The Federal Social Insurance Office (FSIO) is conducting long-term impact monitoring of COVID-19 (Altea reported it here). An initial evaluation for the year 2021 (in French, also available in German and Italian) was published recently. According to the FSIO, these figures are provisional, as not all applications have yet been finalized. This means that the number of benefit approvals is likely to increase.
In 2021, 1’764 individuals with long-term effects from COVID-19 registered for AI/IV. Here are the most interesting figures from the provisional evaluation:
- 38% (683 people) were awarded benefits.
- Of these 683 individuals, 206 were already AI/IV recipients prior to their COVID infection. The remaining 477 individuals are first-time filers.
- Of the benefits awarded, 84% were for rehabilitation measures, 10% for other benefits and 6% for old-age pensions.
- That means, in other words: 62% (1’081 of the 1’764 registered) did not receive any benefits.
According to the FSIO, the low proportion of pensions and the numerous rehabilitation measures indicate that “in very many cases, the earning capacity of AI/IV insured parties affected by long-term disability [...] can be significantly improved or reinstated, which means that a pension is not necessary.”
Various aspects indicate that the AI/IV figures do not fully reflect the magnitude of the problem.
That sounds encouraging. The AI/IV figures suggest that the problem of Long COVID is milder than initially feared. In particular, the number of only 477 first-time claimants in 2021 is minuscule in comparison to the hundreds of thousands of infections, as well as in comparison to the nearly 80’000 annual AI/IV registrations. Long COVID disappears almost completely amidst the background data.
Reasons for cautious interpretation
Unfortunately, the issue of Long COVID cannot simply be put to rest. It might be assumed that the worst cases will be visible in AI/IV numbers, and therefore, the numbers are a good measure of how large the impact of Long COVID is. However, there are some facts that contradict this notion. For example, the FSIO points out that AI/IV figures are not suitable as an indicator of the prevalence of Long COVID.
“The AI/IV figures do not fully reflect the actual situation,” confirms Milo Puhan, Professor of Epidemiology at the University of Zurich. He examined the global burden of Long COVID: According to his study, it is comparable to that of severe neck pain or Crohn's disease, a chronic inflammatory bowel disease.
“You kind of muddle through things instead of signing up for AI/IV.”
In addition, other aspects indicate that AI/IV figures do not adequately reflect the magnitude of the problem.
- Persons who are not insured under AI/IV
Various groups of people are not entitled to AI/IV benefits at all and therefore do not appear in statistics. These include people who were not employed at the time of the illness. This further includes, for example, children, schoolchildren, students and people who look after the household, as well as dependents, on a full-time basis.
- Shame and stigma
“There is also a stigma associated with disability insurance,” says Curdin Brändli. He is group leader for vocational integration at the Bellikon rehabilitation clinic, which belongs to Suva (Swiss Accident Insurance), and provides job coaching for those affected by Long COVID. For young people in particular, this stigma is a major hurdle. People who were fit and able to work before the illness had a hard time associating themselves with disability, he said. “You just kind of muddle through.” Those affected should register at an early stage, and they should not wait until everything stops functioning.
- Ignorance, inability, overstraining
“The AI/IV application is quite demanding and exhausting – even for a professional like me who has to deal with it on a daily basis,” says Curdin Brändli. Some of his clients couldn't possibly do it themselves because of their condition, and they would need assistance to register. In addition, many of those affected, as well as their relatives, are not even aware that registering for AI/IV would be useful. “They're rarely made aware of it at their doctor's office or in therapy, either, because the focus there is on medical issues.”
The benefits you get also depend on where you live.
- Restrained allocation practice
“AI/IV tends to be conservative about giving benefits when it comes to new syndromes," Curdin Brändli has observed. “It has changed from a form of retirement insurance to an integration insurance. After all, that makes sense, especially when it comes to young people.” In addition, there is still no standard for assessing benefit claims. The proposal for guidelines on behalf of Insurance Medicine Switzerland is currently under revision and has only been published in a preliminary version. It will therefore take some time before a uniform assessment can be made.
- Cantonal differences
The cantons whose AI/IV offices are responsible for assessment deal with Long COVID in different ways. Some are proactive and advocate early action, others are more on the slow side. It is frustrating for affected individuals to be treated differently simply because of where they live.
- Delayed applications
Sometimes, a AI/IV application is only considered after months of suffering. This step is delayed for as long as possible because people are still receiving sick pay, because they are not well informed, because they think they have little chance, or because they are occupied with medical rehabilitation. Therefore, it is likely that some individuals who have had severe Long COVID in 2021 will not even show up in the current DI statistics yet.
- Continuing to work despite disability
The prerequisite for registration with AI/IV is a certified incapacity for work of at least 40% of the time. But not everyone who gets sick stops working or reduces their workload. “A lot of people are trying to stay in the workforce at any cost, as long as they can,” says Chantal Britt, President of the patient organization Long Covid Switzerland. “This comes at the expense of their private life: they give up social contacts and leisure activities because all their energy resources go to their work.”
“Affected people give up social contacts and leisure activities because all of their energy goes into their work.”
Increase in cognitive problems
Data from the U.S. supports the notion that there has been an increase in symptoms typical of Long COVID among those who continue to work. This is shown by a careful analysis in an article from Bloomberg. Author Justin Fox analyzed census data and found that the number of working people suffering from concentration and memory problems has increased.
Between January 2020 and April 2022, this increase was equal to 1.2 million people, or a 12.7 percent rise (see the “We’re Having Some Trouble Concentrating” chart in the article). Other data shows that the proportion of individuals with concentration problems is higher among individuals with a confirmed COVID-19 infection than among individuals without a confirmed infection (see graphic “Covid and Brain Fog Go Together” in the article). This suggests a link between the infection and cognitive problems.
The ability to work does not tell the whole story
Looking at work capacity alone is not enough, Justin Fox concludes. “My understanding of the data is that a majority of individuals with Long COVID-like symptoms continue to work, and that even those with severe cases would actually prefer to continue working,” Fox writes.
Chantal Britt sees things similarly. “Being fit to work isn't always the same as being healthy,” she says. “Rather, the question is: how many able-bodied people with or after Long COVID are able to exercise and be active in their free time while working? That would define health, wouldn't it?” After all, getting exercise and maintaining social relationships is also essential for mental health. “Simply looking at Long COVID through the lens of economics doesn't do the issue justice,” she says.
Those affected need recognition, support and treatment.
Conclusion
If Justin Fox's analysis is accurate and can be applied to Switzerland, that would be an argument for proactive integration. This would mean that, with the appropriate support, people affected should only work such that they remain below their maximum limit and can carefully ease their way back into everyday work. This is more successful than working until you can't anymore. The earlier good stress management takes effect, the better the prognosis. Figures from Holland show that, of those who have had Long COVID for more than two years, more than half can no longer work at all.
Low AI/IV numbers are an encouraging signal that Long COVID can be managed by society as a whole, and that many of those affected will improve over time. Nevertheless, it can be assumed that they do not reflect the true extent of the burden of the sickness in Switzerland, and that not everyone recovers equally well. Those affected need recognition, support and treatment.
