More than 75% of patients with long Covid are not hospitalized for the initial Covid

More than three-quarters of Americans diagnosed with long-term Covid did not have symptoms severe enough to be hospitalized when they suffered the initial infection. That’s the conclusion of a new analysis, released on Wednesday (18), of tens of thousands of claims for private insurance payments.

The researchers analyzed data from the first few months after doctors began using a special diagnostic code created last year to designate long-term Covid. The results paint a sobering picture of the serious and long-term impact of long-term Covid on people’s health and the American healthcare system.

The long Covid, a complex constellation of Covid symptoms that persist or new symptoms that appear after Covid and that can last for months or even longer, has become one of the most fearsome legacies of the pandemic. Estimates of the number of people possibly affected range from 10% to 30% of infected adults.

A recent report by the Government Accountability Office, a US federal agency, says that between 7.7 million and 23 million people in the United States may have developed long-term Covid. But there is still much that is not known about the prevalence, causes, treatments and consequences of the condition.

The new study adds to a growing body of evidence that while patients who have been hospitalized are at increased risk of developing long-term Covid, people with mild to moderate early coronavirus infections — who make up the vast majority of coronavirus patients — may still experience debilitating post-Covid symptoms, including breathing problems, extreme fatigue, and cognitive and memory problems.

“This is generating a pandemic of people who didn’t get hospitalized but ended up with increased disability,” said Dr. Paddy Ssentongo, an assistant professor of infectious disease epidemiology at Penn State University, who was not involved in the new study.

Based on what the article described as the largest database of private health insurance claims in the United States, the analysis found that between October 1, 2021 and January 31, 2022, 78,252 patients were diagnosed with the new code. of the International Classification of Diseases — diagnostic code U09.9, referring to “unspecified post-Covid 19 condition”.

Claire Stevens, a physician and clinical academic at King’s College London and not involved in the new research, said the total number of people who receive the diagnosis is huge, considering the study only covered the first four months after the diagnosis code was introduced and it did not include people covered by government health care programs such as Medicaid or Medicare (although it did include people with private Medicare Advantage plans).

“It’s likely just a drop in the ocean compared to the actual number,” Stevens said.

Conducted by Fair Health, an NGO that works with healthcare costs and insurance issues, the study found that 76% of patients with long-term Covid did not need to be hospitalized for their initial infection with the coronavirus.

Another surprising finding was that while two-thirds of patients had preexisting health problems on their medical records, nearly a third did not — a much higher percentage than Ssetongo said he would have predicted. “These are people who were healthy before and they’re saying ‘guys, something’s not right with me’.”

The researchers intend to continue to follow up with patients to see how long their symptoms last, but Robin Gelburd, president of Fair Health, said the organization decided to release data from the first four months now, “given the urgency” of the issue.

She said researchers are seeking answers to some of the questions not addressed in the report; Among them, detailing patients’ previous health problems to try to identify whether certain medical problems may increase the risk of people suffering from Covid.

The organization also plans to look at how many patients in the study were vaccinated and when, said Gelburd. More than three-quarters of patients in the study were infected in 2021, most of them in the second half of the year. On average, patients continued to have symptoms of persistent Covid that qualified them for diagnosis four and a half months after becoming infected.

The findings suggest a potentially astounding impact of persistent Covid on people in the prime of life and on society at large. Almost 35% of patients were between 36 and 50 years of age, almost a third were between 51 and 64, and 17% were between 23 and 35 years old. Children were also diagnosed with post-Covid conditions: nearly 4% of patients were 12 years of age or younger, and nearly 7% were between 13 and 22 years old.

Six percent of patients were 65 years of age or older. This share likely reflects the fact that patients covered by the regular Medicare program were not included in the study. They were much more likely than younger groups with persistent Covid to have preexisting chronic medical problems.

The insurance data analyzed did not include information about the patients’ race or ethnicity.

The analysis, which Gelburd said was evaluated by an independent academic reviewer but did not undergo a formal peer review, also calculated a patient risk score, a way of estimating the likelihood that people would use medical resources. Comparing all claims for insurance payments from patients up to 90 days before contracting Covid with claims they made 30 days or more after becoming infected, the study found that the average risk score rose among patients across all age groups.

Gelburd and other experts said the scores suggest the repercussions of persistent Covid are not limited to increased medical spending. They point out “how many people are quitting their jobs, how many are getting disability status, how much absenteeism is occurring in schools,” Gelburd said. “It’s like a pebble dropped into a pond. The ripples around the pebble are concentric circles of impact.”

Because the study only looked at a population with private health insurance, Ssentongo said, it almost certainly underestimates the scope and burden of persistent Covid, especially as low-income communities have been disproportionately affected by the virus and often have less. access to health. “I think it could be even worse if we include the Medicaid-covered industries and all these other people who were left out” of the study data, he said.

The study found that 60% of patients with a post-Covid diagnosis are women, against 54% of the total Covid patients in the FAIR Health database. But in the younger and older age groups, there is a rough equivalence between men and women.

“I think there’s a female preponderance in this condition,” Steves said, adding that one reason could include differences in biological factors that make women more likely to suffer from autoimmune conditions.

Insurance claims showed that nearly a quarter of post-Covid patients had respiratory symptoms; nearly a fifth had a cough, and 17% were diagnosed with malaise and fatigue, a broad category that can include problems such as mental confusion and exhaustion that worsen after physical or mental activity. Other common problems included abnormal heartbeats and sleep disorders.

The new study sought to determine the extent to which certain symptoms were common before patients were infected, compared to the period when the same patients were diagnosed with post-Covid conditions. The conclusion was that some normally uncommon health problems were much more likely to emerge during persistent Covid. For example, muscle problems occurred 11 times more often in patients with persistent Covid; pulmonary embolisms, 2.6 times more often, and certain types of brain-related disorders occurred twice as often.

Like previous studies, the report concluded that if patients had to be hospitalized for the initial infection, they were at a higher risk of long-term symptoms than outpatients. The report reached this conclusion because 24% of patients diagnosed with the post-Covid condition had been hospitalized – more men than women – with only 8% of all coronavirus patients having to be admitted to a hospital.

Even so, because the vast majority of people do not need to be hospitalized for Covid, medical experts said this study and others indicate that many people with mild or moderate initial illness will eventually experience persistent symptoms or new post-Covid health problems.

^{Translation by Clara Allain}