WC Stakeholders Struggle with Best Treatments for Post-COVID Syndrome Patients

Nancy Grover

Sarasota, FL (WorkersCompensation.com) – The Mayo Clinic estimates that nearly 1 million people in the U.S, will have difficulty returning to work due to the after effects of COVID-19. As providers try to figure out how to best treat their patients, researchers are struggling to understand ‘Post-COVID Syndrome.’

Right now there is very little in the way of solid research to provide insights ? especially as it relates to cognitive and psychiatric problems. What is becoming clear to some is that those most experienced in helping injured workers through the myriad issues they face, such as loss of function, financial stress, or legal entanglements may be in the best position to help employees who continue to suffer after having COVID-19.

“What I’ve seen out there is there are a lot of people offering treatment for the symptoms of Post-COVID syndrome. But this is not the treatment of the condition itself,” said Greg Vanichkachorn, MD, Occupational and Aerospace Medicine Physician at the Mayo Clinic. “It really takes someone familiar with working with all these psychosocial factors that can affect the health outcome; someone that’s used to being the quarterback for the patient through all these factors. That really is needed to successfully treat this condition.”

Vanichkachorn was among the speakers during the American College of Occupational and Environmental Medicine’s recent Navigating a Post-Vaccine World: Virus, Vaccine, and Variants Virtual Symposium! The speakers suggested that the workers’ compensation system will likely face an increasing number of claims from employees who have had the virus.

Extent of the Problem

“There have been roughly 33.4 million COVID-19 cases in the U.S.,” Vanichkachorn said. “Based on our current research we estimate conservatively that 10 percent of them will come down with Post-COVID Syndrome; so that’s 3.3 million. We also anticipate 30 percent of these patients will have long-term difficulties getting back to work. So that’s roughly 990,000 people in the U.S. alone will not be able to get back to their work, after having Post-COVID Syndrome, sometimes for several months.”

While providers can test for various physical symptoms of Post-COVID Syndrome there are some patients who have unexplained conditions.

“There is the patient post COVID who has fatigue, dizziness, dyspnea and your cardio-pulmonary work-up is normal, your nutrition screen is OK, there are no obvious GI, kidney, brain complications,” said James Talmadge, MD, assistant Medical Director for the Tennessee Bureau of Workers’ Compensation, “and you’re left thinking, ‘is this a psychosocial presentation.’”

That scenario presents one of the biggest challenges for providers and others treating injured workers. There are just not enough answers at this point.

“The first question we have to ask ourselves is ‘what do we know about Post-COVID Syndrome.’ We’re hearing a lot about it. Specifically, today, what do we know about cognitive changes that are ongoing and what do we know about psychiatric changes,” said Les Kertay, Clinical and Consulting psychologist with Dr. Les Kertay & Associates, and Medical Director for New York Life Insurance Company. “The short answer to that question is we know too much, and we know not enough.”

Many studies have been undertaken, though few point to conclusive evidence. But there does appear to be a growing consensus among providers and researchers.

“We are seeing some excess burden of cognitive complaints and psychiatric symptoms,” Kertay said. “Those psychiatric symptoms are dominated by depressive disorder, anxiety disorder, post-traumatic and adjustment disorders.”

Among the cognitive complaints being seen in post-COVID patients are difficulty with attention and concentration, trouble finding worlds, and memory issues – symptoms often described as brain fog.

“The problem is we don’t know why. And there are significant issues with the research,” Kertay said. “We don’t know what we don’t know about a lot of these conditions. It’s very early, despite the plethora of articles coming out.”

One of the biggest problems right now is trying to figure out if the symptoms – especially brain fog – are actually related to COVID-19, or something else. Brain fog is fairly common and the testing for it is often over-interpreted, the speakers said. Patients report they don’t feel as sharp as they normally did pre-COVID-19, especially if they were hospitalized with the virus, in the ICU or on a ventilator.

“A significant issue is COVID is novel and frightening,” Kertay said. “A big difficulty is that symptoms of depression, anxiety, adjustment disorder and brain fog are all also associated with events that are frightening, and we see those kinds of results. In short, we’re having a really difficult time sorting out what are actual sequela of COVID-19 infection and what follows from having this experience of being frightened by a disease that we don’t yet well understand. All of that is complicated by methodology.”

Treating Injured Workers with Post-COVID Syndrome

Treating the patient rather than the ‘label’ is advised by the speakers. Someone who has the symptoms of Post-COVID Syndrome may or may not actually have them as a direct result of the disease. Nevertheless, providers should still treat the patient just like any other injured worker.

Reassuring injured workers that they have had a scary experience and likely feel disrupted can go a long way. Listening to them is important, especially since it’s not clear whether they have lasting effects from COVID-19.

“I think there probably are some long-term sequela of COVID that are routed in physiology,” Kertay said. “What I’m afraid of is for a small number of people who have those long-standing problems, they’re going to be lost in the tsunami of people who report symptoms based on their anxieties, and without our ability to measure it. And I think it’s important to take a middle of the road approach here and understand that there are going to be a great many complaints that lack evidence to support actual impairment related to that condition but that there probably are some people who may get lost in that wave.”

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