Long COVID has been described as our “first national health disaster” and the “pandemic after the pandemic,” but we know very little about how many people are affected, for how long it will survive for those affected, and how it could change employment and health. cover landscapes. This policy watch reviews what we know and sets out key issues to watch for employment outcomes and coverage. We continue to pursue research into who is at risk of prolonged COVID and whether there are interventions that can reduce its frequency, duration or severity. The numbers are already alarming and infections are constantly increasing. The newest subvariant—BA.5—easily infects both vaccinated and already immunized individuals. Vaccines and immunity protect against severe illness and death, but it is unclear whether they protect against prolonged COVID. One study of the VA health system found that the risks of prolonged COVID increased with each subsequent re-infection.
Long COVID involves a range of disabling symptoms and may affect 10 to 33 million working-age adults in the United States (Figure 1). Long COVID is not a single condition but “a broad range of new, returning or persistent health problems that people experience after they are first infected with the virus that causes COVID-19,” according to the CDC. Patients report a wide range of physical and mental health conditions including malaise, fatigue, breathing challenges, cardiovascular abnormalities, migraines, and mental health impairments. There is no standard presentation or treatment for prolonged COVID. It is a new phenomenon and an ICD-10 code to identify medical claims was only made available in October 2021. It is also unknown how long people with prolonged COVID will stay ill, although one study reported that 29 percent of self-reported long-term COVID-10 patients. symptoms for more than one year. The prevalence of prolonged COVID is equally uncertain and studies have found that the percentage of working-age adults with prolonged COVID could be 10 percent, 20 percent, or 33 percent. If we conservatively assume that 100 million working-age adults are infected, that suggests that 10 to 33 million may have long-term COVID.
Preliminary evidence suggests that there could be significant implications for employment: Surveys show that over half are out of work or working fewer hours among adults with long-term COVID who worked before the infection (Figure 2 ). Many conditions associated with prolonged COVID – such as malaise, fatigue, or the inability to concentrate – limit people’s ability to work, even if they have jobs that allow for remote work and other arrangements. Two surveys of people with prolonged COVID who worked before the infection showed that between 22% and 27% of those workers were out of work after getting prolonged COVID. In comparison, among all adults of working age in 2019, only 7% were out of work. Given the large number of working-age adults with prolonged COVID, the employment implications could be profound and will likely affect more people over time. One study estimates that prolonged COVID accounts for 15 percent of already unfilled jobs.
It’s too early to have comprehensive data or a clear picture of employment outcomes, but there are reports that demand for disability insurance, workers’ compensation and group health insurance is increasing in claims related to long-term COVID-12. Those higher claims could increase costs for insurers and ultimately, employers. It is unclear how long-term these challenges will be and whether a prolonged COVID will lead to an increase in health insurance spending. It’s also unclear how employment impacts will spread across industries, but certain industries are likely to be disproportionately affected — especially those with higher initial infection rates, such as health care.
There could be significant changes in long-term COVID-related health coverage. Over 60% of working age adults get their health insurance cover through an employer. Employment changes would therefore have a significant impact on people’s sources of health insurance. People who are no longer able to work could lose their current cover and also experience a loss of income. Some people may be eligible for help paying for private health insurance through the ACA marketplaces. Others could qualify for new Medicaid — though eligibility is more limited in the dozen states that didn’t expand the program under the ACA. Those with high medical expenses may qualify for Medicaid through medically necessary programs.
An important question for the future is whether federal disability programs will count COVID as a disability. The Office for Civil Rights within the US Department of Health and Human Services has determined that prolonged COVID may constitute a disability under the Americans with Disabilities Act if an individual assessment determines that it substantially limits one or more major life activities. Despite the recognition that prolonged COVID can be disabling, to qualify for federal programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), applicants must be able to work and conditions have health that lasts for at least a year or result in death. At this point, it is unclear how many people with prolonged COVID will qualify for disability benefits under this definition. If people with long-term COVID qualify for federal disability programs, more people will have publicly funded health insurance through Medicare and Medicaid. People eligible for SSDI are eligible for Medicare after a 2-year waiting period and people eligible for SSI are usually eligible for Medicaid. If people with COVID are unable to work for a long time, federal disability programs can play a key role in helping those patients access the health care they need to recover.
