More than 75 percent of long-term Covid patients were not hospitalized for initial illness, study shows

It is the most succinct and unbiased name for long Covid: U09.9 – a medical diagnostic code created last year to enable doctors to document post-Covid conditions.

Now, a major new study has analyzed data from the first few months after the code went into effect, and the results paint a sobering picture of the severe and lingering impact of Covid on people’s health and the U.S. healthcare system.

The analysis, based on what the report calls the largest database of private health insurance claims in the United States, found 78,252 patients diagnosed with the International Classification of Diseases’ U09.9 code between October 1, 2021 and January. December 31, 2022, and the vast majority of them had not been hospitalized for their first infection.

dr. Claire Steves, a clinical academic and physician at King’s College London, who was not involved in the new study, said the total number of people diagnosed with the diagnosis was “huge”, especially given that the study only covered the first four months. after the diagnostic code was introduced and did not include people covered by government health programs such as Medicaid or Medicare (although it did include people in private Medicare Advantage plans). “That’s probably a drop in the ocean compared to the actual number,” said Dr. Steves.

The study, conducted by FAIR Health, a nonprofit focusing on health care costs and insurance issues, found that in 76 percent of patients, the initial coronavirus infection did not make them sick enough to require hospitalization. But months later, they experienced symptoms diagnosed as post-Covid conditions, including difficulty breathing, coughing, fatigue and hypertension.

“It’s causing a pandemic of people who have not been hospitalized but who have developed this increased disability,” says Dr. Paddy Ssentongo, an assistant professor of infectious disease epidemiology at Penn State, who was not involved in the new study.

Another striking finding was that while two-thirds of patients had pre-existing health problems on their medical records, nearly a third did not, a much larger percentage than Dr. Ssentongo said he expected. “These are people who have been healthy and they say, ‘Guys, something isn’t right with me,'” he said.

The researchers plan to continue to follow the patients to see how long their symptoms last, but Robin Gelburd, the president of FAIR Health, said the organization decided to publish data from the first four months now, “given the urgency.” ” of the problem .

She said researchers were trying to answer some of the questions not covered in the report, including providing details about some patients’ previous health status to try and determine whether certain medical conditions put people at higher risk for long-term Covid. .

The organization also plans to analyze how many patients in the study were vaccinated and when, Ms Gelburd said. More than three quarters of the patients in the study were infected in 2021, most in the last half of the year. On average, four and a half months after their infection, patients still had long-lasting Covid symptoms that qualified for diagnosis.

The findings suggest a potentially dizzying impact of long-term Covid on people in the prime of their lives and on society as a whole. Nearly 35 percent of patients were between 36 and 50 years old, while nearly a third were between 51 and 64 years old and 17 percent were between 23 and 35 years old. patients were 12 years or younger, while nearly 7 percent were between 13 and 22 years old.

Six percent of patients were 65 and older, a percentage that most likely reflects the fact that patients covered by the regular Medicare program were not included in the study. They were much more likely than the younger groups with long-term Covid to have had pre-existing chronic medical conditions.

The insurance data analyzed did not include information about patients’ race or ethnicity, researchers said.

The analysis, which Ms Gelburd said was evaluated by an independent academic reviewer but not formally peer-reviewed, also calculated a risk score for the patients, a way of estimating how likely people are to use medical aids. healthcare. By comparing all insurance claims the patients had up to 90 days before they contracted Covid with their claims 30 days or more after being infected, the study found that mean risk scores increased for patients in each age group.

Ms Gelburd and other experts said the scores suggested the effects of long-term Covid are not just limited to increased medical expenditure. They indicate “how many people leave their jobs, how many people become disabled, how much absenteeism there is at school,” Ms Gelburd said. “It’s like a pebble thrown into the lake, and these ripples circling that pebble are concentric circles of impact.”

Because the study only included a privately insured population, said Dr. Ssentongo, it almost certainly underestimates the magnitude and burden of long-term Covid, especially as low-income communities have been disproportionately affected by the virus and often have less access to health care. “I think it would be even worse if we added the Medicaid population and all those other people that would have been missed” into the data from the study, he said.

Sixty percent of patients with the post-Covid diagnosis were female, the study reported, compared with 54 percent of Covid patients in the FAIR Health database. In the oldest and youngest age groups, however, there were about the same number of men and women.

“I think there is a female predominance in terms of this condition,” said Dr. Steves, adding that the reasons could be differences in biological factors that predispose women to autoimmune diseases.

The insurance claims revealed that nearly a quarter of post-covid patients had respiratory symptoms, nearly a fifth had a cough, and 17 percent were diagnosed with malaise and fatigue, a far-reaching category that could include things like brain fog and exhaustion. that gets worse after physical or mental activity. Other common problems included abnormal heartbeats and sleep disturbances.

Generalized anxiety disorder was more common in 23- to 35-year-olds than in other age groups, the study reported, while hypertension was more common in the oldest patients.

Last year, FAIR Health published a study tracking insurance records for nearly two million people who had contracted Covid, which found that a month or more after their infection, nearly a quarter of them — 23 percent — were seeking medical treatment for new conditions.

The new study sought to determine how common certain symptoms were before the patients became infected compared to the time when those same patients were diagnosed with post-Covid conditions. It found that some typically unusual health problems became much more apparent during prolonged Covid. For example, muscle problems were 11 times more common in patients with long-term Covid, pulmonary embolism was 2.6 times more common, and certain types of brain-related conditions were two times more common, the study said.

Like previous studies, the report found that if patients required hospitalization for their initial infection, they were at higher risk for long-term symptoms than patients who were not hospitalized. The report came to that conclusion because about 24 percent of patients diagnosed with post-Covid disease had been hospitalized — more of them male than female — while only about 8 percent of all coronavirus patients required hospitalization.

But because the vast majority of people don’t require hospitalization for their infection, medical experts said these and other studies indicate that many people with mild or moderate initial illness will develop persistent symptoms or new post-Covid health problems. .

Ms. Gelburd and medical experts said that as doctors become more familiar with the U09.9 code, they could use it in different circumstances than they did in the first four months.

Given the likely magnitude of long-term Covid, said Dr. Ssentongo says he expects doctors in the future to ask patients if they’ve ever been diagnosed with post-Covid conditions, just like doctors ask about other past medical problems so they can treat patients appropriately.

“Post-Covid syndrome may well become one of the most common pre-existing comorbidities in the future,” he said.

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