-19 will exacerbate frailties in rapidly ageing societies where many people have an increasing number of co-morbidities, requiring more care and treatment. Post-COVID-19 fatigue and other subtle or insidious symptoms are real, even if their causes and presentations remain nebulous.
Research will tell us how this group will develop as we gain experience from longitudinal cohort studies, but it will take time until we learn what the real impact will be. Insurers should definitely be vigilant of long-COVID and its development. And it would help us all if this group remains as small as possible so let's not succumb to COVID-19 indifference.