JAMA has published a short (and open access) research letter from a group of Italian physicians late last week. The authors followed up on patients who had been hospitalized with COVID after they had been discharged and describe the ongoing symptoms.
This is the meat of the story:
Patients were assessed a mean of 60.3 (SD, 13.6) days after onset of the first COVID-19 symptom; at the time of the evaluation, only 18 (12.6%) were completely free of any COVID-19–related symptom, while 32% had 1 or 2 symptoms and 55% had 3 or more. None of the patients had fever or any signs or symptoms of acute illness. Worsened quality of life was observed among 44.1% of patients.
This population is a sick population. It was sick enough to require hospitalization with a significant number of individuals receiving assistance to breathe while in the hospital.
Two months after symptom onset, seven out of eight people were reporting at least a symptom from COVID.
One of the greatest known unknowns about COVID is what are the long term effects of the disease? How long will people need additional care? Does that incremental extra care vary in predictable ways and is it stratified by age or other demographic characteristics? Will there be long term COVID related mortality and morbidity effects?
We still don’t know as there is absolutely no way to gain a multi-year persepctive on a disease that we have been aware of for just over seven months now. This is one of the great challenges to actuaries who are trying to price 2021 insurance premiums. They are shooting into the dark on very little evidence and a lot of anecdotes and good guesses based on observation and analogy. But we just don’t know.
debbie
The local news here often interviews people who have “recovered” from COVID. Last night, it was a family of seven, ranging from grandfather to teenagers. Each person’s symptoms were very different, and either they were dealing with a difficult recovery (grandfather) or were yoyoing back and forth between asymptomatic and relapses (teenagers).
mad citizen
David this is very timely as usual. I was thinking about the whole mask wearing thing over the weekend. (At my local Farmers Market there were too many maskless people walking around, even a vendor. On the way out I stopped by my city’s newly-created Health Department booth to tell them how uncomfortable I was walking around, and the city should mandate masks at the Farmers Market.)
I was wondering if the health insurance companies could do anything about the mask issue–such as different rates for those who wear masks, and those who don’t. But now that I’m typing all of this, I’m thinking it is not enforceable. My employer gives us a very slight discount if we promise not to smoke, so maybe something like that?
low-tech cyclist
Thank goodness I didn’t go the actuarial route.
(When you major in math at a college in the Hartford area, you get some heavy nudging in that direction. So it coulda been me having to be part of these decisions. Glad it’s not.)
David Anderson
@mad citizen: Interesting, very hard to verify that someone is mask compliant vs. being able to reasonably cheaply verify nicotine consumption with a cheap blood test. Let me bounce this off of a few workplace wellness folks
Nicole
@David Anderson: I was today years old when I learned how a health insurance company verifies nicotine compliance. I’m a lifelong non-smoker, but most of the generation before me smoked (and of the ones that didn’t quit, they, to a person, did not live to see 70), so I had always wondered how a company could tell if you really were a non-smoker or not (because my dad lied all the time to his doctor about how much he smoked). Thanks for that.
mad citizen
@David Anderson: That’s a good point. I guess I went to the nicotine pledge because I’ve never heard of anyone at work being asked or selected to take a test to prove their statement (I work for the state of Indiana), so to me it seems like the honor system.
Brachiator
Would like to see how this correlates with age, gender, and presence of underlying conditions.
low-tech cyclist
@Brachiator: Given that 18 people = 12.6% of the sample group, I’m getting a total sample size of around 143, so subgroups are going to be awfully small.
Cheryl Rofer
Thanks, David. I’ve been wondering about the incidence of these symptoms. Reporting has emphasized that “some” people continue to suffer, but never how many. Anecdotal sob stories are easier to write than digging for numbers. And, tbf, numbers are only becoming available.
This impacts so much more than health insurance. The military has had many flareups in basic training, for example, and most famously on the ship Theodore Roosevelt. I’ve seen confused reports that the military is considering making having had covid a disqualifier for recruiting.
We are going to have to reconsider so many things.
Sab
@Nicole: Smoking. My mother and her sister in law started smoking at age 15 or 16. Sister in law died at age 52. Mom lived to 84 and died of something else. I tell my stepkids the 10 years of life you lose is an average. Mom lost no years. Dad’s sister lost 30.
Ken
@Cheryl Rofer: If the military makes covid history disqualifying, a “successful” herd immunity campaign will mean that upwards of 70% of the population is ineligible for service. And the remaining 30% would, I would think, strongly skew older and otherwise ineligible.
Perhaps that might get the attention of some of the “herd immunity” idiots? The mere moral issue of a few tens of millions of deaths hasn’t.
wvng
@Cheryl Rofer: we have no.idea how big the universe of things we will have to reconsider might be. It’s why the idea that schools just have to come up with a reopening plan is so difficult, even in the states that don’t have runaway spread.
Bodacious
Two points :
THIS is the factor that I think many young people miss in their evaluation of threat from Covid to self. I have wondered how this will play out in college and professional athletes, if we ever get ‘back’ to normal. Will we see an impact lead to those who caught this lead to careers ended?
And second, while we look into insurance health pricing for 2021- what about all the money saved by insurance providers whose subscribers STOPPED going in for services. Those who put off colonoscopies, breast exams, annual exams. That has to be some large savings for them. Even those who did catch the virus, most were asked to stay home, stay away from services if they weren’t in respiratory distress. Will we see real cost analyst on that?
David Anderson
@Bodacious: KFF just came out with their Q1 MLR report this morning. Actual data that has meaning for Q1 is available as of mid-May and April data is just getting to the point of being reliable.
https://www.kff.org/private-insurance/issue-brief/individual-insurance-market-performance-in-early-2020/
SW
Well, worst of it is that it appears the antibodies only last for about three months. Let that sink in. Like the common cold. No long term immunity. No herd immunity. Yikes!
Ken
@SW: Long-term immunity involves several factors besides antibodies, but those are harder to measure. Derek Lowe’s “In the Pipeline” blog has had several posts on this.
Nicole
@Sab:
Or, maybe she would have lived to 94. Absolutely some smokers still manage to beat the actuarial tables, but I really think it takes years off all their lives.
Brachiator
@Bodacious:
You would expect that many of these costs are deferred, and there will be a catch-up later in the year.
Brachiator
@Ken:
That herd immunity was likely was more a preconception of the general public and conservative than it was anything talked about among medical experts.
Similarly, the “expectation” that a vaccine will be available before the end of the year.
Blue mouser
If mask wearing can’t be accurately measured among individuals and priced as such, can it be or do you see it factored into the health insurance costs of companies that require employees to wear one at work and/or customers to wear one while one while onsite? It could be part of a number of policies such as social distancing, putting up those plexiglass screens, etc. I read that the number of protective measures put into place by Costco cut into the short term profits gained by the surge in purchasing made during the early months of this pandemic. So there are companies trying to open safely while there are companies that are not. Will be interesting to see how the health insurance companies address this in their pricing strategies
Jinchi
I really hope that this gets stressed far and wide. The Republican/FOX strategy to the pandemic has been to embrace “herd immunity” as a solution to all problems. Just let the virus sweep through the population and (those left standing) will be supermen who don’t have to worry. Too many of my own family members subscribe to this idiocy.
Never mind that natural herd immunity implies virtually everyone gets infected. Never mind that implies millions die. Never mind that this is not how the vast majority of illnesses work. Never mind that many people who recover will be permanently impaired.
We don’t even know if herd immunity exists for this virus.