Considerable uncertainty remains about Long Covid, where symptoms can last for months or even years after infection with the pandemic virus. The virus can damage the body in many different ways, with researchers listing more than 200 symptoms, but there is no single diagnostic test or cure. But despite the unknowns, evidence suggests that Long Covid could take a toll on millions of people. The impact on individuals, as well as society as a whole, could be long-lasting and costly.
This is suggested by the findings of two studies just published by the National Academies of Sciences, Engineering, and Medicine. The first study, published June 5, explored the potential obstacles and barriers caused by long-term COVID. The second study, published June 11, offers a much-needed consensus definition of what has been a plethora of different definitions to date, so that patients, physicians, researchers, and policymakers can work on the same page.
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The new definition states that long covid is “a chronic infection-related illness that develops after SARS-CoV-2 infection and persists for at least three months” and is “a continuous, relapsing-remitting, or progressive illness affecting one or more organ systems.” The definition further states that long covid can manifest in various ways, range from mild to severe, affect both children and adults, may develop following asymptomatic, mild or severe covid, and may exacerbate existing health conditions.
According to the initial study, symptoms of long-COVID include chronic fatigue, cognitive impairment, sleep disorders, muscle and joint pain, inattention, forgetfulness, and “brain fog” including impaired concentration and speech. Long-COVID “can affect people throughout the lifespan, from children to older adults, and across sex, gender, race, ethnicity, and other demographic groups,” the study found. Because no diagnostic test for long-COVID exists yet and there has been variability in testing for the pandemic virus, the study suggests that a positive coronavirus test should not be the only criterion for diagnosing long-COVID. A new study from Washington University in St. Louis and the Department of Veterans Affairs St. Louis Healthcare System found that patients hospitalized with COVID-19 are more likely to suffer serious health consequences years later.
Researchers are only just beginning to unravel the mechanisms and health impacts of Long Covid. It is still unclear to what extent it increases the disability burden relative to the baseline morbidity rate people would have experienced without Long Covid. Along with the health impacts, there may also be financial impacts. If Long Covid prevents people from working or studying, it could lead to a wave of disability compensation claims to the government, resulting in new large social expenditures.
The first study noted that the Social Security Administration operates two programs that provide disability benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). As of December, 8.5 million Americans received benefits through SSDI and 7.4 million Americans received benefits through SSI. Based on population surveys, the researchers found that approximately 8.9 million U.S. adults reported symptoms of long-COVID in 2022. More recently, another study found that an estimated 6.9% of adults (17.8 million people) had had long-COVID as of early 2023. So far, applications for disability benefits have remained stable since the start of the pandemic. However, if some of those with long-COVID apply and qualify for benefits, significant new expenditures would be required.
Currently, to receive disability benefits in the United States, applicants must meet the statutory definition of disability. For adults, that definition is “the inability to engage in substantial gainful activity due to a medically determinable physical or mental impairment that is likely to result in death or that is “expected to continue for a continuous period of 12 months or more.” The process of determining whether an individual qualifies is based in part on the Social Security Administration's list of disabilities. So far, long-covid has not been included, but long-covid disabilities can be substantiated by specific medical evidence. Importantly, the study points out that there are three frequently reported health effects that can significantly interfere with the ability to perform work or school activities and that may not be listed: chronic fatigue, cognitive impairment, and dysfunction of the nerves that control bodily functions such as heart rate, temperature, respiratory rate, digestion, and sensation. According to the initial study, the Social Security Administration has already expanded its guidance to address long-covid applicants.
These studies are early warnings for what will likely be a long process: the country must prepare to deal with the coming waves of disease and disability with precision and compassion.
