While we once hoped that the pandemic would be a time-limited phenomenon, we now know that it will affect us long into the future. Long-term COVID has emerged as a new multi-organ chronic disease with a significant health and cost burden, which may disproportionately affect our healthcare workers. As we plan for the next decade, healthcare stakeholders must start to think differently about how patients access and receive healthcare.

Long-term COVID may affect 51 to 75% of people after active infection. IQVIA reported that 22% of individuals in a population study had symptoms beyond 90 days, not including an unknown number of “shadow post-COVID” individuals who may not have had a diagnosis but developed symptoms. A recent study of 273,613 COVID survivors showed that compared to influenza survivors, there was a 16.6% increase in the incidence of long-term COVID, indicating that these symptoms may be specific to coronavirus. The Centers for Disease Control and Prevention (CDC) defines long-term COVID (or post-COVID conditions) as symptoms that occur or continue 4 weeks after initial infection with COVID-19. Eighteen symptoms characterize the disorder, including neurologic, cardiovascular, pulmonary, gastrointestinal, dermatologic, and systemic symptoms. In July, the Department of Health and Human Services (HHS) declared long-term COVID a condition protected under the Americans with Disabilities Act. Knowingly or unknowingly, many people will develop long-term COVID, which can cause new diseases, worsen already present illness, and be costly to the healthcare system.

The most common symptoms appear to be neurologic, respiratory, and cardiovascular, including hypertension and hyperlipidemia, which may cost the healthcare system an estimated 3.8 to 43.2 billion globally. Several studies have shown an increase in the number of patients developing diabetes, which may be due to undiagnosed diabetes, COVID-19 treatment with steroids, or the direct effects of COVID-19 on the beta-cell. In addition to a possible increase in certain chronic diseases, we may also see worsening illnesses. Foster et al found that Latino patients with preexisting asthma were more likely to have a longer duration of asthma exacerbations than non-Latinos, a mean of 3.2 weeks compared to around 1.5 weeks for other groups. The authors attributed this increase to possible ongoing respiratory inflammation post-COVID. Finally, a recent study of hospitalized patients with ongoing dyspnea showed possible myocardial abnormalities. While all patients globally are at risk, frontline workers have had the most exposure and may be unduly affected.

In one hospital system with 144 healthcare employees with previous COVID-19 infections, only 19% felt 100% recovered after 12 weeks. The most common symptoms were fatigue and sleep disorders. Another study showed that 32% of those testing positive had persistent symptoms 3 to 4 months out. An estimated 11% of healthcare workers have had COVID-19, and some reports are higher. The ongoing waves of variants, continued risk of infection, and the emotional drain from the pandemic disproportionately affect frontline healthcare workers, putting the entire healthcare system at risk of dysfunction.

All is not lost, though. Healthcare stakeholders can pivot and create new strategies for healthcare delivery. However, it will take innovative and collaborative approaches to achieve.

  1. Payers and health systems will need to identify patients at risk for long-term COVID to prevent later complications. These include the downstream effects of new-onset diabetes, renal disease, hypertension, hyperlipidemia, and sleep disorders. Electronic health record (EHR) pursuit lists of previously infected patients can target patients who need screening for early intervention.
  2. As we have seen, COVID-19 has accelerated the adoption of telemedicine and remote patient monitoring. In addition, the pandemic has battered the healthcare workforce in terms of burnout from long hours, high hospital mortality rates, and personal COVID infection. Many people have become accustomed to accessing services from home, including groceries and medical care. Investment in telehealth and remote patient monitoring to increase access to care and remote work options for healthcare workers may assist in the healthcare system’s recovery.
  3. Pharmaceutical companies, payers, and academic centers can partner to develop diagnosis and treatment algorithms for post-COVID conditions as we see a growth in the disease burden in the neurologic, respiratory, and endocrinology space. New processes can combat the patient and clinician inertia from stay-at-home orders and remote care.

We need to change our mindset that a pandemic is a one-time event.  It will have long-lasting effects for decades to come, not only in terms of disease incidence and severity but also in how we deliver medical care. The most innovative and forward-thinking companies that develop unique tools to address this population will likely succeed in this new environment.