Five years into the pandemic, long Covid remains a complex and evolving condition. In the Journal of Insurance Medicine, Munich Re’s Dr. Tim Meagher reviews the current state of knowledge, highlighting progress in disease characterization, emerging mechanisms, and ongoing challenges in diagnosis and treatment.

Dr. Meagher outlines six possible disease pathways, including viral persistence, autoimmunity, Epstein-Barr virus (EBV) reactivation, clotting abnormalities, gut microbiome dysbiosis, and mitochondrial dysfunction, that each contribute to the diverse symptom profile of long Covid. He also explores its overlap with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), noting shared features and the implications for diagnosis.

Despite global prevalence estimates ranging from 3% to 50%, the anticipated wave of disability claims among insured populations has not materialized. Dr. Meagher attributes this to factors such as better overall health, higher vaccination rates, and lower severity of initial infections among the insured.

Although no definitive biomarker or effective therapy has been identified, many clinical trials are underway. Dr. Meagher concludes that while scientific understanding is advancing, long Covid remains largely unresolved, and its implications for life and disability insurance continue to evolve.