It is incredible to believe that this current pandemic has reached its 2-year anniversary. This new disease process has developed so many sequelae, it is particularly difficult to keep track in a workers’ compensation environment.  

One of these sequelae has many names. Originally known as “Long-Hauler syndrome”, this disease process has also been called post-COVID syndrome (PCS), post-acute sequelae of SARS-COV2 (PASC), persistent post-COVID syndrome (PPCS) and several more similar naming conventions. What this speaks to is a lack of a “handle” on this problematic clinical situation.  

As one article noted1, Sir Winston Churchill said, “now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” With each passing day, there will be a plethora of journal articles describing tangential issues to this disease process.  

The difficulty, particularly in a workers’ compensation setting, is that the disease process originates with the viral infection. While noting that most individuals completely resolve the infectious process within two weeks, a significant percentage (10-30%)2 have symptoms for many months following the original infection. There is literature showing that PCS has a higher incidence in high-risk individuals with pre-existing comorbidities such as tobacco use, diabetes, hypertension and pre-existing heart disease. 

This viral process spares no organ system. This is not to say that every organ system will be compromised if PCS develops, only that every organ system is a potential target. Some believe there are as many as 55 possible side effects to COVID-19.  

In addition, individuals who have spent a significant amount of time in an intensive care unit can develop mental health issues related to that exposure. And as noted in the article1 cited above, treatment for this clinical entity has focused on the visible aspect of the metaphoric “COVID-19 iceberg”. There is a need for more assessment(s) on the treatment of the long-term sequelae of this disease process. 

We are two years out from the initial notation of this disease process. We have learned a great deal about identification, proper treatment and, to a degree, prevention; and yet what we need to develop is an approach to the part of the iceberg one does not see. As a workers’ compensation professional, be prepared for any number of issues as the overall clinical scenario has not been settled. 

1 Oronsky, B., Larson, C., Hammond, T.C. et al. A Review of Persistent Post-COVID Syndrome (PPCS). Clinic Rev Allerg Immunol (2021). 

2 Med Sci Monit. 2021; 27: e933446-1–e933446-2.Published online 2021 Jun 7. Prepublished online 2021 Jun 7. doi: 10.12659/MSM.933446 Editorial: Long COVID, or Post-COVID Syndrome, and the Global Impact on Health Care Dinah V. Parums, MD PhD