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. 2022 Feb:142:54-59.
doi: 10.1016/j.jclinepi.2021.10.018. Epub 2021 Oct 26.

Estimating total morbidity burden of COVID-19: relative importance of death and disability

Maia P Smith  1
Affiliations

Estimating total morbidity burden of COVID-19: relative importance of death and disability

Maia P Smith. J Clin Epidemiol. 2022 Feb.

Abstract

Objective: Calculations of disease burden of COVID-19, used to allocate scarce resources, have historically considered only mortality. However, survivors often develop postinfectious 'long-COVID' similar to chronic fatigue syndrome; physical sequelae such as heart damage, or both. This paper quantifies relative contributions of acute case fatality, delayed case fatality, and disability to total morbidity per COVID-19 case.

Study design and setting: Healthy life years lost per COVID-19 case were computed as the sum of (incidence*disability weight*duration) for death and long-COVID by sex and 10-year age category in three plausible scenarios.

Results: In all models, acute mortality was only a small share of total morbidity. For lifelong moderate symptoms, healthy years lost per COVID-19 case ranged from 0.92 (male in his 30s) to 5.71 (girl under 10) and were 3.5 and 3.6 for the oldest females and males. At higher symptom severities, young people and females bore larger shares of morbidity; if survivors' later mortality increased, morbidity increased most in young people of both sexes.

Conclusions: Under most conditions most COVID-19 morbidity was in survivors. Future research should investigate incidence, risk factors, and clinical course of long-COVID to elucidate total disease burden, and decisionmakers should allocate scarce resources to minimize total morbidity.

Keywords: COVID-19; DALY; Disability; Disability-adjusted life year; Equity; Gender; QALY; SARS-COV-2.

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Figures

Image, graphical abstract
Graphical abstract
Fig 1
Fig. 1
The top of each colored bar segment represents average healthy years lost per COVID-19 case in that group for that severity of long-COVID symptoms (mild, moderate, or severe.)
Fig 2
Fig. 2
The top of each colored bar segment represents average healthy years lost per COVID-19 case in that group for that severity of long-COVID symptoms (mild, moderate, or severe), under the assumption that long-COVID resolves in 10 years.
Fig 3
Fig. 3
The top of each bar segment represents average life-years lost per COVID-19 case in that group from immediate death (published case fatality) and delayed death an average of 10 years later, such as might be caused by damaged heart or lungs.
See this image and copyright information in PMC

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