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 Her throat, head and eyes hurt, her muscles and joints ached and she
felt like she was in a fog. Her diagnosis was COVID-19. Four months
later, these symptoms remain.
Gross sees a primary care doctor and specialists including a
cardiologist, pulmonologist, endocrinologist, neurologist, and
gastroenterologist.
"I've had a headache since April. I've never stopped running a
low-grade temperature," she said.
Studies of COVID-19 patients keep uncovering new complications
associated with the disease.
With mounting evidence that some COVID-19 survivors face months, or
possibly years, of debilitating complications, healthcare experts
are beginning to study possible long-term costs.
Bruce Lee of the City University of New York (CUNY) Public School of
Health estimated that if 20% of the U.S. population contracts the
virus, the one-year post-hospitalization costs would be at least $50
billion, before factoring in longer-term care for lingering health
problems. Without a vaccine, if 80% of the population became
infected, that cost would balloon to $204 billion.
Some countries hit hard by the new coronavirus - including the
United States, Britain and Italy - are considering whether these
long-term effects can be considered a "post-COVID syndrome,”
according to Reuters interviews with about a dozen doctors and
health economists.
Some U.S. and Italian hospitals have created centers devoted to the
care of these patients and are standardizing follow-up measures.
Britain's Department of Health and the U.S. Centers for Disease
Control and Prevention are each leading national studies of
COVID-19’s long-term impacts. An international panel of doctors will
suggest standards for mid- and long-term care of recovered patients
to the World Health Organization (WHO) in August.
YEARS BEFORE THE COST IS KNOWN
More than 17 million people have been infected by the new
coronavirus worldwide, about a quarter of them in the United States.
Healthcare experts say it will be years before the costs for those
who have recovered can be fully calculated, not unlike the slow
recognition of HIV, or the health impacts to first responders of the
Sept. 11, 2001 attacks on the World Trade Center in New York.
They stem from COVID-19's toll on multiple organs, including heart,
lung and kidney damage that will likely require costly care, such as
regular scans and ultrasounds, as well as neurological deficits that
are not yet fully understood.
A JAMA Cardiology study found that in one group of COVID-19 patients
in Germany aged 45 to 53, more than 75% suffered from heart
inflammation, raising the possibility of future heart failure.
A Kidney International study found that over a third of COVID-19
patients in a New York medical system developed acute kidney injury,
and nearly 15% required dialysis.
Dr. Marco Rizzi in Bergamo, Italy, an early epicenter of the
pandemic, said the Giovanni XXIII Hospital has seen close to 600
COVID-19 patients for follow-up. About 30% have lung issues, 10%
have neurological problems, 10% have heart issues and about 9% have
lingering motor skill problems. He co-chairs the WHO panel that will
recommend long-term follow-up for patients.
"On a global level, nobody knows how many will still need checks and
treatment in three months, six months, a year," Rizzi said, adding
that even those with mild COVID-19 "may have consequences in the
future."
Milan's San Raffaele Hospital has seen more than 1,000 COVID-19
patients for follow-up. While major cardiology problems there were
few, about 30% to 40% of patients have neurological problems and at
least half suffer from respiratory conditions, according to Dr.
Moreno Tresoldi.
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Some of these long-term effects have only recently emerged, too soon for health
economists to study medical claims and make accurate estimates of costs.
In Britain and Italy, those costs would be borne by their respective
governments, which have committed to funding COVID-19 treatments but have
offered few details on how much may be needed.
In the United States, more than half of the population is covered by private
health insurers, an industry that is just beginning to estimate the cost of
COVID-19.
CUNY's Lee estimated the average one-year cost of a U.S. COVID-19 patient after
they have been discharged from the hospital at $4,000, largely due to the
lingering issues from acute respiratory distress syndrome (ARDS), which affects
some 40% of patients, and sepsis.
The estimate spans patients who had been hospitalized with moderate illness to
the most severe cases, but does not include other potential complications, such
as heart and kidney damage.
Even those who do not require hospitalization have average one-year costs after
their initial illness of $1,000, Lee estimated.
'HARD JUST TO GET UP'
Extra costs from lingering effects of COVID-19 could mean higher health
insurance premiums in the United States. Some health plans have already raised
2021 premiums on comprehensive coverage by up to 8% due to COVID-19, according
to the Kaiser Family Foundation.
Anne McKee, 61, a retired psychologist who lives in Knoxville, Tennessee and
Atlanta, had multiple sclerosis and asthma when she became infected nearly five
months ago. She is still struggling to catch her breath.
"On good days, I can do a couple loads of laundry, but the last several days,
it's been hard just to get up and get a drink from the kitchen," she said.
She has spent more than $5,000 on appointments, tests and prescription drugs
during that time. Her insurance has paid more than $15,000 including $240 for a
telehealth appointment and $455 for a lung scan.
"Many of the issues that arise from having a severe contraction of a disease
could be 3, 5, 20 years down the road," said Dale Hall, Managing Director of
Research with the Society of Actuaries.
To understand the costs, U.S. actuaries compare insurance records of coronavirus
patients against people with a similar health profile but no COVID-19, and
follow them for years.
The United Kingdom aims to track the health of 10,000 hospitalized COVID-19
patients over the first 12 months after being discharged and potentially as long
as 25 years. Scientists running the study see the potential for defining a
long-term COVID-19 syndrome, as they found with Ebola survivors in Africa.
"Many people, we believe will have scarring in the lungs and fatigue ... and
perhaps vascular damage to the brain, perhaps, psychological distress as well,"
said Professor Calum Semple from the University of Liverpool.
Margaret O'Hara, 50, who works at a Birmingham hospital is one of many COVID-19
patients who will not be included in the study because she had mild symptoms and
was not hospitalized. But recurring health issues, including extreme shortness
of breath, has kept her out of work.
O'Hara worries patients like her are not going to be included in the country's
long-term cost planning.
"We're going to need ... expensive follow-up for quite a long time," she said.
(Reporting by Caroline Humer and Nick Brown in New York; Emilio Parodi in Milan
and Alistair Smout in London; editing by Michele Gershberg and Bill Berkrot)
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