The Long Haul of Long-COVID: A Comprehensive Look at the Pandemic’s Persistent Impact

Las Vegas, NV (WorkersCompensation.com) -- On Thursday, Sept. 21, 2023, at the Mandalay Bay Convention Center in Las Vegas, Nevada, an insightful conversation occurred concerning the long-term implications of COVID-19. The National Workers' Compensation and Disability Conference hosted the event, featuring John Smolk and Douglas Benner as the keynote speakers. Smolk is the Principal Manager of Workers' Compensation & Disability Management at Southern California Edison, and Benner is the Chief Medical Officer at EK Health Services, Inc.

The COVID-19 pandemic has left an indelible mark on the world, claiming nearly 12 million lives from almost 769 million confirmed cases. Globally, as of Aug. 2, 2023, there had been 768,983,095 confirmed cases of COVID-19, including 11,740,933 deaths, reported to the World Health Organization (WHO), of which 352,943 reported within the prior seven days of August 2, 2023. As of July 30, 2023, 13,492,099,754 vaccine doses have been administered.

Even as billions of vaccine doses are being administered, a new concern is emerging that threatens to be as disruptive: Long-COVID. Officially known as post-acute sequelae of SARS-CoV-2 infection (PASC), Long-COVID involves a range of symptoms and illnesses that persist or relapse months after an individual has recovered from an acute COVID-19 infection. Remarkably, no specific test to diagnose this condition is currently complicating matters further. "Delta is still killing Americans. Long-covid is the crisis waiting to take its place," a quote sighted by the presenters, attributed to Dr. Bruce Patterson in the SF Chronicle on Aug. 21, 2023.

Statistical models estimate that about 10% of infected worldwide could experience long-term COVID-19. What's more alarming is that the estimates go as high as 50-70% for those hospitalized during acute infection. Even among the vaccinated population, 10-12% report experiencing Long-COVID symptoms. The most increased occurrence is among those aged 36 to 50, raising concern for the workforce.

The symptoms of Long-COVID are as varied as they are debilitating. Top symptoms include fatigue, reported by 45% of sufferers, and 'brain fog,' affecting 40%. Sleep disturbances and vision problems were also commonly reported, among other symptoms like joint pain and gastrointestinal issues. The root causes of these symptoms often involve organ damage, viral persistence, and imbalances in the immune system, making it particularly difficult to develop a one-size-fits-all treatment protocol.

Delving into Long-COVID's more specific symptoms and pathology, the range of symptoms and their underlying pathologies span various bodily systems. The heart may experience chest pain and palpitations, often due to cardiac impairment, myocardial inflammation, or Postural Orthostatic Tachycardia Syndrome (POTS). The lungs can exhibit a persistent cough and dyspnea, often rooted in abnormal gas exchange. Immune system irregularities include autoimmunity and Mast Cell Activation Syndrome (MCAS), while the pancreas can suffer from diabetes and tissue injury. In the gastrointestinal tract, abdominal pain and nausea can arise from gut dysbiosis and viral persistence. Neurologically, cognitive impairments, fatigue, sleep disorders, memory loss, and tinnitus may occur, often due to conditions like Dysautonomia, ME/CFS, neuroinflammation, reduced cerebral blood flow, or small fiber neuropathy.

Other organs like the kidneys, spleen, and liver can experience general organ injury. Blood vessels can manifest issues like fatigue, which may be linked to pathologies such as coagulopathy, deep vein thrombosis, endothelial dysfunction, microangiopathy, microclots, pulmonary embolism, and stroke. The reproductive system is not spared, with symptoms like erectile dysfunction and irregular menstruation corresponding to pathologies like reduced sperm count. This comprehensive view underscores The multi-systemic and highly individualized nature of Long-COVID, complicating diagnosis and treatment.

A closer look at the California Workers' Compensation System provides further insight into the pandemic's long-lasting effects. Studies indicate that of the cases analyzed, 12% presented mild acute symptoms, 38% had severe acute symptoms, and 41% were classified as critical. These data points show the potential longevity and severity of Long-COVID symptoms in the workforce.

When it comes to treatment, there's no generalized protocol. Every treatment is tailored to the individual's symptoms and/or impairments. Physical therapy is commonly employed, but mental health ramifications are a challenging frontier.

In a fascinating twist, researchers at UCSF have identified a genetic mutation that could explain why some people, termed "super dodgers," seem to elude severe COVID-19 symptoms. Approximately 20% of those infected with SARS-CoV-2 are asymptomatic, seemingly unaffected by the virus. These individuals can clear the infection quickly or may not develop severe disease. However, the study also reveals a perplexing caveat: some of these "super dodgers," despite being asymptomatic during the acute phase of infection, may still develop symptoms of long-term COVID later. This discovery adds another layer of complexity to our understanding of the virus and Long-COVID and suggests the potential for targeted interventions based on genetic markers.

The financial implications are also noteworthy. According to a Workers' Compensation Research Institute study, 6% of all COVID-19 claims turned out to be long-term COVID-19, with an average of 20 weeks of temporary total disability and $29,000 in medical expenses. At Southern California Edison, there has been an increase in sick days, and usage of the Family and Medical Leave Act (FMLA) benefits for intermittent symptoms, even though no Work Comp Long-COVID cases have been reported. These numbers suggest that the impact of Long-COVID is hiding in plain sight, masked by other forms of absence and accommodations.

As the world grapples with the immediate threats posed by the COVID-19 pandemic, Long-COVID looms as a significant and largely uncharted challenge for the future. It raises numerous questions that employers, healthcare providers, and policymakers must answer, ranging from processing claims to legal and human resources implications. Preparing for the next major world event that could have long-lasting similar consequences is even more crucial. As Fred Rogers aptly put it, "Often when you think you are at the end of something, you're at the beginning of something else."

Workers' compensation can often seem cold, complicated, and emotionally draining for injured parties. Our free eBook Mastering Empathy & Strategy: The Top 10 Traits Every Workers' Compensation Claims Adjuster Needs to Thrive aims to change that perception by shedding light on the profound impact that claims adjusters can have on the lives of injured workers. With an intricate blend of legal and healthcare frameworks, the workers' compensation process often becomes a maze that many find overwhelming. Yet, nestled within this complex system, claim adjusters have the incredible potential to turn the experience into a transformative journey for the injured parties involved.

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