In a market that is already known to evolve and adapt, it is no surprise that COVID-19 has changed the group insurance industry. A rapid increase of COVID-19 cases over the past fifteen months has caused a spike in short-term disability (STD) claims, and continued persistence of symptoms have transitioned into long-term disability (LTD) claims. Brown & Brown Absence Services Group recently facilitated a webinar for our physician and nurse consultants who help drive many of our solutions powered by PDA, including Claims Management Solutions and Talent Solutions. This webinar, which focused on COVID-19 and the functional capacity of claimants with symptoms, provided our consultants and teammates with a wide range of knowledge to help better understand the complexities and duration of this diagnosis, with specific focus on understanding the functional impact.
The phases of COVID-19
COVID-19 can be broken down into three phases: acute COVID-19, post-acute COVID-19, and long COVID-19. Most individuals who are diagnosed with COVID-19 spend their time in this acute, or active COVID-19, phase. It is these cases, which typically range from asymptomatic through critical level of care, that helped to drive the rise in STD cases over the past year. Studies show that most acute COVID-19 patients are either asymptomatic or exhibit mild to moderate symptoms. This consists of minimum lung or respiratory involvement and typically does not result in a hospital stay. While in these cases the disease may only last between two and four weeks, it is most of these patients who clear the disease diagnostically but continue to have long lasting symptoms and may even experience complications.
After clearing the disease, those who have COVID-19 typically see a persistence of symptoms for up to three months including cough, fatigue, difficulty breathing, anosmia, impaired memory, and poor concentration. For those patients who have had a stay in the hospital, there are increased instances of behavioral health symptoms including anxiety, depression, and post-traumatic stress disorder. At least half of those patients who were hospitalized will show a significant reduction in their quality of life for approximately three months or more. While potentially as impairing as acute COVID-19, these post-acute symptoms, or the existence of them, however, is not exclusive to COVID-19. There are other diseases such as influenza, West Nile Virus, Zika, MERS-CoV, and SARS, which are known to have post-acute symptoms once the disease is cleared.
What continues to plague the healthcare systems and continues to cause an increase in both the number of STD and LTD cases, is the transition of COVID-19 into what is referred to as long COVID. For these patients, more than twelve weeks after they diagnostically clear the virus, they still exhibit a range of symptoms, including those they may not have experienced during the acute or even post-acute phase. On top of continued fatigue, malaise, and other acute COVID-19 symptoms, long haul COVID-19 patients may experience cardiac, cardiovascular, thromboembolic, or neurological complications. Despite ongoing symptoms and protentional complications, there is no diagnostic test to confirm that a patient has long COVID-19. To make this determination, physicians must examine the symptoms to which the patient is exhibiting and review any previous findings of a COVID-19 diagnosis. For patients who may have been asymptomatic and unaware they even had COVID-19, an antibody test can be useful to verify the existence of antibodies to determine if there was a past infection.
Returning to work post COVID-19
As there are currently no diagnostic criteria for long COVID-19, there is also no specific treatment. Instead, each patient’s symptoms must be treated accordingly. Graded exercise and pacing, symptomatic treatment of myalgias, physiological assessment, and support are among the common treatments for long COVID-19. Despite diagnostically clearing the virus, it may be several months before patients who suffer from COVID-19 are able to return to work. Sedentary and less exertional positions may not require such a long wait time, but for those patients whose work falls along the lines of more exertional with a consistent physicality, post-acute or long COVID-19 symptoms may keep them out of work for at least three months. It is imperative that these patients receive proper support and treatment they need to reclaim their health and make a return to the workforce.
If you are interested in learning more about functional capacity and COVID-19, we encourage you to check out the webinar hosted with Dr. Allen Blaivas and Dr. Kent Crossley, FACP — “Functional Capacity Reviews in the Time of COVID-19.”
As more information becomes available, Brown & Brown Absence Services Group will continue to provide resources to our customers to help them navigate long COVID and its impact on the absence continuum.