WorkCompCentral
Full article on: WorkCompCentral.com
Author: Mark Powell (Reporter)
About a quarter of COVID-19 patients will develop long-term symptoms, which has prompted health care officials and workers’ compensation stakeholders to engineer multifaceted treatment strategies and new case management approaches, medical and comp experts said.
And while many patients who contract COVID experience only mild symptoms, injured workers who suffer from complicated post-infection issues may require complex and expensive rehabilitation for pulmonary, physical and mental health needs, they said.
“Navigating a patient through long COVID or long-hauler syndrome really is unchartered territory,” said Kathy Galia, general manager of clinical solutions for care management company Paradigm.
Researchers so far have identified dozens of long-term COVID symptoms that can last for weeks or months after a patient contracts the virus, including abnormal organ function, respiratory issues, decreased heart and aerobic function, and psychological issues stemming from long-term hospital stays, Galia and other speakers noted during a recent webinar.
Because of myriad symptoms that can persist, physicians and case managers must advocate for patient-specific treatment plans that can allow injured employees to not only recover from the disease but also return to work and a sense of normalcy, she said.
“Don’t forget to understand the injured worker’s pre-injury job and their physical restrictions,” Galia said. “Talk with their employer about accommodations. It is possible for the injured worker to recover in place and return to work with restrictions.”
Recovery for some patients may take relatively longer, including injured workers with preexisting kidney issues, said Stan Smith, Paradigm’s vice president of post-acute care.
For injured workers with established kidney diseases, researchers have seen “a sort of an acute kidney-injury effect,” where long COVID can progress renal diseases by one or two stages, Smith said.
Other workers who have respiratory issues may need mechanical ventilation or oxygen delivery for long-term breathing help during recovery. Some patients may require multiple nurses or doctors from different specialties offering consistent care, Smith said.
“When we see those things tracking with that patient into the post-acute care setting for our injured worker with COVID, several disciplines mobilize around immediately,” he said. “Both physical and occupational therapy are very, very important.”
Some workers may be generally diagnosed with a condition known as “brain fog,” a term attributed to symptoms that may make it harder for patients to think clearly. Others who return from long stays in intensive care units may find their sleep patterns significantly disrupted, which can create barriers for those hoping to return to normal life, Smith said.
Workers suffering from long-term COVID also may experience skin issues, bouts of malnourishment and thyroid dysfunction, all of which can require extensive nursing services and clinical treatment, he said.
“In workers’ compensation, we know that when acuity increases and when treatment complexity increases, cost of care is also going to increase significantly,” Smith said.
To make matters worse, emerging COVID variants such as the delta variety have ensured that stakeholders will be dealing with lingering virus issues and treatment needs for the foreseeable future, Paradigm Medical Director Dr. Lawrence Lottenberg said.
“COVID is back on the upswing, and certainly we’re going to have to deal with these patients as well,” Lottenberg said.
Research published earlier this year in the National Health Institute’s Library of Medicine found that about 80% of nearly 48,000 patients — around 38,400 people — included in a study who contracted the virus developed at least one long-term COVID symptom.
Of those patients, 58% developed fatigue, 44% reported headaches, 27% had attention disorder issues, 25% experienced hair loss and 24% suffered from dyspnea, also referred to as shortness of breath.
“You can imagine what this does to an injured worker who’s trying to recover from this devastating disease and get back to normal life and work,” Lottenberg said.
Another study conducted by Nebraska-based Madonna Rehabilitation Hospitals looked at 189 long COVID patients who had an average length of stay of 23 days.
Among those with long COVID, just under half were discharged back to their communities, while 22% were sent back to an acute-care setting and 18% were discharged to skilled nursing centers, said Paul Dongilli Jr., CEO of Madonna Rehabilitation Hospitals.
“This reinforces the complexity of these patients and their fragile states,” Dongilli said. “Recovery for this group of patients, as we found, is atypical, prolonged and incomplete. That outpatient care really needs to be stressed or guided so it decreases the risk of secondary medical complications, enhances function and improves cardio and pulmonary fitness.”
As persistent symptoms related to long COVID have emerged, clinics aimed at treating patients with lingering issues also have begun to spring up.
According to the Journal of the American Medical Association, 39 states now have at least one long COVID recovery clinic.
“We have started to see more and more post-COVID recovery clinics popping up across the country,” said Dr. Michael Choo, Paradigm’s chief medical officer.
As these clinics continue to operate — and as more start to open — clinic managers will need to invest in an allied-caregiver approach to ensure that staff members will consist of mental health professionals, dermatologists, nutritionists and others who can provide recovery and rehab for all issues that long COVID sufferers face, he said.
“I think the medical care needs are growing for those who have survived the COVID-19 infection or recovered from the COVID-19 infection, and now we’re seeing more and more people with persistent symptoms requiring medical care,” Choo said.
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