Long-Term Disability From COVID-19?
Coronavirus (COVID-19) infections may not be self-limited, as most viral infections usually are, meaning that long-term (“chronic”) effects of the virus may follow an acute infection after the infection itself has resolved. Chronic effects of COVID-19 may result, in part, from an immunological hyper-reaction (“cytokine storm”) to the virus.
What is a Virus?
A virus is an RNA or DNA (but not both) nucleic acid genome that is surrounded by a protein envelope (“capsid”). Some viruses may have a lipid envelope as well. They require a “host” to be able to replicate. The “host” can be human, animal, or avian. Outside of a host, viruses are inert. They are not “alive” and cannot replicate until they infect a host. Once they infect a host, the virus commandeers the cellular genetic material of the host and rapidly replicates itself. The viral copies that it makes infect other cells in the host, and they can then infect other hosts.
Sometimes viruses “jump” from species to species. That's what happened with the coronavirus, which most scientists believe originated in a bat species and then jumped to an intermediate animal host, before jumping to humans.
What type of Virus is the Coronavirus?
The coronavirus belongs to a group of RNA-viruses that includes the SARS and MERS viruses. They, along with COVID-19, cause diseases in mammals and birds.
The structure of the coronavirus is a single-stranded RNA genome, which has a molecular protein called a “spike” protein, which attaches to a receptor on the surface of human respiratory cells (called angiotensin-converting enzyme 2, or ACE2). Once the virus attaches to its ACE-2 receptor, the virus breaks into the human cell. Once inside a human cell, the virus begins a rapid process of replication and invades multiple other cells in the body.
It's called a “corona” virus because of its appearance under an electron microscope, which is spherical with bulbous projections on its surface.
What is COVID-19?
The term “COVID-19” is the name given to the illness that occurs in patients infected with the coronavirus. “CO” stands for corona, “VI” for virus, “D” is for disease, and “19” represents the year 2019, when the virus was first identified.
Acute Respiratory Distress Syndrome (ARDS) and COVID-19
When coronavirus infects the lungs, it goes through three phases. (1) There is a rapid period of viral replication which produces more and more viral particles. (2) The immune system reacts to try to stop the virus and sometimes “over-reacts,” with what some scientists have termed a “cytokine storm.” This is a form of immune hyper-reactivity that causes severe inflammation and fluid in the lungs, resulting in lung damage. (3) Permanent lung tissue destruction and respiratory functional impairment, with shortness of breath on minimal exertion and requiring oxygen to breathe.
When COVID-19 causes pneumonia, in some cases it can lead to acute respiratory distress syndrome (ARDS). This is a form of lung failure in which ventilator support may be required to oxygenate the body.
ARDS can be fatal. However, patients who survive ARDS and COVID-19 may be left with permanent scarring of the lungs, shortness of breath, hypoxemia, chronic fatigue, and other disabling symptoms.
Hypoxemia, with a marked drop in oxygen saturation, may occur suddenly in COVID-19 patients, which can be life-threatening. It is not always clear why that happens, but many pulmonologists believe that it is the result of micro emboli (multiple small blood clots) in the lungs, with abnormal shunting of blood within the lung tissues to areas where it cannot be oxygenated.
Neurological Manifestations of COVID-19
In a study from China, published in the Journal of the American Medical Association (JAMA), patients with COVID-19 infections developed significant neurological problems. They can include stroke (even in young people with no risk factors) and cognitive dysfunction. In the study, neurological manifestations occurred in approximately 30% of hospitalized patients. [Ref: Ling M, et al. “Neurological manifestations of hospitalized patient with coronavirus disease.” JAMA 2020.]
Post-Intensive Care Syndrome Associated with COVID-19
COVID-19 patients can suffer a “post-intensive care syndrome” (PICS), which is the term used to describe patients who have survived a severe critical illness that has left them with physical (weakness and malnutrition), cognitive (decreased memory, attention and acuity), and psychiatric (depression, PTSD) impairments.
Some of these impairments can be chronic.
Heart Disease Related to COVID-19
COVID-19 virus can infect the heart muscle. Studies show some degree of cardiac damage in as many as 20% of hospitalized patients. Complications can include chronic congestive heart failure, myocarditis, and arrhythmia.
Kidney Disease Related to COVID-19
Respiratory impairment from COVID-19 can result in widespread oxygen depletion to all the organs and tissues of the body, including the kidneys. The kidneys can also be damaged by inflammation and sepsis. In some patients, kidney damage can require dialysis and result in permanent azotemia.
Liver Damage Related to COVID-19
Liver damage may occur in COVID-19 patients. Patients with pre-existing liver disease, including patients with fibrosis, cirrhosis, or fatty liver, are more at risk for developing hepatic damage from coronavirus infection.
Blood Clots and COVID-19
COVID-19 is associated with a coagulopathy. There is an increased risk of developing blood clots in the veins of the lower extremities (DVT) when you are hospitalized with COVID-19. The blood clots can tear loose and travel to the lungs (pulmonary emboli) or they can cause a chronic post-phlebitic syndrome in the affected leg(s).
There are many urgent and on-going clinical studies to try to find an effective and safe treatment for coronavirus infection.
Remdesivir is an anti-viral drug that blocks an enzyme that the coronavirus uses in its replication. It has been authorized for emergency use in hospitalized patients and is administered by intravenous infusion. Dr. Anthony Fauci, at the National Institutes of Health (NIH), has reported on a clinical study of about 1,000 patients in whom Remdesivir reduced the number of illness-days by about 30%. He called it a “proof of concept” study, meaning that it demonstrated Remdesivir was capable in blocking the virus at least partially and could lead to the development of other more effective drugs.
Possible treatments that may protect the lungs
Aviptadil may protect the lungs during coronavirus infection. It helps to prevent injury and inflammation and repairs leakage between the air sacs (alveoli) in the lungs and the small blood vessels where oxygen is exchanged. Vitamin C infusions may help lung injury. Hyperbaric oxygen treatments may help oxygenation. Colchicine reduces inflammation. It's an old gout drug that's been around for many years. Dapagliflozin (Farxiga) is a diabetes drug may help respiratory disease. Fluvoxamine (Luvox) is an anti-depressant drug that may help respiratory disease.
Possible treatments that modulate the immune system
Ruxolitinib (Jakafi) is being evaluated to dampen an over-active immune response to the coronavirus and help prevent tissue damage from “cytokine storm.” The term “cytokine storm” has been coined to describe a dramatic over-reaction of the immune system, when it responds to a coronavirus infection, with a massive outpouring of “cytokines.” These are inflammatory proteins released by an immune system that has “gone wild.” Etoposide (Etopoophos) is a chemotherapy drug that may reduce or prevent cytokine storm. Sirolimus (Rapamune), which is used in organ transplantation, may help reduce cytokine storm. Baricitinib(Olumian), sarilumab (kevzara), and tocilizumab (Actemra) are also being evaluated for treatment and prevention of “cytokine storm.”
Possible treatments that bind to the coronavirus receptor
Losartan (Cozaar) and telmisartan (Micardis) are drugs to treat hypertension, but they work by attaching to the same receptors (ACE-2) that coronavirus attaches to when it infects cells. It is possible that they may help to prevent the coronavirus from penetrating into the cell.
Famotidine (Pepcid) may work to disrupt the coronavirus by binding to one of its enzymes. Tranexamic acid (TXA) helps the blood to clot and may help prevent blood clots in coronavirus infections. Hydroxychloroquine (Plaquenil) has been touted by President Trump, but medical professionals have not been enthusiastic about it and worry that it can cause heart problems and arrhythmias in seriously ill patients.
The development of a safe and effective vaccine is an urgent project for COVID-19. However, vaccines are not easy to make. The HIV virus has been with us for more than 40 years, and while thankfully there is effective anti-viral drug treatment, scientists have been unable to develop a vaccine. It took 20 years to develop the polio vaccine. How long it will take to develop a vaccine for COVID-19 is unknown.
There is also “herd immunity,” which means that if 50-70% or more people are infected with coronavirus, who eventually recover and develop protective antibodies, then that can stop the spread of the virus. However, as is the case with the influenza virus, it is possible the coronavirus will mutate on a seasonal basis and “herd” immunity will fail to offer adequate protection.
Long-Term Disability Benefits for COVID-19
As people develop and recover from COVID-19 infections, some individuals may be left with chronic disabling conditions involving one or more organ systems. These can include the lungs, heart, kidneys, liver, vascular, and neurological systems. Such persons may be eligible for long-term disability (LTD) benefits under the Social Security Administration Program (SSDI) and/or a private group disability policy (ERISA).
At Law Med, we keep track of the medical and legal developments relating to COVID-19 infections and will be available to help you with your LTD claim, if the need arises.