Long COVID Examining Long-Term Health Effects of COVID-19 and Implications for the Social Security Administration: Proceedings of a Workshop (2022) / Chapter Skim
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2 Overview of Long COVID and Disability
2 Overview of Long COVID and Disability
Pages 13-30
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From page 13... ...
WHAT IS LONG COVID? Stuart Katz, professor of medicine and principal investigator for the RECOVER Clinical Science Core at New York University Langone Health, began the session by giving an overview of what is known about Long COVID, including the variety of symptoms, how it is recognized in clinical practice, and the risk factors for developing Long COVID.
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From page 14... ...
A subgroup of people continue to experience symptoms after this initial phase; Katz said symptoms more than 4 weeks postinfection is the cutoff that is generally used to define Long COVID. At that point, these symptoms may be subacute, ongoing symptoms of the infection, or may become chronic, postinfection symptoms that can persist for months or years.
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From page 15... ...
, Nalbanian et al., 2021, p. 602, in Stuart Katz presentation, 15 March 21, 2022.
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or "isolation" and treatment guidelines using relevant databases, "loneliness" or "sleeplessness" or "sleep" or "smell" including nice.org.uk and clinicaltrials.gov. In total, or "taste" or "olfactory" or "gustatory" or "risk 218 references were included.
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Evidence on post-COVID symptoms, said Katz, demonstrates that symptoms can wax and wane over time. For some patients, symptoms may start during the acute phase and continue into the chronic phase; other patients may feel fully recovered after acute COVID-19 and begin to experience symptoms weeks or months after the infection.
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(CDC, 2021b) Further, the CDC guidance states: "Understanding of post-COVID conditions remains incomplete, and guidance for health care professionals will likely change over time as the evidence evolves." Long COVID Research While evidence is still evolving, a number of risk factors can make it more likely that an individual will develop Long COVID, said Katz.
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In addition, the study integrates electronic health record data; Katz said that using these "real-world" data can help us understand the ways PASC affects people's lives and support the development of new diagnostic tests and therapeutic targets. FIGURE 2-3 RECOVER study plan.
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Vos and his colleague, Sarah Wulf Hanson, research scientist at IHME at the University of Washington, set out to create a systematic approach for making epidemiologic estimates for Long COVID, with the aim of adding Long COVID to the Global Burden of Disease (GBD) estimates, which quantify health loss from diseases, injuries, and risk factors.7 Vos shared their preliminary estimates of Long COVID with workshop participants, noting that the estimates would soon be finalized and available following the workshop (see Hanson et al., 2022, for the final results)
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Using disability weights, Vos and his colleagues estimate that on average, people lost 21 percent of their health while living in a state of Long COVID. This is equivalent, he said, to the disability weight of people with complete hearing loss or severe traumatic brain injury.
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From page 22... ...
SOURCE: Hanson et al., 2022, Appendix 1, p. 42, in Theo Vos presentation, March 21, 2022.
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From page 23... ...
SOURCE: Hanson et al., 2022, Appendix 1, p. 42, in Theo Vos presentation, March 21, 2022.
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Study protocols often lack follow-up to determine the "tail" of duration; only a few studies followed patients to the 12-month mark. Vos also said that symptom clusters used in the estimates may miss patients who have isolated symptoms.
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may be needed to help individuals with Long COVID transition back into the workforce when symptoms begin to wane. IMPACT OF COVID-19 ON THE WORKFORCE Rakesh Kochhar, senior researcher at Pew Research Center, gave workshop participants a broad overview of labor market trends for workers overall in the United States, as well as for the population of people with a disability.
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From page 26... ...
However, the ebb and flow of recovery has been similar for all age groups. While the unemployment rate receives a great deal of attention, said Kochhar, the number of people who are not in the labor force at all is also an important indicator of labor market strength.
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From page 27... ...
Bureau of Labor Statistics. 11 People with a disability reported having at least one of the following conditions: deaf or serious difficulty hearing; blind or serious difficulty seeing; difficulty concentrating, remembering, or making decisions; difficulty walking or climbing stairs; difficulty dressing or bathing; and difficulty doing errands alone.
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SOURCE: Rakesh Kochhar presentation, March 21, 2022, based on data from the U.S. Bureau of Labor Statistics.
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In the model estimates, why was the decision made to assume that asymptomatic people do not develop Long COVID? This decision, said Vos, was based on the fact that the small number of asymptomatic infections included in the cohort studies showed a very low proportion of cases that demonstrated the three symptom clusters, which are (1)
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From page 30... ...
Moreover, he said, the fact that so many cases of Long COVID occur in patients with mild infections suggests that there are other mechanisms at play. Katz added that the RECOVER study is collecting data to help answer these questions; there is an autopsy cohort in which tissues will be examined for viral persistence, and there will be a large biobank with blood samples that can be examined to explore hypotheses about mechanisms.
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