More than 75% of patients with long-term Covid were not hospitalized for initial illness, study finds

It’s the most succinct and unbiased name for Long Covid: U09.9 – a medical diagnostic code created last year to allow doctors to document post-Covid conditions.

Now a large new study has analyzed data from the first few months after the code took effect, and the results paint a sobering picture of the serious and ongoing impact of Long Covid on people’s health and the American healthcare system.

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

Dr Claire Steves, a clinical scholar and doctor at King’s College London, who was not involved in the new research, said the total number of people diagnosed was “huge”, especially since the study only covered the first four months after the diagnosis code was introduced and did not include people covered by government health programs like Medicaid or Medicare (although it did include people in plans private Medicare Advantage). “It’s probably a drop in the ocean compared to the actual number,” Dr Steves said.

The study, conducted by FAIR Health, a non-profit organization that focuses on healthcare costs and insurance issues, found that for 76% of patients, the initial infection with the coronavirus left them did not make them sick enough to require hospitalization. Yet months later they were showing symptoms that were diagnosed as post-Covid conditions, including breathing problems, coughing, fatigue and high blood pressure.

“It’s generating a pandemic of people who haven’t been hospitalized, but have ended up with this increased disability,” said Dr. Paddy Ssentongo, assistant professor of infectious disease epidemiology at Penn State, who did not. participated in the new study.

Another striking finding was that while two-thirds of patients had pre-existing conditions in their medical records, almost a third did not, a much higher percentage than Dr Ssentongo said he would have expected. . “These are people who were healthy and they’re like, ‘Guys, something’s wrong with me,’” he said.

Researchers plan to continue following patients to see how long their symptoms last, but Robin Gelburd, president of FAIR Health, said the organization has decided to release data from the first four months now, “given the urgency” of the matter. .

She said researchers are working to try to answer some of the questions that aren’t covered in the report, including providing details of some patients’ previous health conditions to try to determine if certain medical conditions put people at risk. a higher risk of long Covid.

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

The results suggest a potentially staggering impact of the long Covid on people in their prime and on society at large. Nearly 35% of the patients were between 36 and 50 years old, while almost a third were between 51 and 64 years old and 17% between 23 and 35 years old. Children were also diagnosed with post-Covid conditions: almost 4% of the patients were 12 or younger, while almost 7% were between 13 and 22 years old.

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

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

The analysis, which Ms Gelburd said was assessed by an independent academic reviewer but not formally peer-reviewed, also calculated a patient risk score, a way to estimate the likelihood that people would use resources. health care. Comparing all insurance claims patients had up to 90 days before contracting Covid with their claims 30 or more days after becoming infected, the study found that mean risk scores increased for patients of all age groups.

Ms Gelburd and other experts said the scores suggest the repercussions of the long Covid are not just limited to increased medical spending. They report “how many people are leaving their jobs, how many are receiving disability status, how much truancy is there at school,” Ms Gelburd said. “It’s like a pebble thrown into the lake, and those ripples surrounding that pebble are concentric circles of impact.”

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

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

“I think there’s a female preponderance in terms of this condition,” Dr. Steves said, adding that reasons could include differences in biological factors that make women more prone to autoimmune diseases.

Insurance claims showed almost a quarter of post-Covid patients had respiratory symptoms, nearly a fifth had a cough and 17% had been diagnosed with malaise and fatigue, a wide-ranging category which could include issues like brain fog and exhaustion. that gets worse after physical or mental activity. Other common issues included abnormal heartbeats and trouble sleeping.

According to the study, generalized anxiety disorder was more common among 23-35 year olds than other age groups, while hypertension was more common among older patients.

Last year, FAIR Health published a study tracing the insurance records of nearly two million people who had contracted Covid, which found that a month or more after they were infected, almost a quarter of them they – 23% – sought medical treatment for new conditions.

The new study attempted to determine the frequency of certain symptoms before patients were infected compared to when those same patients were diagnosed with post-Covid conditions. He found that certain generally rare health conditions were much more likely to appear during a long period of Covid. For example, muscle problems occurred 11 times more often in patients with long Covid, pulmonary embolisms occurred 2.6 times more often and certain types of brain-related disorders occurred twice as often, according to the study. .

Like previous studies, the report found that if patients needed hospitalization for their initial infection, they were at higher risk of long-term symptoms than patients who were not hospitalized. The report came to this conclusion because around 24% of patients diagnosed with a post-Covid condition had been hospitalized – more men than women – while only around 8% of all coronavirus patients needed to be hospitalized.

Yet, since the vast majority of people do not need to be hospitalized for their infection, medical experts said this study and others indicate that many people with mild or moderate initial illness will end up with 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 might use it in different circumstances than they did in the first four months.

Given the likely scale of long Covid, Dr Ssentongo said he expects doctors in the future will ask patients if they have ever been diagnosed with post-Covid conditions, while as doctors ask about other past medical issues so they can treat patients appropriately.

“Post-Covid syndrome is going to become perhaps one of the most common pre-existing comorbidities in the future,” he said.

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