Long COVID Causes Health Policy Shifts Across States

October 06, 2021 | Emely Sanchez

Illustration of a COVID molecule inside a head with swirl and manga ray burstData reveals that nearly one-third of COVID-19 patients experience one or more post-COVID conditions that linger for weeks or months after infection. These conditions—post-acute sequelae of SARS-CoV-2 (PASC), or “long COVID”—may include chronic fatigue, shortness of breath, fever, depression, anxiety, inability to focus, and sleep problems. Rarely, patients may also develop multisystem inflammatory syndrome (i.e., MIS-C in children, MIS-A in adults) during which different parts of the body (e.g., heart, lungs, kidneys, brain, skin, eyes, and other internal organs) become inflamed.

In a recent study, CDC found one-third of adults who tested positive for COVID-19 reported PASC symptoms two months after infection. The study also found that minority and female patients experienced PASC symptoms at higher rates, indicating that resources for the condition should be provided and dispersed equitably.

Since June 2020, there have been several reports of MIS-A, which include documentation of long-lasting COVID-19 symptoms and autoimmune disorders. Other evidence shows children and adolescents from minority populations who contract COVID-19 are at higher risk of developing MIS-C, which can occur after even mild cases of COVID-19. With the Delta variant’s emergence coinciding with the return to school, there has been an increase in COVID-19 cases among school-aged children. As a result, there may be an increased risk of MIS-C.

The cause, duration, and potential treatments for PASC and MIS-related conditions are still being investigated. As more information about post-COVID conditions emerges, federal and state policies are beginning to support “long-COVID” patients by clarifying how post-COVID conditions correlate to disability benefits, workers compensation and protections, and supporting further research into the conditions.

Feds Issue Guidance on Long COVID as Disability

The cycle of COVID-19 illness, exposure, and recovery has significantly disrupted workflow in nearly every place of employment. Employees may face further barriers and hardships if they must return to work with post-COVID conditions. To prevent discrimination and promote reasonable modifications, the civil rights branches of the Departments of Health and Human Services and Justice released guidance in July 2021 offering federal protections for persons with long COVID if it “substantially limits one or more major life activities.”

For some people, the effects of long COVID may make it impossible to work for a period, and they may seek temporary or permanent disability assistance through the Social Security Administration (SSA). Although SSA has not developed a disability determination or listing for long COVID, the agency released an emergency message in December 2020 acknowledging the long-term effects of COVID-19 and directing SSA offices to flag long COVID as a medically determinable impairment that would qualify for disability benefits.

Workers’ Compensation

The U.S. Department of Labor has issued guidance for federal workers who suffer from long COVID (FECA Bulletin No. 20-05 and Bulletin No. 21-01). The Federal Employees' Compensation Act “covers the injuries of federal employees when sustained in the performance of their duties, including injuries from a disease that are proximately caused by federal employment.”

Meanwhile, more than 19 states and Puerto Rico have proposed action to extend workers’ compensation to cover COVID-19 injuries for emergency response and healthcare workers who can show a positive COVID-19 test and are determined to have become disabled or died as a result.

This year, California enacted AB 845, which establishes that public safety, fire, and medical professionals for whom COVID-19 leads to a disability or death, will be presumed to have acquired COVID-19 through work and will qualify for disability retirement. Similarly, New Jersey enacted A 3945, extending disability and accidental death benefits for law enforcement officers, firefighters, or emergency medical responders who contract and test positive for COVID-19 during a state-declared public health emergency.

Additionally, Massachusetts is considering H 1105, which would require health insurance coverage for treatment of post-COVID conditions for any active or retired state employee. These efforts not only acknowledge the burden on emergency responders and other essential personnel but also underscore the need for resources to treat post-COVID conditions.

Supporting Further Research on Post-COVID Conditions

Federal and state governments are making efforts to clarify the effects of post-COVID conditions. The National Institutes of Health (NIH) received $1.15 billion in federal funding to advance research initiatives into long COVID. NIH also launched research opportunities through its newly-formed NIH PASC Initiative, which will collect data and gather insights into potential treatments for post-COVID conditions.

Additionally, an observational five-year study supported by the NIH and National Heart, Lung, and Blood Institute (NHLBI), will follow as many as 600 children with MIS-C through 2025 to better understand and develop evidence-based MIS-C treatment guidelines. The study will also examine the extent to which age, race, health insurance status, income, and location play a part in MIS-C cases.

States are also proposing efforts to fund and organize research for post-COVID conditions. A bill in Florida, HB 3167, sought to appropriate funding for university research of post-COVID conditions and treatment. There are also bills pending in New Jersey, A 5238/S 3770, to establish a state taskforce to study post-COVID conditions, develop rehabilitation clinics, and understand the racial and ethnic disparities of the conditions. In order to maximize our understanding of and resources for post-COVID conditions, it will be critical to increase research of and supports for those who suffer from their effects. This may truly be the pandemic after the pandemic that policy makers and our health system will face. ASTHO will continue to keep its members informed of laws and policies impacting post-COVID conditions as they emerge.