Late in March, Laura Gross, 72, was recovering from gall bladder surgery in her Fort Lee, N.J., home when she became sick again.
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, health-care 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 per cent of the U.S. population contracts the virus, the one-year post-hospitalization costs would be at least $50 billion US, before factoring in longer-term care for lingering health problems. Without a vaccine, if 80 per cent of the population became infected, that cost would balloon to $204 billion.
Some countries hit hard by the novel 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 centres devoted to the care of these patients and are standardizing followup measures.
Britain’s Department of Health and the U.S. national 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) this month.
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Years before cost is known
More than 18 million people have been infected by the coronavirus worldwide, about a quarter of them in the United States.
Health-care 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.
The costs 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 per cent 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 per cent required dialysis.
Dr. Marco Rizzi in Bergamo, Italy, an early epicentre of the pandemic, said the Giovanni XXIII Hospital has seen close to 600 COVID-19 patients for followup. About 30 per cent have lung issues, 10 per cent have neurological problems, 10 per cent have heart issues and about nine per cent have lingering motor skill problems. He co-chairs the WHO panel that will recommend long-term followup 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 followup. While major cardiology problems there were few, about 30 per cent to 40 per cent of patients have neurological problems and at least half suffer from respiratory conditions, according to Dr. Moreno Tresoldi.
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 U.S., 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 per cent 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 U.S. Some health plans have already raised 2021 premiums on comprehensive coverage by up to 8 per cent due to COVID-19, according to the Kaiser Family Foundation.
Anne McKee, 61, a retired psychologist who lives in Knoxville, Tenn., 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 three, five, 20 years down the road,” said Dale Hall, managing director of research with the Society of Actuaries.
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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 Prof. 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 followup for quite a long time,” she said.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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