Scientific American We need to plan for a future where millions of survivors are chronically ill.
Even as U.S. policy makers and business leaders seek to put the COVID pandemic in the rearview mirror with the help of highly effective vaccines, a fundamental policy and planning gap is looming. Many who survive the initial viral illness suffer debilitating long-term sequelae. Unlike the common cold or even influenza, this virus causes a bewildering array of symptoms that persist long after the acute illness is resolved and can render some affected unable to resume their usual activities. As scientists and clinicians continue to delineate the “long-haul” course of COVID, policy makers and planners must anticipate and prepare for the impact of this new cause of disability, including its implications for federal and private worker’s compensation and disability insurance programs and support services.
Consider the numbers we know. At least 34 million Americans (and probably many more) have already contracted COVID. An increasing number of studies find that greater than one fourth of patients have developed some form of long COVID. (In one study from China, three quarters of patients had at least one ongoing symptom six months after hospital discharge, and in another report more than half of infected health care workers had symptoms seven to eight months later.) Initial indications suggest that the likelihood of developing persistent symptoms may not be related to the severity of the initial illness; it is even conceivable that infections that were initially asymptomatic could later cause persistent problems.
Common long-term symptoms include fatigue; respiratory problems; “brain fog”; cardiac, renal and gastrointestinal issues; and loss of smell and taste. Surprising manifestations continue to emerge, such as the recent realization that infection may precipitate diabetes.
For some, symptoms have now continued for many months with no apparent end in sight, with many survivors fearing that they will simply have to adjust to a “new normal.” More and more sufferers have not been able to return to work, even months after their initial illness. While the number of patients with persistent illness remains undetermined this early in the pandemic, estimates suggest that millions of Americans may enter the ranks of the permanently disabled.
The related health care and disability costs are also still unknowable. How many “long haulers” will never be able to return to work? How many will need short-term disability payments? How many will be permanently disabled and become dependent on disability programs? As increasing numbers of younger people become infected, will we see an entire generation of chronically ill? We must actively work to better understand the size and scope of the problem and begin planning now.