“In short”, we hear much about new case numbers, deaths within 28 days of a positive diagnosis and recoveries. But as you’ll also have heard, Covid also has a “long” side. Here, Dr. Achim Regenauer shares with you an overview of what’s known so far about “long Covid”, covering who’s at risk, how it manifests and which life insurance products are potentially impacted by the various symptoms. He also considers the outlook – as you’ll read below, it could be that vaccines can help there too.
What do we mean by long Covid? Well there’s no concrete, internationally agreed definition, and even the name varies, e.g. also known as “post-Covid-19 syndrome”1, but as with the well-known potential for post-viral fatigue after an influenza infection, individuals infected with SARS-CoV-2 can continue to be affected by the virus for months after the typical acute phase of the illness has passed. The best estimation at the moment for COVID-19 is that at least 10% are still unwell 4-9 months after infection2. This could of course extend as time passes and more data becomes available, but as a noteworthy comparison, 40% of SARS-CoV-1 (SARS) patients suffered from chronic fatigue up to 3.5 years after infection3.
Viral fatigue is not the only symptom. From what we know so far, the symptoms of long Covid can be grouped into two broad categories: Unspecific, fluctuating (over hours/days) post-viral fatigue and joint pain symptoms (let’s call these Group 1); and specific, objectively measurable organ-centered disease symptoms (let’s call these Group 2). From a life insurance product perspective, Group 1 cases could primarily impact Disability covers, while Group 2 cases could additionally impact Critical Illness, Long-term Care and Life covers.
|Extreme fatigue||Post viral-fatigue? CFS||DI|
|Muscle weakness||Post viral-fatigue?||DI|
|Low grade fever||Post viral-fatigue?|
|Changes in mood||Brain affection?||DI|
|Sleep difficulties||Post viral-fatigue?|
|Headaches||Brain affection? Post viral-fatigue?|
|Cognitive dysfunctions||Brain affection? “Brain fog” → Dementia||DI, LTC|
|Changes in mood||Brain affection?||DI|
|Renal function tests||Kidney dysfunction||Life, CI, DI|
|Liver function tests||Liver dysfunction||Life, CI, DI|
|New onset of diabetes||Diabetes||Life, CI, DI|
|New onset of hypertension||Hypertension||Life, CI, DI|
|Shortness of breath, cough||Lung affection → Lung fibrosis?||Life, CI, DI|
|Chest pain, palpitations||Heart affection → Cardiomyopathy, Chronic heart failure?||Life, CI, DI|
Table 1: Summary of the symptoms/signs of long Covid and potentially impacted life insurance products; Disability (DI), Critical Illness (CI), Long-term Care (LTC) & Life. Left, Group 1 symptoms/signs of long Covid fluctuate and are medically unspecific. Right, Group 2 symptoms are specific and can be objectively measured. You’ll notice a lot of question marks in these tables: This, I’m afraid, is the reality of a new virus as more time/data is needed to fill-in the gaps in our understanding. Source: PartnerRe.
Who’s at risk? All ages can be impacted, even the young and healthy. However, the risk of developing long Covid increases amongst those who were hospitalized, older ages, and for those with pre-existing chronic conditions4.
And can it be stopped? Here I am pleased to end on a positive note. Although further studies are needed, SARS-CoV-2 vaccination has been reported to significantly reduce, if not stop, long Covid symptoms in some individuals5. The efficacy of some of the vaccines is very high, in particular the mRNA vaccines (currently at 94-95% efficacy with respect to hospitalization and death). As vaccination programs expand and new vaccines are developed, including the highly promising pan-corona vaccine6, vaccination could, in my opinion, also hold the key to conquering the long side of Covid.
Achim Regenauer, Chief Medical Officer, Europe and Asia Pacific
1 E.g. https://www.nursingtimes.net/news/coronavirus/nice-defines-long-covid-as-symptoms-lasting-more-than-12-weeks-30-10-2020/
4 E.g. https://www.nature.com/articles/s41591-021-01292-y
6 E.g. https://jamanetwork.com/journals/jama/fullarticle/2776542