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The many faces of long COVID

COVID 19 Pandemic

More than two years into the COVID-19 pandemic, many of us have experienced the coronavirus in its various guises. For some of us, the symptoms may have been just a slight cough or mild fever, but for others, it may have been so bad that it meant intensive care at the hospital.

Regardless of its severity, early studies have estimated as many as 60% of adults who have recovered from COVID-19 reported one or more persistent symptoms.

So, what is long COVID? Simply put, it describes a set of physical and mental health abnormalities that persist after recovery from an acute COVID-19 infection. Long COVID goes by multiple names and its symptoms can manifest very differently from person to person. 

In this brief update, we take a closer look at what exactly we know (and don't know) about long COVID.

What does long COVID look like?

The most common symptoms include physical fatigue, shortness of breath on exertion, sleep difficulties, mood changes, an inability to concentrate, and short-term memory loss. These symptoms may appear anywhere from days to months after recovery. While the symptoms can persist for months, its severity tends to wax and wane.

Does long COVID have an official name?

Long COVID, post-acute COVID syndrome, persistent COVID, are among the most common names for the condition. Just as it has many names, long COVID also has multiple definitions according to different medical guidelines around the world. In November 2021, the World Health Organisation developed a working definition under the name “post COVID-19 condition“.

How are we at predicting long COVID risk?

Unfortunately, the initial severity of acute COVID-19 is not a great predictor of the risk that someone will develop long COVID later on. We know that certain risk factors are correlated with higher risk of severe acute COVID-19. For example, older men with one or more chronic medical conditions are at high risk of severe COVID-19. However, long COVID appears to be much less correlated with these known risk factors.

What are the long-term effects?

Studies on the long-term effects of COVID-19 are only now emerging and are cause for alarm:
  • Heart conditionsA study from Johns Hopkins University found that recovered COVID-19 patients were more prone to developing a broad spectrum of heart problems, at one year after the initial infection.
  • New-onset diabetes: Another study from The Lancet found that COVID-19 patients had a 40% increased risk of developing diabetes compared to those who did not have COVID-19. Recovered COVID-19 patients also showed an 85% increased risk of needing anti-hyperglycemic medications to treat diabetes.
  • Brain atrophyData from the UK Biobank showed that recovered COVID-19 patients had significantly reduced brain tissue size on MRI imaging. The biggest changes were observed in areas of the brain involved in smell and memory retrieval. Furthermore, these changes were associated with greater decline in cognitive function.
All this is just what we know so far in adults. The long-term effects of COVID-19 on children remain unclear, although it is estimated that as many as 25% of recovered children still experience persistent symptoms. Another point to keep in mind is that most of the research on long COVID so far are on those who recovered from earlier variants of the virus. It is still too early to tell if we will we see different types of long COVID from the different variants. It is also unclear whether COVID-19 vaccines are effective in preventing long COVID.

How are insurers addressing the protection gap when it comes to long COVID?

What we know today about long COVID and its effects are based on observations in the last two years. Many recovered COVID-19 patients will need increased access to medical care to manage their persistent symptoms. And as re/insurers, we should continue to study consumers' evolving needs and provide personal and financial support they need.

Given the relatively short timeframe we've had studying COVID-19, the full spectrum of medium-to-long term effects of COVID-19 is not clear. For Life & Health insurers with mortality & morbidity portfolio durations of 5-10 years or more, there remains much uncertainty on the full effects of long COVID. The true long-term incidence and effects of long COVID cannot be fully estimated today. We must continue to monitor new evidence from the medical literature to understand its risks.


This article was originally published by the Swiss Re. You may find the link to the original article here.

Author: David Lu, CMO Asia

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