Why is there a discrepancy between commercial claims data — indicating that less than 2% of people who contracted COVID-19 also experienced long COVID — and studies that suggest this figure is closer to 20%? There are several reasons why this occurred. Understanding them can help organizations make informed decisions about their benefits offerings in the coming year.

There's a lack of alignment on how long COVID should be defined: One problem with long COVID is that it's still considered a new condition, and there are no specific diagnostic tests to identify it. Because symptoms are often vague or nonspecific (e.g., cough, fatigue, headache), long COVID can be easily mistaken for other diseases. As a result, when people are sick and visit their doctor, it's possible that long COVID is misdiagnosed as something else, like the common cold or bronchitis, further depressing the number of reported long COVID cases. What's more, experts disagree on a definition for the condition, with the CDC saying long COVID patients experience symptoms for "more than four weeks," and the WHO saying symptoms must last for at least two months. With so much uncertainty around how to define this disease, many doctors may hesitate to make a diagnosis, leading to the condition being underreported.
Long COVID didn't appear in health claims data until October 2021: For long COVID cases to appear in claims data, physicians must diagnose patients. But because long COVID is such a new disease, a health care reporting code for this condition didn't even exist until October 2021. In other words, individuals who had COVID-19 in 2020 and early 2021 may have had higher rates of long COVID. We can't know for sure, though, because there was no reporting code for this condition.
COVID-19 variants are unpredictable: Variants of COVID-19 also seem to play a role in long COVID rates, making it difficult to project the number of future cases. For example, a 2022 study published in The Lancet suggests that rates of long COVID may be up to 50% lower with patients who contract the omicron variant compared with those with the delta variant. Because we can't predict the nature of future COVID-19 variants, it will, in turn, be a struggle to predict the number of future long COVID cases.
The role of vaccines is becoming clearer: While researchers are still learning about long COVID, several studies have shed light on the role of vaccines. The UK Health Security Agency found that among people who contracted COVID-19, those who are vaccinated are less likely to suffer from long COVID than those who are unvaccinated. Meanwhile, analysis of data from the U.S. suggests that vaccinated patients are up to 10 times less likely to experience two or more long COVID symptoms than those who are unvaccinated.

Employers need to recognize the threat of long COVID

Benefits claims data may also be skewed by employees who have been forced to drop out of the workforce due to long COVID. If an employee finds they can no longer work because their symptoms prevent them from being able to perform, they may lose their health insurance and their diagnosis, in turn, won't appear in claims data.

Instant Insights /

Big gaps in long COVID data: How employers can make health coverage decisions

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