Long Covid: an Internist's Medical-legal Perspective

• Publication year: 2022
• Author: IRA B. FISHMAN, MD, QME

Long COVID: An Internist's Medical-Legal Perspective

IRA B. FISHMAN, MD, QME

SAN DIEGO, CALIFORNIA

INTRODUCTION

Though scientific research continues to focus on understanding COVID-19, we are faced with a new unknown in the form of long COVID. The medical-legal community must grapple with the challenges of assessing industrial claims of these persisting COVID complications.

BACKGROUND

COVID-19 is the infectious disease caused by the most recently discovered coronavirus, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). SARS-CoV-2 and the resulting viral syndrome of COVID-19 were unknown before the outbreak in Wuhan, China, in December 2019.

The World Health Organization (WHO) declared the COVID-19 outbreak a Public Health Emergency of International Concern on January 30, 2020, and a viral pandemic on March 11, 2020.

Note: The U.S. Centers for Disease Control (CDC) defines a pandemic as an event characterized by a disease spreading across several countries and affecting many people.

SARS-CoV-2 virus is generally spread person to person through nose- or mouth-generated airborne droplets, or tinier particles called aerosols, carrying the virus into the air. A droplet of fluid such as a mucous secretion can remain briefly airborne and be projected for distances up to one to two meters. An aerosol is similarly projected but lingers longer in the air.

Such virus-containing droplets and aerosols are released when a virus-infected person coughs, sneezes or talks. A viral-contaminated surface (fomite) can also spread coronavirus if someone touches it and then touches their mouth, nose or eyes, but coronavirus fomite contamination is a less common route of viral exposure.

The average SARS-CoV-2 viral incubation period is 5.2 days. The symptoms of COVID-19 include fever, new continuous cough, loss or change of smell or taste, shortness of breath, fatigue or exhaustion, muscle aches, headaches, sore throat, blocked or runny nose, loss of appetite, diarrhea, sense of malaise and/or "feeling sick." These symptoms resemble those of other viral illnesses such as the common cold and influenza.

COMPLICATIONS

Up to 80 percent of COVID-19 patients recover from the disease without treatment. However, approximately one out of six infected individuals, particularly those with preexisting comorbidities, become seriously ill.

COVID-19 complications causing serious illness include pneumonia, progressive respiratory failure, acute respiratory distress syndrome (ARDS) requiring mechanical ventilation, myocarditis or other acute cardiac injury, thrombotic events, hospital-acquired infection and intensive care unit psychosis. Such COVID-19 complications lead to prolonged hospitalization, substantial morbidity, long recovery time and objectively measurable permanent damage to affected organs such as the lungs, heart and peripheral vascular system.

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Preexisting comorbidities worsening COVID-19 include age over 65, chronic immunosuppression, obesity, type 2 diabetes, asthma, chronic renal failure, hypertension, cancer, cardiovascular disease, cerebrovascular disease, chronic obstructive pulmonary disease, tobacco smoking, chronic steroid use, chronic liver disease, and dementia.

There are well recognized, objectively demonstrated sequelae of COVID-19, including new-onset asthma, diabetes, heart disease, paroxysmal orthostatic tachycardia syndrome (POTS) and renal disease.

DEFINITION

Long COVID (popularly termed "long haul COVID") refers to COVID-19 symptoms that persist beyond the acute phase of a SARS-CoV-2 infection; these are often referred to as "post...