Irv Lichtenwald

No mask, no pandemic, right?

May 26, 2022

COVID-19, Healthcare Industry, Public Health 7 Minute Read

The end of the public transportation mask mandate, officially undone by federal Judge Kathryn Mizelle on April 18, may be recognized as the day the COVID-19 pandemic ended in America.

Except it hasn’t ended in any real sense. The virus continues to produce new variants of greater or lesser transmissibility and lethality; for now, comparatively small numbers of people continue to die of the virus daily and weekly; and the CDC continues to recommend that the elderly and immunocompromised take every precaution.

But America is mostly done with the virus, even if the virus is not done with us.

In truth, the virus won’t really be done mucking with things for some time … some undetermined amount of time in which reality will feel off-kilter and the country will be aware of COVID-19 but in a remote, unsettling way, like far-off thunder.

And that’s just with regard to the rate of infection. The extenuating circumstance — that a set of tenacious virus-related symptoms now commonly called long Covid might extend the performance longer than Cats ran on Broadway —has scientists and public health experts concerned about a slow-burning epidemic that lasts for years and touches almost every corner of American society.

“Researchers still don’t know who’s most at risk, or how long the condition might last; whether certain variants might cause it more frequently, or the extent to which vaccines might sweep it away,” writes Katherine Wu in the Atlantic. “We do not have a way to fully prevent it. We do not have a way to cure it. We don’t even have a way to really quantify it: There still isn’t consensus on how common long COVID actually is. Its danger feels both amorphous and unavoidable.” 

But more than two years into the pandemic, the repercussions of long Covid are not that hard to define, even if the virus itself remains elusive. In several ways, both the coronavirus and long Covid are having a significant impact on American society, but the signs are probably not overt or common knowledge unless we connect some dots.

You’re probably already aware of the American labor shortage, for example. Maybe you tried to go to a nearby restaurant for lunch and found it closed for lack of employees. Perhaps your company is trying to hire and can’t find qualified applicants. There is a decent chance that the shortage of labor is in part the product of long Covid.

According to an analysis by the Brookings Institution, there are currently more than 10 million unfilled jobs in the United States. After evaluating long-Covid studies and crunching the numbers, “under reasonable assumptions given the data available, long Covid could account for 15 percent of the nation’s 10.6 million unfilled jobs.”

While many economists see a return to normalcy after the pandemic burns out or is brought under control, neither has happened, and long Covid just pushes the finish line further and further out. That Covid infections have waned but not dissipated still has some positive economic impact, to be sure, but none of that is helped by the numbers of workers with long Covid who cannot return to the labor force full-time or at all.

“If workers flood back to the job market as school and child care becomes more dependable and health risks recede, it will be easier for manufacturers and shipping companies to ramp up production and deliveries, giving supply a chance to catch up to demand,” says The Washington Post’s Ben Casselman. “That in turn could allow inflation to cool without losing the economy’s progress over the past year.”

The more the virus spreads, the more long Covid persists, and the greater the impact on the labor market and the economy as a whole, making it a significant concern for the foreseeable future.

Of course, a labor shortage across American industry will also impact healthcare, but that’s nothing new—healthcare was operating with fairly acute and worsening labor shortages before anyone had heard of COVID-19.

That scarcity of labor naturally creates a competition for qualified personnel that drives up healthcare costs overall, and the scarcity has worsened during the pandemic as many exhausted and often abused clinicians have opted out of healthcare entirely. Long Covid just adds more patients with chronic illness to a system with fewer providers. Costs cannot help but rise, even if how much is still an open question.

Unless the virus loses strength and becomes more endemic than the pandemic, and then perhaps even if it does, we can also expect increased costs created by the unvaccinated. In several months of 2021 there were 163,000 deaths and 700,000 hospitalizations among the unvaccinated at a cost of $13.8 billion. Recent studies suggest that vaccines reduce the likelihood of long Covid without fully eliminating the possibility.

Many of the costs created by long Covid in particular may be borne by the patient, not the system.

“The system is gearing itself against individuals with long Covid,” said Dr. David Putrino, director of rehabilitation innovation for Mount Sinai Health System in New York. “And that makes them sicker and sicker over time … causing them so much stress and exertion as they’re trying to get care that it actually makes the condition worse.”

Indeed, skepticism regarding long Covid — some medical professionals have labeled it a mental illness— calls to mind the medical response to conditions like fibromyalgia, particularly because more women than men experience long Covid.

“Extrapolating from the experience with other postinfection syndromes, the varied elements of the biomedical and media ecosystems are coalescing into two familiar polarized camps,” wrote Steven Phillips and Michelle Williams in the New England Journal of Medicine. “One camp believes that long Covid is a new pathophysiological syndrome that merits its own thorough investigation. The other believes it is likely to have a nonphysiological origin.”

As past experience has shown, chronic illnesses that are not treated directly by the healthcare system often end up as ER visits that increase both overall healthcare costs and the financial burden on individual patients, ensuring that almost everyone loses.

And then there is the impact of Covid, both short and long, on American society in general, which will be felt but difficult if not impossible to actually quantify. Most countries don’t keep a running total of long Covid cases, which means the virus will sort of lurk in the background, often out of sight and mind but occasionally front and center as someone you know deals with acute illness or the long-term implications of infection.

“As people rack up different combinations of shots and infections with different variants, what worsens or soothes long COVID is also getting harder to understand,” says the Atlantic’s Wu. “Many of the experts I’ve spoken with over the past two years have told me that while they think long COVID is essential to study, it’s too complex for them to want to tackle themselves.”

Assuming what these experts say holds, the country faces a disconcerting prospect: The virus continues to evolve and infect. Meanwhile, a certain percentage of all those infected develop long-term symptoms for which there are no well-defined treatments—at least not yet. These long-haulers, as they are sometimes called, become a chronic disease class that the system works to treat in terms of symptoms but which adds costs for care, labor requirements, and probably the price of insurance premiums.

At this point, we’re left with stopgap measures, which include mRNA vaccines and which are similar to dealing annually with influenza.

Our hope and prayer at this point might be that another virus or a particularly virulent version of this one not emerge until we figure out what Covid-19 is, exactly, and how it can be dealt with.

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