It’s the most succinct and abstract name for Covid: U09.9 – a medical diagnostic code created last year to allow doctors to document post-Covid cases.
Now, a large new study has analyzed data from the first few months after the code went into effect, and the results paint a realistic picture of Covid’s serious and continuing impact on people’s health and the US health care system.
The analysis, based on what the report calls the largest database of private health insurance claims in the United States, found 78,252 patients diagnosed with the ICD U09. Between October 1, 2021 and January 31, 2022, the vast majority of them were not hospitalized due to the primary infection.
Dr Claire Steves, a clinical academic and physician at King’s College London, who was not involved in the new research, said the total number of people who received the diagnosis was “huge”, in particular. Given that the study covered only the first four months after the diagnosis code was submitted and did not include people covered by state health programs like Medicaid or Medicare (although it did include people on private Medicare Advantage plans). “It’s probably a drop in the ocean compared to the real number,” Dr. Steves said.
The study, conducted by FAIR Health, a nonprofit focused on health care costs and insurance issues, found that for 76 percent of patients, initial coronavirus infections did not make them sick enough to require hospitalization. However, months later, they were experiencing symptoms diagnosed as post-Covid conditions, including breathing problems, coughing, fatigue and high blood pressure.
“It leads to a pandemic of people who are not hospitalized, but who end up with increasing disability,” said Dr. Paddy Sentongo, assistant professor of infectious disease epidemiology at Penn State, who was not involved in the new study.
Another startling finding was that while two-thirds of patients had pre-existing health conditions in their medical records, nearly a third did not, a much larger proportion than Dr. Sentongo said he had expected. “These are the guys who have been healthy and are like, ‘Guys, something’s not right with me,'” he said.
The researchers plan to continue tracking patients to see how long their symptoms last, but Robin Gilboard, president of FAIR Health, said the organization has decided to release data from the first four months now, “due to the necessity” of the problem. .
She said the researchers were working to try to answer some of the questions not covered in the report, including providing details of some patients’ previous health conditions in an effort to determine whether certain medical problems put people at risk of developing Covid for a long time.
The organization also plans to analyze how many patients were vaccinated in the study and when, Ms Gilbord said. More than three-quarters of the patients in the study were infected in 2021, most in the latter half of the year. On average, patients were still with prolonged Covid symptoms qualifying for a diagnosis four and a half months after infection.
The findings suggest a potentially staggering impact of Covid on young people, and on society as a whole. Nearly 35 percent of patients were between the ages of 36 and 50, while nearly a third were between 51 and 64 years old, and 17 percent were between 23 and 35 years old. Patients were 12 years old or younger, while nearly 7 percent were between 13 and 22 years old.
Six percent of the patients were 65 years of age or older, a percentage likely reflecting the fact that patients included in the regular Medicare program were not included in the study. They were more likely to have pre-existing chronic medical conditions compared to younger groups with long-term Covid disease.
The insurance data analyzed did not include information on the race or ethnicity of the patients, the researchers said.
The analysis, which Ms Gilboard said was evaluated by an independent academic reviewer but not formally peer-reviewed, also calculated a risk score for patients, a way of estimating how likely people are to use health care resources. Comparing all insurance claims patients had up to 90 days before contracting Covid with their claims 30 or more days after injury, the study found that average risk scores rose for patients in each age group.
Ms Gilbord and other experts said the scores indicate that the fallout from Covid-19 is not just about increased medical spending. Gilboard said it refers to “how many people are leaving their jobs, how many have a disability status, and how much school is absent.” “It’s like a pebble thrown into a lake, and these ripples that go around the pebble are concentric circles from the collision.”
Because the study only accommodated the privately insured population, Dr Sentongo said, it almost certainly underestimates the long scope and burden of Covid, especially since low-income communities have been disproportionately affected by the virus and often have less access to healthcare. “I think it could be worse if we added the Medicaid population and all those other people that would have been missed” in the study data, he said.
The study reported that sixty percent of patients with a post-Covid diagnosis were female, compared with 54 percent of COVID patients overall in the FAIR Health database. However, in the older and younger age groups, the number of males was approximately equal to the number of females.
“I think there is a female preponderance for this condition,” Dr. Steves said, adding that reasons could include differences in biological factors that make women more susceptible to autoimmune diseases.
Insurance claims showed nearly a quarter of Covid patients had respiratory symptoms, nearly a fifth had a cough, and 17 percent were diagnosed with malaise and fatigue, a far-reaching category that can include problems such as brain fog and fatigue. It gets worse after physical or mental activity. Other common problems included abnormal heartbeats and sleep disturbances.
The study reported that generalized anxiety disorder was more common in people aged 23-35 years than in other age groups, while hypertension was more common in older patients.
Last year, FAIR Health published a study tracking the insurance records of nearly two million people who contracted Covid, which found that after a month or more of infection, nearly a quarter — 23 percent — had sought medical treatment for new cases.
The new study attempted to determine how common some symptoms were before patients became infected compared to the period when these same patients were diagnosed with post-Covid cases. It found that some uncommon health issues were more likely to arise during the prolonged Covid period. For example, muscle problems occurred 11 times more often in patients with long-term Covid disease, pulmonary embolisms occurred 2.6 times, and certain types of brain-related disorders occurred twice as often, the study said.
Like previous studies, the report found that if patients needed to be hospitalized for an initial infection, they were at greater risk of developing long-term symptoms than patients who were not hospitalized. The report came to this conclusion because about 24 percent of patients diagnosed with a post-Covid condition have been hospitalized – more males than females – while only about 8 percent of all coronavirus patients required hospitalization.
However, because the vast majority of people do not need to be hospitalized because of their infection, medical experts said this and other studies suggest that many people with mild or moderate initial illness will end up with long-term symptoms or health problems. New after covid.
Ms Gilboard and medical experts said that as doctors became more familiar with the U09.9 code, they might use it for different circumstances than they did in the first four months.
Given the potential size of the Covid-19 virus, Dr. Sentongo said he expects doctors to ask patients in the future whether they have been diagnosed with post-Covid cases, just as they ask doctors about other past medical problems so they can treat patients appropriately.
“Post-Covid syndrome may become one of the most common pre-existing comorbidities in the future,” he said.