What Employers Need to Know About Lasting COVID-19 Complications & Rx Costs

A year has passed since the COVID-19 pandemic began, and we are learning more every day about the virus and its lasting “long-hauler” health impact. Rather than taking a wait-and-see approach, employers should be proactively managing these employee health risk factors and plan for the related benefits cost increases.

It’s hard to believe that a year has passed since the COVID-19 pandemic began. We are learning more every day about the virus, its variations, and the health impact they have on affected people – both in the short-term and long-term. While we know that the majority of people who contract COVID-19 are not dying, we also know that not all of them are recovering as expected. What we don’t know is just how many people will remain affected long-term and the toll it will take on their health, our healthcare system, and healthcare costs. All of these potential impacts should be considered, as fully-insured plans receive their premium renewal notices and as self-insured plans prepare their upcoming benefits strategies for 2021 and beyond.

A year has passed since the COVID-19 pandemic began, and we are learning more everyday about the virus and its lasting “long-hauler” health impact. Rather than taking a wait-and-see approach, employers should be proactively managing these employee health risk factors and plan for the related benefits cost increases.

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Long-Haulers: COVID-19’s Lasting Health Impact

It is plausible that tens of thousands of people in the United States alone may never be the same again after recovering from a COVID-19 diagnosis. Older people and those with serious underlying medical conditions are the most likely to experience lingering COVID-19 symptoms. However, even young, otherwise healthy, people report feeling unwell for weeks to months after infection.

The virus can damage the lungs, heart, and brain, which increases the risk of potential long-term health problems. The most common signs and symptoms that linger include fatigue, shortness of breath, cough, joint pain, muscle pain, chest pain, brain fog, depression, headache, intermittent fever, and heart palpitations. Additional lingering symptoms may include muscle pain or headache, fast or pounding heartbeat, ongoing loss of smell or taste, memory, concentration or sleep problems, and rash or hair loss. These persistent symptoms have led to a new term used to refer to recovering individuals: “long-haulers.”

Here’s a breakdown of what has been seen so far and the effects on various parts of the body:

• Heart damage: Imaging tests taken months after recovery from COVID-19 have shown lasting damage to the heart muscle, even in people who experienced only mild COVID-19 symptoms. This may increase the risk of heart failure or other heart complications in the future.
• Lung damage: The type of pneumonia often associated with COVID-19 can cause long-standing damage to the tiny air sacs, called alveoli, in the lungs. The alveoli damage results in an irreversible scar tissue (fibrosis) forming, which can lead to long-term breathing problems.
• Brain damage: Even in young people, COVID-19 can cause strokes, seizures and Guillain-Barre syndrome — a condition that causes temporary paralysis. COVID-19 may also increase the risk of developing Parkinson’s disease and Alzheimer’s disease.
• Blood clots and blood vessel damage: COVID-19 can make blood cells more likely to clump up and form clots. While large clots can cause heart attacks and strokes, much of the heart damage caused by COVID-19 is believed to stem from very small clots that block tiny blood vessels (capillaries) in the heart muscle. Blood clots also affect the lungs, legs, liver, and kidneys. COVID-19 can also weaken blood vessels and cause them to leak, which contributes to potentially long-lasting problems with the liver and kidneys.
• Mood changes and fatigue: People with severe COVID-19 symptoms are often treated in a hospital’s intensive care unit, with mechanical assistance such as ventilators to breathe. Simply surviving such an experience increases the likelihood of that person later developing post-traumatic stress syndrome, depression, and anxiety.

The long-term significance of these “long-hauler” symptoms and complications are not yet known. The situation is different for everyone infected, which presents a unique challenge for health management in general and specifically for employers providing healthcare benefits to impacted employees and members. The Centers for Disease Control (CDC) is continuing to actively investigate the virus and providing updates as new data emerge. Insights gleaned over the coming months may help inform COVID-19 clinical care as well as the public health response to the virus.

General Population Mental Health Impacts

The devastation of the pandemic — including 500,000 deaths and counting, severe economic strife, and unprecedented curbs on social interaction — has had a significant impact on people’s mental health regardless of whether they were infected with COVID-19. In a December 2020 U.S. Census Bureau survey, more than 42% of people reported symptoms of anxiety or depression in December, an increase from 11% the previous year. The distress is believed to stem from people’s limited social interactions, tensions among families in lockdown together, and fear of illness.

Data also shows that young people are more vulnerable than older people to the increased psychological distress – perhaps because their need for social interactions are stronger – and that young women are more vulnerable than young men. Additionally, people with young children or a previously diagnosed psychiatric disorder, are at particularly high risk for pandemic-induced mental health problems.

With long-term closures of schools and childcare centers, many parents are experiencing ongoing disruption to their daily routines. KFF reports that over half of women with children under the age of 18 have reported negative impacts to their mental health due to worry and stress from the coronavirus. Early on, roughly 30% of men with children reported these negative mental health impacts. By summer, nearly half (49%) of men with children under the age of 18 reported the pandemic was having a negative impact on their mental health.

Costs of Treating Long-Term COVID Complications

To date, several treatment options are being used to manage symptoms. These therapies represent a small fraction of possibilities in how “long-hauler” complications are treated. Understanding the potential costs to both the medical and pharmacy benefits is important, as employers prepare for the potential health and cost implications.

• Cardiovascular Treatment: People with lasting damage to the heart muscle may require blood pressure medications, which help the heart not work as hard. Fortunately, many blood pressure medications are inexpensive generics. Examples include thiazide diuretics priced at $2 – $5 per month; or ACE (Angiotensin-Converting Enzyme) Inhibitors, such as lisinopril which ranges from $2 – $10 per month.
• Pulmonary Treatment: The lung scarring that occurs in pulmonary fibrosis is irreversible, and no current treatment has proved effective in stopping the progression of the disease. Some treatments used to temporarily or slow the disease’s progression and manage symptoms can be quite costly. Examples include Ofev^®, which costs about $10,600 per month; Esbriet^® priced at approximately $9,600 per month; or steroids and immunosuppressants, such as prednisone or mycophenolate that cost less than $100 per month.
• Neurological Treatments: People requiring short- or long-term seizure prevention and control medications may be prescribed carbamazepine or topiramate, both of which are available as generics and priced at around $25 per month. Newer seizure prevention and control therapies can exceed several hundreds of dollars per month.
• Hematological Treatments: Several medications may be prescribed to treat an acute, post-stroke, or at-risk patient. Examples include inexpensive over-the-counter blood-thinning agents, such as a daily aspirin. Prescription-based options include clopidogrel, priced at about $5 per month, and brand-name Xarelto^® or Eliquis^®, which cost about $500 per month. An additional layer of protection can be provided using cholesterol-lowering agents, such as generic Lipitor^® or Crestor^® (atorvastatin or rosuvastatin), which can be procured for less than $20 per month.
• Mood and Fatigue Treatment: Treating mood-related conditions may involve the use of antidepressant medications, such as generic sertraline or paroxetine, which cost around $15 per month. Additionally, anti-anxiety medications or mood stabilizers may be prescribed, such as generic lorazepam and clonazepam priced at approximately $5 per month. It’s important to note that some anti-anxiety medications may cause psychological dependence, which has separate cost implications unaccounted for here.

The Bottom Line

The bottom line is we don’t know what we don’t know in terms of long-term COVID-19 complications for those infected and the overall mental health impact on the larger population. However, we can work to prepare for the possibilities based on the preliminary “long-hauler” reports and mental health data – and the associated healthcare costs. Taking a wait-and-see approach toward healthcare decision-making may introduce economic and clinical risks that could catch plan administrators unaware. Self-insured plans especially should take a proactive approach to evaluating prescription drug claims data, identifying trends and red flags, and ensuring adequate cost control measures are in place that put the plan and employee health first.

 

 

Resources

• A Clinic Blueprint for Post-Coronavirus Disease 2019 Recovery
• COVID-19 (Coronavirus): Long-term Effects
• CDC: COVID-19 Treatments Your Healthcare Provider Might Recommend if You Are Sick
• CDC: Long-Term Effects of COVID-19
• Harvard Health: What Are the Long-Lasting Effects of COVID-19?
• EPI-WIN: WHO Information Network for Epidemics
• New Data Show Treatment with Lilly’s Neutralizing Antibodies Together Reduced Risk of COVID-19 Hospitalizations and Death by 70 Percent
• IDSA Guidelines on the Treatment and Management of Patients with COVID-19
• COVID’s Mental-Health Toll: How Scientists are Tracking a Surge in Depression
• KFF: The Implications of COVID-19 for Mental Health and Substance Use
• Mayo Clinic: Pulmonary Fibrosis Diagnosis and Treatment
• Pulmonary Fibrosis Treatment Options
• Guideline for Treatment of High Blood Pressure in Adults
• Stroke Treatment and Medications
• Mayo Clinic: Seizure Diagnosis and Treatment
• Mayo Clinic: Post Traumatic Stress Disorder Diagnosis and Treatment
• Harvard Health: Post Traumatic Stress Disorder A-to-Z