More than 6 million people have died from COVID-19 worldwide, including nearly 1 million in the US.1 But mortality is not the only adverse consequence of COVID-19. Many survivors suffer long-term impairment, officially termed postacute sequelae of SARS-CoV-2 infection and commonly called long COVID. Long COVID—typically defined as symptoms lasting more than 30 days after acute COVID infection—has received some public attention, but it is not nearly as intense as it is for acute COVID-19 infection. Support groups are devoted to the condition, and Congress has allocated more than $1 billion to the National Institutes of Health to study it. But the relatively meager attention that has been paid to long COVID is unfortunate because its health and economic consequences are likely to be every bit as substantial as those due to acute illness. Open access, https://jamanetwork.com/journals/jama-health-forum/fullarticle/2792505
"People who are no longer able to work may also apply for Social Security Disability Insurance. To date, there has been no sustained increase in disability insurance applications since the onset of COVID-19. This is good news, though it bears watching as disability centers continue reopening from their COVID-19 shutdowns. Increased medical spending is another consequence of long COVID. The medical costs for treating long COVID have not been estimated, but costs have been estimated for similar conditions. If treatment of long COVID is similar to treatment of myalgic encephalomyelitis (chronic fatigue syndrome), these estimated costs could be about $9000 per person annually.8 In an October 2020 analysis, we estimated9 the then-nascent COVID-19 pandemic might result in $2.6 trillion of cost as a result of long COVID. Unfortunately, our estimate seems very much on target."
That's very strange, given the wave of LC. Maybe many pwLC aren't even bothering? Also, SSDI applications seem to be correlated with the economy. They drop as unemployment drops--presumably people in marginal health are shifting towards work. Maybe an increase in long haulers is being offset by a drop in other applications.
What treatment of ME? It's not treating ME that costs $9K per year, it's not even treated at all in most cases. And the economic loss per person is far greater than $9K on average, it not only has to account for loss of income (at a median of something like $40K/y in the US) in addition to other indirect costs such as carers. Those numbers are way off. The bit about disability insurance applications is impressive, it simply does not understand that most people simply never get to that point because you need a GP to sign off on that and they mostly aren't. In most cases it's not even coded using the same excuses as with us: "there's nothing we can do about it anyway". Which is of course a main reason why, a special kind of loopy self-defeat. The cost analysis is very different here. ICU hospitalization costs that are typical in death from COVID are enormous direct expenses. In the case of issues like Long Covid, most of the costs are indirect and hard to track, most of those have to do with the complete inefficiency of how there is no expertise in chronic illness, how testing is chaotic and random, patients bumped around between people who check one thing and one thing only. Needs to do a lot better than this.
You don't need a doctor's permission to apply for SSDI. A doctor who provides detailed info about your functioning will help you get approved, but this stat tracks applications. However, you may be right that people aren't applying because their doctors don't support them, hence, they don't expect to get approved.
Back in the day (1999-2000) when I finally applied for US social security disability, I first had to exhaust 6 months of state disability. And prior to applying for social security disability (federal), I also went through a vocation rehab program run by the state to exhaust all possible alternative careers. It made my application more convincing. And then after being awarded SSD benefit, still had to wait a long time for medical benefits (Medicare). Article in the US news about social security office having a back log of applications for people applying for retirement benefits because of general office-covid problems.
There's cross over with this thread: https://www.s4me.info/threads/chron...rkforce-the-sickest-in-developed-world.28736/ esp.this post: https://www.s4me.info/threads/chron...sickest-in-developed-world.28736/#post-441347 The picture of where in the general population postacute sequelae of SARS-CoV-2 infection is distributed is still poorly described, if it were to follow the main morbidity pattern then it might be expected that postacute sequelae are most prominently represented in the over 50s. This population includes those already on pensions and those able to take early ill health retirement with few financial penalties. It also includes a high number of people who are already chronically and/or disabled. The conflation of postacute sequelae of SARS-CoV-2 with ME/CFS is looking more unhelpful as time goes on, that some postacute sequelae of SARS-CoV-2 equate to ME/CFS isn't grounds to take the two as a mix and match.
It's mostly that it's the step of last resort. Especially in the US, private insurance is the first step, then there are (usually state) programs for temporary disability and only later SSDI with nothing in-between, federal disability often happens many years into it. It's similar here in Canada, in my case it took 8 years, there was simply no way to initiate it without my GP signing off and my father had to do all the work, chasing what form to use, then many backs-and-forth with my GP, there are clearly instructions to keep those to a minimum.
Won’t the stopping work and applying for benefits for many still be a bit down the track? I fought for years to keep working. I only went part time after some four years post onset and was eventually force to give up work altogether after some eight years.
The author has updated his cost estimate in this PDF, mostly based on ME/CFS. He assumes people with 3+ LC symptoms are at 0.71 QALY for five years and 70% of them are out of work. That seems a little high to me for the number of people out of work, but probably in the ballpark. The five years is optimistic.
It depends on your profession, location (if there is a commute) etc I guess. I also wonder whether those who are in positions where they are more able to manage ie in relationships where partner works giving options to cut back or go self-employed or look after kids (people don't like to say 'gave up work') combine in similar demographics to those who might be in roles that aren't on their feet or physical and migth have had increased homeworking. Flexibility of hours is a tricky one - who gets to go part time and still keep their salary and job has always been a question that intrigues me and seems to involve those who know how to go about it too. Anyway all of these adjustments I will be honest, and we are honest about the bigotry, are often more likely to happen if someone doesn't cite their disability (particularly chronic illness) just like I'm pretty sure my workload went up the more honest I was because you seem to have to prove yourself but also - well if you are in a team then even if you are doing all the work if the team underperforms then the boss has the 'illness/disability' excuse upwards and so I suspect instead of excess work (eg when someone leaves and isn't replaced for a long time) being on the plate of the person 'who is ill anyway' vs dividing it across everyone and them getting ill. Well my point is that 'playing the game' involves not focusing on your 'weaknesses' when getting 'special measures'. Consequently I'm not sure those people would count themselves into these numbers either. Until they have to be counted into them.
I'm in the USA. Back in 2000-2001, when I was going through the application process for long term disability (LTD), my lawyer told me that most workers have only social security (SSDI) coverage for LTD benefits - no private or employer LTD policy. (and some folks don't even qualify for SSDI due to various reasons, eg, haven't worked long enough to qualify) (I'm leaving out state disability benefits programs since I don't know anything about them!) I have no idea what the statistics are now. Maybe things have changed? Maybe most people now do have both SSDI coverage and some additional LTD policy on top of that? Also, I think I use the term "private" a bit differently from you? There are two categories of LTD policies that I know about. 1. Large employers often have LTD policies as part of their employee benefits package (the company pays the insurance premiums). Almost all company provided LTD policies are covered by ERISA laws. It's very hard to get benefits approved for these policies. Most claims are denied. I don't know of anyone who won an ERISA benefits claim without a lawyer (unlike SSDI where I applied myself, no lawyer, and was approved). These LTD policies usually require the employee to file for social security disability benefits in order to reduce the amount the insurance company has to pay. 2. Some people buy what I would call private LTD policies (the employee pays the insurance premiums themselves). These are usually people with higher income and who buy "own occupation" policies. Let's say a surgeon develops a tremor. They can't do surgery any more but they probably could do some other job. Their private "own occupation" LTD policy still pays them benefits if they can't do their specific job. These do not have the problems with denying benefits that ERISA LTD policies have. Social security disability is "any occupation" policy. You have to show that you can't work at any kind of full time job. Getting back to Long Covid, this is pure speculation but I agree with the comments that it may take a while before someone gets to the point where they have to go long term disability. When I first got sick I used my short term disability (go on medical leave, rest for a few months, go back to work, repeat) for a few years. I didn't realize that pushing myself was making me worse over the long term.
