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pandemic in early 2020, many individuals infected with the virus that causes COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) , have continued to experience lingering symptoms for months or even years after acute infection.
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Even individuals with a mild initial course of illness can develop Long COVID with severe health effects. In January of 2024, approximately 22 percent of adults with Long COVID reported significant activity limitations (NCHS, 2024)
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STUDY CHARGE AND SCOPE In August 2022, SSA requested that the National Academies of Sciences, Engineering, and Medicine (NASEM) convene an ad hoc consensus study committee to investigate the state of medical knowledge surrounding persistent functional limitations related to a past SARS-CoV-2 infection.
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Describe any variations in functional or long-term effects based on initial infection with the various identified strains of the virus or based on vaccination status, both at the time of initial infec tion and illness or that are long-lasting; and 9. Summarize completed, on-going, or planned research, and any resultant medical knowledge, regarding similarities between this condition and impairments such as fibromyalgia or myalgic en cephalomyelitis (chronic fatigue syndrome)
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Ultimately, the literature selection was made by consensus judgment of the committee members based on population, study design, measurement, and clinical and functional outcomes relevant to the statement of task. In addition to examining the published literature, the committee commissioned a paper on chronic conditions similar to Long COVID, such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
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Finally and importantly, the committee's work was informed by presentations from individuals with lived experience of Long COVID, made at a concurrent NASEM workshop titled Symposium on Long COVID: Examining the Working Definition, hosted by the Committee on Examining the Working Definition for Long COVID (NASEM, 2023b) ;1 by follow-up presentations from two individuals with lived experience who originally spoke at a 2022 SSA-sponsored workshop titled Long COVID: Examining Long-Term Health Effects of COVID-19 and Implications for the Social Security Administration (NASEM, 2022a)
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started to emerge, reporting that many previously healthy individuals had not fully recovered from COVID-19 and were experiencing lingering health problems. These patients leveraged social media platforms to share their experiences with these lingering health effects.
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(Impairments) Contextual Factors Environmental Personal Factors Factors FIGURE 1-1 International Classification of Functioning, Disability and Health framework SOURCE: WHO, 2001, p.
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from SSA, an individual must meet the statutory definition of disability, which, for adults, is the "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months."2 Substantial gainful activity is defined via an earnings threshold. In short, for an adult to be deemed disabled, a medical condition must lead to limitations that themselves affect the ability to engage in substantial gainful activity in the labor market.
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For adults, the Listings describe, for each of the major body systems, impairments SSA considers to be severe enough to prevent a person from engaging in any gainful activity, regardless of his or her age, education, or work experience, and serve as a "screen-in" step. When an impairment is severe but does not meet or medically equal any of the Listings, SSA assesses in step 4 whether the applicant's physical or mental residual functional capacity allows her or him to perform past relevant work.
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for evaluating these conditions.7 In the guidance for providing medical evidence for claims involving Long COVID, SSA notes that the claimant should provide medical records that include "a thorough description of the individual's medical history, with information on the diagnosis, onset, duration, and prognosis of the individual's COVID-19; Long COVID; conditions that might be associated with, exacerbated by, or consistent with Long COVID; and any other conditions," as well as treatments prescribed and the response to those treatments. SSA explicitly states that "a positive viral test result for SARS-CoV-2 is not necessary for a diagnosis of COVID-19 or Long COVID." It considers all findings related to the claimant's condition, including those that relate to another disorder or establish that the claimant has a co-occurring condition.
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NO YES ALLOWED TOTAL ALLOWANCES ALLOWED STEP 3B: Functionally Equals Listings Impairment Functionally Equals Listing? YES NO DENIED ALLOWED FIGURE 1-3 Social Security Administration's adjudication process for children.
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. Finally, SSA considers descriptions of functional limitations, including the following: • physical functions -- the ability to walk, stand, sit, lift, push, pull, reach, carry, and handle; and/or • mental functions -- the ability to understand, remember, and carry out simple instructions; the ability to use appropriate judgment; and the ability to respond appropriately to supervision, coworkers, and usual work situations, including changes in a routine work set ting (SSA, 2023a)
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This is particularly true for individuals disadvantaged by their social or economic status, geographic location, or environment, and can result in preventable disparities in the burden of disease and opportunities to achieve optimal health (CDC, 2017)
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Chapter 4 reviews the literature on the functional trajectories of those long-term health effects, and includes discussion of differences among hospitalized, nonhospitalized, post-ICU, and pediatric patients. It also comments on how rehabilitation affects functional outcomes.
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2023. Nirmatrelvir/ritonavir and risk of Long COVID symptoms: A ret rospective cohort study.
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2015. Beyond myalgic encephalomyelitis/chronic fatigue syndrome: Redefining an illness.
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2023a. Long COVID: A guide for health professionals on providing medical evidence for Social Security disability claims.
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sequelae of symptoms, or other health effects 2023) SARS CoV-2 occurring after the acute phase of infection SARS-CoV-2 infection (i.e., present four or more weeks after the acute infection)
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infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis; common symptoms include fatigue, shortness of breath, and cognitive dysfunction, and generally have an impact on everyday functioning; symptoms might be new onset after initial recovery from an acute COVID-19 episode or persist from the initial illness; symptoms might also fluctuate or relapse over time; a separate definition might be applicable for children; recognize "Long COVID" Broader Research Persistent Persistent signs and symptoms that (Behnood Community symptoms or continue or develop after acute et al., 2022) COVID-19 COVID-19 for any period of time consequences
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American Thoracic Long COVID The term that is often used to describe (ATS, 2022) Society these persistent symptoms.
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• Post-acute sequelae of COVID-19 National Institute Ongoing Signs and symptoms of COVID-19 (NICE, 2020) for Health and symptomatic from 4 weeks up to 12 weeks Care Excellence COVID-19 (NICE)
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* United Kingdom National Institute for Health and Care Excellence (NICE)
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