The Impact of Long Covid Keeps Growing. NewsWire

NewsWire: 12/13/21

• For Long Covid sufferers, it’s difficult to get support from the current social safety net. Unable to work, they’re finding themselves without health insurance and unable to qualify for disability aid either. (The Washington Post)
• NH: If you’re looking for a humanizing portrait of what it’s like living with Long Covid, this piece is a good place to start. It’s based on 30 interviews with long-haulers and vividly portrays just what a slog it is, with patients facing debilitating fatigue, the loss of their careers, and (after their employer health insurance gets cancelled) mounting medical bills.
• One thing there isn’t much of here is data. A statistic cited early on caught my attention. In discussing how many Americans are suffering from Long Covid, the author cites “several medical specialists” who estimate that 750,000 to 1.3 million patients likely remain “so sick for extended periods” that they can’t return to full-time work.
• 1.3 million? That seems ridiculously low. I’d put the total at much higher than that.
• In my August piece about Long Covid (see “The Long Shadow of Long Covid”), I reviewed several major studies that concluded that 20 to 30% of those who test positive for Covid-19 have at least one Long Covid symptom after 30 days. If anything, that range could be an underestimate, since many Long Covid sufferers have “soft” symptoms like fatigue or insomnia that they might not go see a doctor for. Long Covid symptoms varied so widely, so estimates of prevalence were all over the map. Other studies with smaller sample sizes put the share of Long Covid patients at anywhere from 10% to 52% of infections.
• More recent studies have produced estimates at the higher end. In an October JAMA report, researchers at Penn State College of Medicine reviewed 57 global studies covering 250K+ unvaccinated patients who recovered from Covid-19 from December 2019 through March 2021. The researchers analyzed patients’ health post-recovery during three intervals: 1 month, 2-5 months, and 6+ months. They found that just over 50% of patients experienced residual health issues during every interval. In other words, the prevalence did not decline appreciably over time.
• In a September study (n=273K), researchers at Oxford University examined the medical records of people (mostly Americans) who were diagnosed with Covid-19 in 2020. They identified those who reported 9 common Long Covid symptoms (e.g. fatigue, difficulty breathing, cognitive impairments) and found that 57% of patients had at least one symptom in the 180 days after infection. Over a third (37%) had symptoms 90 to 180 days after infection.
• In my original piece, I estimated, conservatively, that 26M Americans had Long Covid (= 20% of 115M infections). As of November 16, the CDC estimate of infections has grown to 146.6M. That bumps up my estimate by over 3M, or to 29.3M Americans with Long Covid.
• Of these people, how many are likely to be in the workforce? U.S. LFP is around two-thirds of the population, and Long Covid incidence does not vary much by age. So that’s amounts to roughly 19.5M people. Many of them could still be able to work or have recovered, but it’s clear that a significant share cannot. Earlier research estimated that 22% of Long Covid respondents cannot work at all due to their symptoms, which would give us 4.3M people who are out of the labor market.
• This 4.3M estimate lines up with figures we reported in November. Then, 3.7M Americans said they were not working because they were sick with Covid-19 or caring with someone who had it, and an additional 0.5M said they were sick for unrelated reasons--many of whom, I suspect, might have undiagnosed Long Covid. (See “Reasons Americans Aren’t Working.”)
• Large-scale data on Long Covid and its impact on work are still scarce, but we are seeing more studies with small sample sizes. NYT reported earlier this month that, of the 102 patients in Mount Sinai Health System’s post-Covid rehab program who had been working full-time prior to their illness, nearly half had been forced to stop because of their symptoms. The 22% estimate, in other words, could be low.
• The WaPo piece underscores the difficult predicament faced by Long Covid patients. Those who can no longer work end up losing their health insurance, leaving many of them unable to pay for tests or treatments. They are also unlikely to receive federal disability benefits (DI). In order to protect the program against scammers, DI procedures and administrative law judges very much prefer that disability claims be backed by "hard" evidence, like CAT scans or serum tests. Unfortunately, Long Covid’s most debilitating symptoms rarely generate such evidence. The fact that applicants have to demonstrate that their symptoms have lasted or are expected to last at least 12 months is another hurdle.
• Even under routine circumstances, two-thirds of DI claims are denied. The Social Security Administration has received only 16,000 claims for Covid-19-related disability insurance since December 2020—probably, IMO, because many patients haven’t reached the 12-month threshold or don’t even want to bother going through the process.
• That potentially leaves millions of Americans too sick to work, but not sick in a way that would qualify them for DI. These are not people who are staying home just because of a headache or two. As I have pointed out, those who have been infected with Covid-19 have a significantly higher risk of death. Specifically, they have a +60% higher risk of dying in the six months after they’ve recovered than a demographically identical group of individuals who have never been infected. While some Long Covid patients will get better in time, we have to prepare for the possibility that the lion’s share will not.