A tsunami of disabilities coming as a result of “Long Corona”
We need to prepare for a future in which millions of survivors will suffer from chronic diseases
Even as U.S. policymakers and business leaders move to make the COVID pandemic a thing of the past with the help of highly effective vaccines, fundamental policy and planning gaps loom. Many who survive the initial viral illness will suffer from debilitating long-term sequelae. Unlike the cold or flu, this virus causes a bewildering array of symptoms that last long after the acute illness has subsided, potentially preventing some patients from resuming normal activities. As scientists and clinicians continue to chart the “long” course of COVID, policymakers and planners must anticipate and prepare for the impacts of this new cause of disability, including its impacts on federal and private workers’ compensation and disability insurance programs and support services.
Consider the numbers we know: At least 34 million Americans (probably more) have already had COVID. A growing number of studies show that more than a quarter of patients develop some form of long COVID. (In one study from China, three-quarters of patients continued to have at least one symptom six months after being discharged from the hospital, and another report found that more than half of infected health care workers had symptoms seven to eight months later.) Early indications suggest that the likelihood of developing persistent symptoms may not be related to the severity of the initial illness. It is even possible that an initially asymptomatic infection could cause persistent problems later.
Common long-term symptoms include fatigue, respiratory problems, “brain fog,” cardiac, renal and gastrointestinal problems, and loss of smell and taste. Alarming signs are emerging, including the recent realization that infections can trigger diabetes.
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With symptoms persisting for months for some with no end in sight, many survivors fear they will have no choice but to adapt to a “new normal.” More and more patients are unable to return to work, even months after they first fell ill. While it is unclear at this early stage of the pandemic how many patients will have persistent illness, estimates are that millions of Americans could be permanently disabled.
The associated medical and disability costs are also still unknown. How many of the “long-term patients” will never be able to return to work? How many will need short-term disability benefits? How many will be permanently disabled and end up relying on disability programs? As more and more young people become infected, will we create a generation of chronically ill people? We must work aggressively to better understand the magnitude and scope of this problem and start planning now.
In addition to personal suffering, long-term disability comes at huge costs, including increased medical expenses, reduced or lost employment, and financial strain on workers’ compensation and disability assistance programs. It’s estimated that up to 30% of COVID-related health damage stems from COVID-related disabilities. As Steven Martin, a physician and University of Massachusetts medical professor, recently told NPR, “When you have an additional million people who continue to suffer from debilitating symptoms, that’s a huge burden not only for each individual, but also for the health care system and for society.”
Current U.S. disability programs seem ill-prepared to handle this new flow of patients with chronic disabilities. Patients and employers alike can be overwhelmed by the bureaucracy inherent in the systems, including workers’ compensation, Social Security Disability Insurance, and private disability insurance. For example, it is very difficult to pinpoint whether a worker was infected at work or in the community. Limited access to testing means many patients are unable to document their initial infection. And the Social Security Administration’s (SSA) requirement that the disability must last or be expected to last at least 12 months and prevent “substantial gainful” activity is daunting. But we must not be shortsighted. Barriers to disability assistance can exacerbate the severity of medical problems and prolong the period during which patients are unable to return to normal activities.
Here’s what you need now:
Research to better understand disabilities caused by long COVID. Scientists are partnering with patient groups such as Survivor Corps to better define these syndromes, and the NIH is calling for proposals that will be supported with $1.15 billion in funding recently provided by Congress. Health economics studies should be prioritized to determine the economic impact of disabilities associated with the virus.
Clinical services to manage long COVID. Clinics to treat long COVID patients are opening but need adequate staffing and funding. The CDC and AMA have both recently released treatment guidelines. Coordinated collection of data at the national (and global) level will accelerate insights.
Workers’ compensation and private disability insurance. National agreement on standards for access to benefits is important. Insurance plan administrators should use health economics research to plan for future costs.
Federal disability programs. Analysis of the estimated number of patients who will need short-term and long-term disability benefits and services should be at the forefront of SSA’s agenda, followed by modeling the funding needed to assist those patients. Eligibility requirements for assistance (such as types of medical documentation and waiting periods) should also be reconsidered.
It’s no surprise that all the issues surrounding COVID-related disability are still uncovered; we don’t yet know the full impact of this vicious (and still somewhat mysterious) disease. After all, since the beginning of 2020, we’ve been struggling to address the immediate crisis and new issues that arise every day. But now is the time to start proactively planning for the undoubtedly enormous new impacts that long COVID will have on our disability programs.
This is an article of opinion and analysis, and the views expressed by the author do not necessarily coincide with those of Scientific American.