COVID-19 is an acute, albeit sometimes fatal illness, right? Not necessarily so. While many who become infected by COVID-19 make a full recovery, a significant minority experience persisting symptoms.
Indeed, the illness is highly variable in nature, with symptoms ranging from minimal (or even none) to severe respiratory distress and organ failure. In some cases respiratory symptoms may be absent. Risk of severe symptoms, need for hospitalisation and death appear to depend on a number of factors including age, gender, obesity, the presence of co-morbid conditions and ethnicity. The duration of in-patient hospitalisation can vary greatly: recently a man in the UK finally emerged from hospital having been admitted almost five months earlier.
However, something currently termed as ‘long COVID’ is being observed. Long COVID is yet to be officially defined but consists of the persistence of symptoms significantly beyond the subsiding of the acute, predominantly respiratory ones. These lingering symptoms include:
- Physical fatigue, possibly ‘crippling’ in severity
- Shortness of breath
- Post-exertional malaise
- Difficulty in concentrating
- Inability to think clearly – ‘brain fog’
- Low mood, lack of motivation.
Among a series of 143 patients in Italy1, discharged from in-patient treatment for COVID-19, only 12.6% were symptom-free when followed up later at a mean of 60 days; 55% had three or more symptoms and “worsened quality of life was observed among 44.1% of patients.” In a survey of 1,600 people in the Netherlands who had had a relatively mild form of the illness not requiring hospitalisation2, 95% reported that they continued to experience symptoms including fatigue, shortness of breath, headache and aching muscles more than three months later.
The severity of long-term symptoms is not necessarily related to the severity of those in the acute phase. Not all the long-term effects are non-specific either: organ damage inflicted in the acute phase may persist for months and be demonstrable via CT scans and suchlike.
Chronic malaise is not uncommon following Epstein-Barr virus infection, glandular fever, Lyme disease and also severe acute respiratory distress syndrome (SARS) and Middle East respiratory syndrome (MERS). Persistence of such symptoms may be referred to as chronic fatigue syndrome or post-viral syndrome. It has been postulated that COVID-19 is capable of inflicting serious damage to the immune system from which recovery is a slow, possibly incomplete, process.
As time marches on our understanding of COVID-19 infection expands with the widening spectrum of case characteristics. Fairly early on in the COVID pandemic it became clear that earlier views that the illness was invariably short, with either a fatal outcome or a satisfactory recovery, were mistaken.
The acute symptoms of the illness may still be fatal, especially for obviously vulnerable groups, but growing clinical experience in managing cases means an improving rate of favourable outcomes. But it is clear that survival of the acute illness does not invariably mean a return to normal health and to normal rates of mortality and morbidity among those affected.
Applicants for life or disability cover can be readily screened for long-term problems via the underwriting process. For existing policyholders, some mild increase in mortality can presumably be expected. But for disability insurers the effects of COVID-19 on their portfolios looks like being rather more profound, with increased rates of claims and some of those extra claims being of long duration. And those claims featuring non-specific post-viral-type symptoms may be tricky to manage.
- JAMA 2020;324(6):603-605. doi:10.1001/jama.2020.12603