The Covid Economy

Covid-19 leaves some patients with high medical bills, job insecurity and lingering health problems

Cars line up at a community coronavirus testing site operated by Cone Health and the county Health Department in Burlington, N.C., July 9, 2020.
Gerry Broome | AP

Welcome to the Covid Economy, CNBC Make It's deep dive into how the coronavirus pandemic is impacting all areas of our lives, from food to housing, health care to small business. We're focusing on North Carolina, a swing state that has seen rapid economic growth — and growing inequality — since the last recession to learn how residents are weathering the economic consequences of this once-in-a-lifetime health crisis.

Ann only let her guard down for an afternoon. After months of being careful and following social distancing guidelines, she got together with a friend over the Fourth of July weekend. The next day, that friend let her know they were feeling sick. Four days after that, Ann began developing symptoms, too. 

An HR manager based in the Charlotte, North Carolina, area, Ann, who agreed to speak to CNBC Make It on the condition that she be identified only by her middle name to protect her privacy, scheduled a Covid-19 test on July 15. She received a positive result two days later. 

It's been more than four months, and Ann's still struggling to fully recover from the virus. But it's not just her health that's been impacted. She's had to take an unpaid leave of absence from work, and despite having health insurance, she's worried about the mounting medical bills.

During the nearly three weeks that Ann suffered from the worst effects of Covid-19, she was mainly isolated at home. "There was an entire week that I had to lie on my stomach for hours just to breathe without a crushing pain in my chest," Ann says. "The vomiting and diarrhea were so unyielding that one day I contemplated just sitting in the tub instead of going back and forth to the toilet."

At one point, Ann's symptoms were so serious, she did go to the emergency room. Fortunately, her hospital stay was short, and she never had to be put on a ventilator. But even after the worst of her symptoms passed, her life has yet to return to normal. One of the rising number of so-called "long haulers," Ann is still feeling the ongoing effects of the virus. 

"It's just so weird to me to be someone who is healthy and in their thirties to have something just completely ravage you so hard that it affects every organ in your body," Ann says. 

Costs of Covid-19 vary dramatically and can go beyond just medical bills

As Ann continues to struggle with the lingering effects of Covid-19, there's been a staggering increase in the number of cases around the world. Nationwide, the number of Americans testing positive for Covid-19 reached 99,000 on Friday, the equivalent of more than one new case per second, according to the New York Times. Overall, there have been more than 9.2 million cases of Covid-19 in the U.S. so far and at least 231,000 deaths as of Monday morning, according to data from Johns Hopkins University.

North Carolina is also seeing rising numbers. The state has seen a 62% increase in the number of positive cases over the past month, according to a CNBC analysis of the last week of data from the Centers for Disease Control and Prevention, Johns Hopkins and the Covid Tracking Project. Since mid-September, the number of Covid-19 deaths have increased 34% in North Carolina. As of Nov. 1, the state had a total of 276,692 Covid-19 cases, up 6.4% over the past seven days, according to the Covid Tracking Project.

Beyond the short- and long-term health implications, Covid-19 patients like Ann are struggling with the financial fallout as well. 

"Many people think that only those who are financially ill-prepared can be knocked down by something like this," Ann says. But the night she caught the virus she says she was telling her friends that she was considering buying a foreclosed home next door for her mother to live in. "Now, I'm scraping my savings to get by. Anyone who isn't a millionaire should fear this virus."

Anyone who isn't a millionaire should fear this virus.
Ann
tested positive for Covid in July

Although Ann initially went back to her job in August, she ultimately couldn't work, and her employer has put her on unpaid leave through the end of the year. By her estimation, she's lost about $10,000 in take-home pay, even after filing for unemployment. Currently, the maximum weekly unemployment insurance benefit is $350 in North Carolina, but the average payout is closer to $265, according to the North Carolina Justice Center.

In addition to losing income, Ann is struggling to manage the medical bills that are piling up. Over the course of four months, her insurance claims have totaled more than $12,700 — the bulk of which were accrued during her ER visit. And that's not including the physical therapy that Ann's been doing on a weekly basis or the echocardiogram that she's scheduled to undergo — a test that will cost another estimated $500 to $2,000.

"If my insurance did not cover Covid-19 care, I would be out thousands of dollars in medical bills," she says. She's grateful that her leave of absence has allowed her to keep her health insurance. Her plan has covered 95% of her costs related to the treatment, leaving Ann to pay about $650 out of pocket so far. 

Health insurance can help lower costs — but not everyone has access to it

The costs for Covid-19 care can vary dramatically. The majority, about 76%, of patients ages 21 to 40 who are hospitalized undergo a stay of one to five days, according to the national independent nonprofit FAIR Health. Those who are uninsured will be billed an average of $36,610 for that length of stay, according to FAIR Health. Medical providers charge someone with insurance in the same age bracket $19,425 for that length of care on average.

But insured patients typically only pay a portion of that bill. The average deductible on U.S. health insurance plans — otherwise known as the amount patients are responsible for paying before their insurance plan starts to pay — was $1,931 for a single employee and $3,655 for a family in 2019, according to Kaiser. Some health insurance plans cover the total cost of care once the deductible is met, while others have a cost-sharing structure that kicks in once the deductible is reached.

Many North Carolina residents are in a much worse situation than Ann: About 1.16 million state residents, or roughly 11.3% of the population, did not have health insurance last year, according to the latest data from the U.S. Census Bureau

That uninsured rate could be even higher this year due to job losses. Based on May unemployment figures, the Kaiser Family Foundation estimated that 723,000 North Carolina residents had likely lost health insurance due to job loss or because they're the dependent of someone who was laid off. 

That doesn't include the many residents who are struggling with only minimal coverage and working low-wage jobs. Evie Hawkins contracted Covid-19 at the beginning of August. Although she's currently on her parents' health insurance, Hawkins, 23, relied on the free Covid-19 testing provided by the city of Durham to keep costs down. Across North Carolina, the average cost for a Covid-19 test for uninsured residents who can't get free testing is about $157, according to FAIR Health's data. 

"It started with just migraines and major upper respiratory congestion," Hawkins says. She suspects she picked up the virus from her job as a cashier at a local grocery store chain. She didn't get a fever until five days after her symptoms began.

Hawkins, who lives in a two-bedroom, two-bathroom apartment with two other roommates, including one whom she shares a room with, had to quarantine for about 15 days. And although her employer paid her sick leave while she was isolated, it only amounted to about 30 hours over the course of two weeks, when she usually works an average of 30 hours per week, though her schedule tends to vary. Her parents helped Hawkins with her rent and bought supplies to help her make ends meet that month. 

"The whole experience was exhausting and stressful. I was sleeping almost 12 to 18 hours a day. My body didn't want to function," Hawkins says, adding that she's thankful the symptoms didn't spread to her lungs as far as she knows. 

Yet two months later, even though she had an arguably mild case that required no hospitalization, Hawkins is still experiencing lack of stamina and lethargy, as well as the so-called "brain fog" where she says she now forgets names more often or even where she placed items. She had to re-learn all the product codes for produce and grocery items at work after coming back. "My days off are literally just me sleeping half the time," she says. 

Hawkins hasn't been to see a doctor for these lingering issues. "I can't afford it," she says. She can't take more time off of work, and she worries any further treatment would be too expensive. 

'Take this seriously'

As cases rise both in North Carolina and nationwide, medical professionals worry that the biggest hurdle is fighting "covid fatigue." Many people are tired of staying isolated and social distancing, and so they start rationalizing their decision to stop taking precautions. But that, in turn, could lead to more cases if people get together without social distancing or refuse to wear masks, according to public health experts.  

"We're going to have to do everything we can to convince people [that] this is serious business that has to be attended to properly or people will get hurt," says Dr. Gregory Poland, an infectious diseases expert and head of Mayo Clinic's Vaccine Research Group.

"People are so numb to Covid — they've heard it so much. It's been all over the news, so I think people now are to the point like they just don't care," says Michael Holbrook, who works as an ICU nurse at a Raleigh hospital. "It is frustrating, because from my standpoint, I've seen so many people die."

Covid-19 is "very unpredictable," Holbrook adds. He's worked with young nurses who contracted Covid-19 and had much worse cases than older patients he's seen, he says. "It attacks people differently."

By the time most patients get to Holbrook, they aren't able to breathe on their own and need to be put on a breathing machine. And when that happens, most patients are in for a long, expensive stay. "I've seen so many people that have been there for months on end," he says. "I don't want to make it seem like every case is bad, but you also don't know how quickly it can go bad."

For cases that are more severe, the fallout can be financially devastating as well. A 15-day hospital stay or longer costs over $360,000 on average for insured patients who are between 21 and 40. While that includes the amount the insurer will cover, the patient's out-of-pocket cost can be thousands depending on their plan's deductible, cost-sharing rules and exclusions. 

While only about 4% of patients ages 21 to 40 actually stay in the hospital for Covid-19 treatment that long, Holbrook emphasizes that everyone should wear a mask in order to protect themselves and others.

"You really need to take this seriously," he says, adding that it's not "just the flu."

If you're interested in sharing your experiences related to the pandemic, please email senior reporter Megan Leonhardt at megan.leonhardt@nbcuni.com.

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