Late in March, Laura Gross, 72, was recovering from gall bladder surgery in her Fort Lee, N.J., home when she became sick again.
Her throat, head and eyes hurt, her muscles and joints ached and she felt like she was in a fog. Her diagnosis was COVID-19. Four months later, these symptoms remain.
Gross sees a primary care doctor and specialists, including a cardiologist, pulmonologist, endocrinologist, neurologist, and gastroenterologist.
"I've had a headache since April. I've never stopped running a low-grade temperature," she said.
Studies of COVID-19 patients keep uncovering new complications associated with the disease.
With mounting evidence that some COVID-19 survivors face months, or possibly years, of debilitating complications, health-care experts are beginning to study possible long-term costs.
Bruce Lee of the City University of New York (CUNY) Public School of Health estimated that if 20 per cent of the U.S. population contracts the virus, the one-year post-hospitalization costs would be at least $50 billion US, before factoring in longer-term care for lingering health problems. Without a vaccine, if 80 per cent of the population became infected, that cost would balloon to $204 billion.
Some countries hit hard by the novel coronavirus — including the United States, Britain and Italy — are considering whether these long-term effects can be considered a "post-COVID syndrome," according to Reuters interviews with about a dozen doctors and health economists.
Some U.S. and Italian hospitals have created centres devoted to the care of these patients and are standardizing followup measures.
Britain's Department of Health and the U.S. national Centers for Disease Control and Prevention are each leading national studies of COVID-19's long-term impacts. An international panel of doctors will suggest standards for mid- and long-term care of recovered patients to the World Health Organization (WHO) this month.
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Years before cost is known
More than 18 million people have been infected by the coronavirus worldwide, about a quarter of them in the United States.
Health-care experts say it will be years before the costs for those who have recovered can be fully calculated, not unlike the slow recognition of HIV, or the health impacts to first responders of the Sept. 11, 2001, attacks on the World Trade Center in New York.
The costs stem from COVID-19's toll on multiple organs, including heart, lung and kidney damage that will likely require costly care, such as regular scans and ultrasounds, as well as neurological deficits that are not yet fully understood.
A JAMA Cardiology study found that in one group of COVID-19 patients in Germany aged 45 to 53, more than 75 per cent suffered from heart inflammation, raising the possibility of future heart failure.
A Kidney International study found that over a third of COVID-19 patients in a New York medical system developed acute kidney injury, and nearly 15 per cent required dialysis.
Dr. Marco Rizzi in Bergamo, Italy, an early epicentre of the pandemic, said the Giovanni XXIII Hospital has seen close to 600 COVID-19 patients for followup. About 30 per cent have lung issues, 10 per cent have neurological problems, 10 per cent have heart issues and about nine per cent have lingering motor skill problems. He co-chairs the WHO panel that will recommend long-term followup for patients.
"On a global level, nobody knows how many will still need checks and treatment in three months, six months, a year," Rizzi said, adding that even those with mild COVID-19 "may have consequences in the future."
Milan's San Raffaele Hospital has seen more than 1,000 COVID-19 patients for followup. While major cardiology problems there were few, about 30 per cent to 40 per cent of patients have neurological problems and at least half suffer from respiratory conditions, according to Dr. Moreno Tresoldi.
Some of these long-term effects have only recently emerged, too soon for health economists to study medical claims and make accurate estimates of costs.
In Britain and Italy, those costs would be borne by their respective governments, which have committed to funding COVID-19 treatments but have offered few details on how much may be needed.
In the U.S., more than half of the population is covered by private health insurers, an industry that is just beginning to estimate the cost of COVID-19.
CUNY's Lee estimated the average one-year cost of a U.S. COVID-19 patient after they have been discharged from the hospital at $4,000, largely due to the lingering issues from acute respiratory distress syndrome (ARDS), which affects some 40 per cent of patients, and sepsis.
The estimate spans patients who had been hospitalized with moderate illness to the most severe cases, but does not include other potential complications, such as heart and kidney damage.
Even those who do not require hospitalization have average one-year costs after their initial illness of $1,000, Lee estimated.
'Hard just to get up'
Extra costs from lingering effects of COVID-19 could mean higher health insurance premiums in the U.S. Some health plans have already raised 2021 premiums on comprehensive coverage by up to 8 per cent due to COVID-19, according to the Kaiser Family Foundation.
Anne McKee, 61, a retired psychologist who lives in Knoxville, Tenn., and Atlanta, had multiple sclerosis and asthma when she became infected nearly five months ago. She is still struggling to catch her breath.
"On good days, I can do a couple loads of laundry, but the last several days, it's been hard just to get up and get a drink from the kitchen," she said.
She has spent more than $5,000 on appointments, tests and prescription drugs during that time. Her insurance has paid more than $15,000, including $240 for a telehealth appointment and $455 for a lung scan.
"Many of the issues that arise from having a severe contraction of a disease could be three, five, 20 years down the road," said Dale Hall, managing director of research with the Society of Actuaries.
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To understand the costs, U.S. actuaries compare insurance records of coronavirus patients against people with a similar health profile but no COVID-19 and follow them for years.
The United Kingdom aims to track the health of 10,000 hospitalized COVID-19 patients over the first 12 months after being discharged and potentially as long as 25 years. Scientists running the study see the potential for defining a long-term COVID-19 syndrome, as they found with Ebola survivors in Africa.
"Many people, we believe will have scarring in the lungs and fatigue … and perhaps vascular damage to the brain, perhaps, psychological distress as well," said Prof. Calum Semple from the University of Liverpool.
Margaret O'Hara, 50, who works at a Birmingham hospital is one of many COVID-19 patients who will not be included in the study because she had mild symptoms and was not hospitalized. But recurring health issues, including extreme shortness of breath, has kept her out of work.
O'Hara worries patients like her are not going to be included in the country's long-term cost planning.
"We're going to need … expensive followup for quite a long time," she said.