SSA and Covid-19 Residual Symptoms
Preliminary reporting from Hong-Kong, Italy, and other locations hit hard by the Covid-19 virus are showing that lung damage resulting in decreased lung capacity and chronic fatigue could be longterm. While most patients who have contracted Covid-19 under the age of fifty make a full recovery, up to thirty percent are still showing signs of significantly decreased lung capacity. This symptom is especially prevalent in patients greater than fifty years of age.
Post-infection follow-up evaluations are showing patients complaining of shortness of breath on exertion and difficulty with air exchange requiring additional medical intervention. These findings are essential to disability advocates because these symptoms may result in an allowance determination in a case that would otherwise be denied.
We are suggesting that advocates identify any applicant who has contracted the virus. Ask the patient if they have had any continuing breathing problems such as shortness of breath after recovery. If so, be sure to acquire medical data on the claimant’s current lung capacity. While lung capacity alone may not win an SSDI case, it could result in a reduction of the claimant’s residual functional capacity. A reduced RFC will result in a reduction of the claimant’s ability to perform work.
Think of lung capacity as a secondary symptom that, if combined with a severe primary diagnosis such as arthritis, diabetes, or COPD, could significantly improve the claimant’s chances of winning benefits.
Post Covid-19 Lung Damage
Covid-19 is considered to be a respiratory infection, so it makes sense, to begin with, the effects on the lungs. Immediately after the first patients in China, the UK, and the United States, severe chronic lung disorders began to manifest themselves. Patients have complained of chest pain, reduced breathing and exercise capacity, chronic cough, and a burning sensation in the lungs. These post-infection symptoms are often accompanied by significant medical signs supporting damage to lung tissue.
While the airflow spaces of healthy lungs appear black, post Covid-19 patients on both X-ray and CT scans show light gray patches called ground-glass opacity. The gray appearance implies soft tissue damage and scarring of the lungs. It is unclear if this condition will ever heal or how long healing will take.
A Chinese study of post infected individuals showed that the presence of ground-glass opacity was evident in seventy-seven percent of recovering Covid-19 patients. The majority of hospitalized Covid-19 patients on Ct scan showed lesions that doctors believed would result in permanent lung scarring.
Even Covid-19 patients who experienced mild to moderate symptoms of the disease showed that an overwhelming majority (up to 95%) showed some degree of ground-glass opacities in their lungs. The even scarier finding is that doctors still see lung scarring on the earliest recovered patients, which implies that this damage might be permanent. Keep in mind that damage to the lungs, referred to here as scarring, can cause significant declines in respiratory function.
It would be prudent to note that we do not have enough data to determine if lung symptoms and damage will be permanent at this early stage of the pandemic. But, as scientists review the effects of similar coronaviruses like SARS and MERS on lung tissue, things do not look good for post infected patients. Several respiratory specialists have suggested that a small subset of Covid-19 patients will never wholly recover their pre-disease pulmonary function. Keep this in mind when representing a SSA disability claim.
Post Covid-19 Cardiac Damage
Doctors treating Covid-19 patients without a previous history of heart problems are seeing signs of cardiac stress with increased troponin levels. Physicians think that these cardiac symptoms might be related to low oxygen exchanged caused by the virus’s effect on the lungs. They also believe that viral particles may be causing inflammation of the cardiac muscles, compromising cardiovascular function. It is not clear if the Covid-19 patients with cardiovascular symptoms like chest pain suffered a previous cardiac incident or that the symptoms are directly related to the Covid-19 infection. Since the patients did not have a prior history of heart disease before infection, this suggests that the virus may be causing direct damage to heart muscles.
If Covid-19 is causing direct damage to the cardiovascular system as suspected, then the virus may cause lingering damage to the heart in a percentage of patients. This cardiac damage, which can include cardiomyopathy, could result in a higher risk of future acute cardiac problems such as heart attacks, congestive heart failure, and strokes. If the patient has a history of a previous cardiovascular disorder, the damaging effects of the virus could worsen their condition.
Post Covid-19 Liver Damage
Patients with chronic liver disease, including hepatitis B and C, appear to be at greater risk of experience worsening symptoms with a Covid-19 infection. Some patients hospitalized with severe Covid-19 infection do show increased levels of liver enzymes, alanine aminotransferase (ALT), and aspartate aminotransferase (AST). An increase in these enzymes indicates that the patient’s liver is at least temporarily damaged. However, we do not know if this increase in liver enzyme levels is related directly to the virus that causes Covid-19 in the liver or if the liver damage is a result of other factors. More research is needed to determine if Covid 19 patients with hepatitis, cirrhosis, fatty liver, and other chronic liver diseases are more likely to suffer from liver damage than Covid -19 patients without chronic liver disease.
Covid-19 Related Blood Clotting
An increasing number of Covid-19 patients are suffering from blood clotting symptoms that are leading to increased embolisms that can lead to heart attacks, pulmonary heart disease, and strokes. Embolisms cause damage by blocking circulation to an organ or an extremity. In one well-publicized case, an individual underwent an amputation of a lower limb as a result of deep vein thrombosis. It has been reported that up to 24% of Covid-19 patients have suffered strokes, pulmonary embolisms, and other severe disorders related to abnormal blood clotting.
Covid-19 induced blood clotting abnormalities are also causing severe organ-related problems such as acute renal disease and kidney failure. In severe Covid-19 infections, a percentage of patients have required renal dialysis in addition to critical respiratory support. These types of complications can significantly reduce a patient’s chances of surviving the initial infection.
Complications related to blood clotting can also result in permanent disabilities in patients who survive. Those patients suffering from embolisms are treated with anticoagulants in addition to supportive care. As a result of a high number of recovering Covid-19 patients experiencing latent blood clotting symptoms, prophylactic anticoagulant therapy is recommended for recovering patients.
Neurocognitive Disease
A few little-known side effects of severe Covid-19 infection are neurocognitive disorders such as severe headaches, dizziness, sensory loss, nerve pain, muscular weakness, peripheral nerve dysfunction, impaired consciousness, confusion, cognitive decline, memory loss and difficulty concentrating. These symptoms are now seen in up to fifty percent of those hospitalized for Covid-19 disease. These types of residual neurocognitive impairments can have serious long-term effects on a recovery patient’s lifestyle and on their ability to return to work.
Keep in mind that those suffering from acute Covid-19 infection are primarily treated for acute respiratory distress syndrome as the primary condition caused by the virus. Studies of post-ARDS patients generally show evidence of secondary severe neurological side effects, which should also be expected in Covid-19 infections. As many as one in five ARDS patients show symptoms of cognitive reduction, memory problems, and difficulty learning up to five months after treatment.
Covid-19 is a highly stressful disease and may trigger secondary psychological disorders. There is evidence that those recovering from an acute Covid-19 infection have a higher risk of anxiety and depression. Many recovering Covid-19 patients also suffer from post-traumatic stress disorder (PTSD). Recovered Covid-19 patients are also being stressed with unforeseen medical expenses as many are losing their livelihoods. These stress-related symptoms may also be prolonged and exacerbated by the continuing coverage of Covid-19 in the media.
Gabriel Scott CEO
Disability Associates, Inc.