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Institute Report
Assessing the Global Burden of Post-COVID-19 Conditions
Modeling the incidence of post-COVID conditions worldwide based on real-word evidence (RWE) and clinical literature review
Dec 06, 2021
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Summary

As the number of reported cases of COVID-19 exceeds 250 million globally and deaths exceed 5 million, there is growing awareness and concern about those who suffer long-term conditions which appear to be associated with the virus. These long-term conditions are likely to impose a large burden on the healthcare system and require careful examination and understanding. However, the breadth of these conditions and their incidence remains unclear.

The objective of the research reflected in this report is to quantify the magnitude of patients with post-COVID-19 conditions based on analysis of medical open claims data and a review of the growing body of literature globally. The research also models the potential demand for medicines required to treat these patients with the post-COVID conditions, even as optimal treatment for these patients is currently based on existing therapeutics.

Key Findings

  • While there are multiple definitions of post-COVID conditions, it generally refers to an umbrella term for the wide range of physical and mental health consequences that are present after at least four weeks of infection with SARS-CoV-2.
  • Despite a growing volume of research, post-COVID conditions remain insufficiently studied, with a lack of consensus on the definition, epidemiology, underlying causes, and effective therapeutics and treatment strategies for patients.
  • Based on IQVIA U.S. medical open claims data as of June 2021, at least 22% (2.2 million) of the 9.7 million COVID-19 tagged patients in the database had one or more conditions (newly diagnosed or persistent) even after 90 days since their COVID-19 diagnosis.
  • The organ systems most frequently affected by these post-COVID conditions as per the claims data include central nervous, cardiovascular, and respiratory systems.
  • Using a global modelling approach and considering the total population diagnosed with COVID-19, at least 104.6 million newly diagnosed conditions were estimated among the reported COVID-19 survivors as of September 15, 2021. If undiagnosed cases are considered, this number would rise to at least 167.3-334.6 million conditions, assuming a factor of 3.2 undiagnosed cases for every 1 reported case in the U.S. and 50% of this factor as a conservative estimate.

Other Findings

  • Various healthcare bodies have been working to define post-COVID conditions; however, these definitions still lack clarity on the exact conditions which can be considered a part of the post-COVID.
  • Post-COVID conditions are known to affect several organ systems in the body including the central nervous system (CNS), cardiovascular system, respiratory, gastrointestinal, renal, and other systems.
  • The public impact of post-COVID conditions is being increasingly recognized by the public health bodies around the world as these groups undertake several initiatives to advance the research and understanding of post-COVID conditions.
  • While terms such as post-acute COVID syndrome, chronic COVID, long-haul COVID, late sequelae, etc., are also being used, the term ‘post-acute sequalae of SARS-CoV-2 infection (post-COVID)’ is used most commonly for research purposes.
  • Post-COVID conditions are now understood as a multi-organ disorder or syndrome that consist of a constellation of different conditions that are acute, chronic or both, and vary in terms of severity.
  • Emerging evidence highlights the post-COVID conditions as dynamic and evolving, with the latest studies reporting more than 200 conditions, which is an increase from the ~100 conditions that were being reported previously.
  • Although less severe, post-COVID conditions are also being detected in children.
  • Within CNS, anxiety disorder, fatigue and depression were the top conditions. Other organ systems including musculoskeletal, gastrointestinal, renal, endocrine, dermatology, ENT, and pediatric together contributed for the remaining 32.4% to this pool.
  • Potential direct effects on the kidney include endothelial damage from viral entry, complement activation, local inflammation, and collapsing glomerulopathy.
  • Although it is well known that acute kidney failure can lead to chronic kidney disease (CKD), knowledge of the long-term effects of COVID-19 on the kidney remains limited.
  • Based on the model calculations, at least 104.6 million conditions were estimated among the 44.2 million post-COVID patients (i.e., 20% of the report COVID-19 survivors), with an average of 2.4 conditions per patient.
  • In order to account for the undiagnosed COVID-19 cases, CDC estimates that for every single COVID-19 reported infection, more than three COVID-19 infections are not reported were assumed for all the countries. These additional number of so-called “shadow post-COVID” patients could bring the total number of post-COVID conditions to 167.3 million-334.6 million, assuming 50% and total shadow post-COVID patients.
  • Within the estimation of 104.6 million newly diagnosed conditions, the majority was represented by CNS organ system totaling nearly 28.7 million, followed by respiratory organ system totaling nearly 22.5 million, and 18.4 million newly diagnosed CVS conditions.
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