COVID-19 long-haul claims and our clinical approach

With the advent of vaccines, we now have more hope in combating the COVID-19 pandemic, but there is still clinical data to digest and trends to keep a close eye on. One of them being long-haul cases. Most people infected by COVID-19 experience little to no symptoms, or mild to moderate symptoms that dissipate after several days or weeks. However, there are instances of others experiencing chronic symptoms, severe illness with hospitalization, long-term complications and even death.

From the worldwide clinical data available, we know the risk for symptom development and its severity is dependent on various factors, such as viral load, comorbidities and immune response. Of the more than 155 million people that have been infected by COVID-19 around the world, 80% experience mild symptoms which may be managed in an outpatient setting. However, 15% of those infected become seriously ill, with 5% potentially requiring ICU care. Unlike other viruses, COVID-19 can cause acute symptoms, as well as long-term complications. The information we have seen at Sedgwick indicates 90% of our claims are mild to moderate with 10% being severe.

A quick look at long-haul cases of COVID-19

People who continue to experience the physical symptoms of the coronavirus long after they recover from the infection are referred to as “long-haulers”. And while muscle aches and fatigue are at the top of the list, many patients also report cognitive impairment as a long-term symptom. Commonly recognized as “brain fog”, patients may have difficulty focusing, concentrating and thinking

Individuals with more severe infections are more likely to develop long-term issues such as chronic fatigue, respiratory problems, as well as neurologic and cardiac symptoms. These chronic issues that contribute to long-haul cases are also referred to as post-acute sequelae of SARS-CoV-2 infection, post-acute sequelae of COVID-19 (PASC), or chronic COVID syndrome (CCS). The data is still fluid, and the scientific community remains uncertain as to how some of those infected develop chronic symptoms while others do not, but we continue to learn more as information develops.

There are various components to consider at every phase of the coronavirus — from acute to chronic. It’s also important to recognize that the treatment strategies that were once added to disability guidelines are always evolving. Not too long ago, hydroxychloroquine was considered a protocol treatment but has since been removed from the list of recommendations.

Our clinical approach

Our team of specialized pharmacists, nurses and doctors are constantly reviewing clinical studies and literature to stay ahead of the latest trends. In addition, we have developed acute and chronic formularies with our pharmacy benefit management partners specific to COVID-19 claims. This allows us the opportunity to ensure that the injured worker is getting the right treatment at the right time for the right indication. Our clinical leadership is actively reviewing claims to confirm that guidelines are being followed for these comorbidities and if needed, claims are referred to appropriate rehabilitation centers of excellence.

The symptoms related to COVID-19 are difficult enough, but the psychosocial effects of these long-term claims on an injured worker is also something to consider. Not all patients can be treated the same way, that’s why we believe individualized care with evidence-based medicine is both necessary and beneficial. Our clinicians work closely with providers to ensure we are not neglecting drug details that can often be overlooked. A patient’s age, comorbidities, disease progression, symptoms and other drugs all play an important role when choosing a treatment plan.

There is still so much that the scientific community is learning about COVID-19, but rest assured we are all working toward a common goal. Ensuring that we use all available tools to determine and obtain the very best outcomes for the injured workers we serve is a top priority. We will continue to closely monitor long-haul cases of COVID-19 and provide updates as more is learned about these lingering conditions.

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