More than 18 million people have been infected by coronavirus worldwide, about a quarter of them in the United States. And healthcare experts say it likely will be years before the costs for those who have recovered can be fully calculated, according to Reuters interviews with approximately a dozen physicians and health economists.

These experts point to the potential for billions of dollars in long-term healthcare expenses, as studies of patients with COVID-19 continue to uncover new complications associated with the disease. They say the costs stem from COVID-19’s toll on multiple organs, including heart, lung and kidney damage that likely will require costly care, such as regular scans and ultrasounds, as well as neurologic deficits that are not yet fully understood. 

The added costs likely will lead to increases in insurance premiums and long-term care costs. 

For example, Bruce Lee of the City University of New York Public School of Health estimated that if 20% of the U.S. population contracts the virus, then the one-year post-hospitalization costs would be at least $50 billion, before factoring in longer-term care for lingering health problems. Without a vaccine, if 80% of the population became infected, that cost would jump to $204 billion.

“On a global level, nobody knows how many will still need checks and treatment in three months, six months, a year,” Marco Rizzi, M.D., told Reuters. Rizzi is a physician in Bergamo, Italy, who has seen close to 600 people with COVID-19 for follow-up. He is co-chairing a World Health Organization panel recommending long-term follow-up for patients. 

Even those with mild COVID-19 “may have consequences in the future,” he added.