Long COVID And Workers’ Comp, A Deep Dive Into A Real Issue

Episode Notes

Transcript

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Intro: Workers Comp Matters, the podcast dedicated to the laws, the landmark cases, and the people that make up the diverse world of workers’ compensation. Here are your hosts, Jud and Alan Pierce.

Alan Pierce: Hello again. It’s Alan Pierce, your host today on Workers Comp Matters on the Legal Talk Network. And we are pleased to have a returning guest, Dr. Bogdan Savych from the Workers’ Compensation Research Institute. He’s going to be discussing with us a study recently published by WCRI in which Bogdan was the chief analyst in terms of assessing Long COVID and what that is, what that means, and what that has meant and will continue to mean for the workers’ compensation industry going forward. Dr. Savych is a public policy analyst for WCRI.

He analyzes issues related to labor and health economics. He conducts research that examines outcomes of injured workers and adequacy and efficacy of workers’ compensation benefits. He explores the role of provider choice in policies in workers’ comp outcomes and compares payments for ambulatory surgery and other medical benefits. He examines the performance of workers’ comp system in Virginia and he received his PhD from the Pardee RAND Graduate School.

What about WCRI? Those of you who are familiar with our podcast, or even if you’re not, you may be familiar with the Workers’ Compensation Research Institute. It is an organization that is based in Cambridge, Massachusetts. It is one of the leading, if not the leading, research organizations that provides data to policymakers and regulators and Industrial Accident Boards and Commissions. This year, WCRI will be celebrating its 40th anniversary and their annual Issues and Research Conference will once again take place in March of 2024, specifically March 5 and March 6, 2024 in Boston, where experts and policymakers will discuss latest research and findings with respect to all areas of workers’ compensation. The keynote speaker will be David Cutler, a very noted economist. So if any of you want more information about WCRI or to participate or attend, you can register and learn more at wcrinet.org. So having said that, Dr. Savych, I’d like to welcome you once again to Workers Comp Matters.

Dr. Bogdan Savych: Hello, everybody. I’m really glad to be here.

Alan Pierce: And we were chatting before we went live on the podcast that the last time, I think I saw you or saw anybody from WCRI in person was at your annual Issues and Research Conference, which was in March of 2020. And I believe it was probably the last public gathering I went to, or in fact, any of us went to, because I think it was within a day or two, the world as we knew it shut down. We didn’t know then that what we thought would be a small, minor upset in our daily life lives and work lives would continue through pretty much the rest of 2020. And we are still, I guess, in the process of emerging.

But one of the issues that certainly became a subject of discussion is how is COVID going to impact the workers’ comp system in terms of costs, in terms of whether the system could even handle it? I think we can all say in a brief retrospective look now, three and a half years later, that the pandemic certainly showed some shortcomings in the workers’ comp system and also gave us some ideas on how to prepare or deal with something similar that may in fact happen again. So Bogdan, tell us about your latest article and area of interest as it relates to COVID. What did you study?

Dr. Bogdan Savych: Thanks. So we sort of reflected on what happened right after COVID-19 started. And at that time there were quite a few reports that many workers who were injured, many patients who were injured, their symptoms did not go away after the acute stage of the infection. From what we knew at that time in early waves of COVID-19 is that majority of patients recover really fast. But there were reports that some patients continued having symptoms months later, two months later, even three months after the initial acute stage of the infection. And these reports of continuing symptoms became known as Long COVID. So at WCRI, we decided to sort of look at how big is this Long COVID phenomenon?

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What are the cost implications, what does it mean for workers recoveries and how long does it last? So we’ve done analysis looking at prevalence of disease, cost and duration of disability for workers who had potentially Long COVID conditions.

Alan Pierce: In fact, I’m looking I should have actually given you credit for the title of your article. It is actually entitled ‘Long COVID in the Workers’ Compensation System in 2020 and 2021.’ First of all, I don’t think we ever heard a diagnosis of Long COVID. I’m not even sure there is an official medical diagnosis, but we’ve been using for, I guess, shorthand purposes, Long COVID. I think you’ve identified some other terms like post-COVID conditions, post-acute COVID, long-term COVID, chronic COVID, long haul COVID. I guess they are all sort of describing the same thing. Has either the CDC, the Centers for Disease Control or the World Health Organization or any other organizations actually defined what is, I guess for lack of better term Long COVID?

Dr. Bogdan Savych: Well, that’s a really interesting aspect of this problem. When the first reports of Long COVID came in, we don’t know what to expect. The medical community didn’t know what is the Long COVID? Why do people continue having some of the symptoms later on? So CDC and World Health Organization decided to sort of take a scientific look at the problem and decided to sort of collect all of the information that they can trying to see are there any common conditions that patients are experiencing months, two, three months later?

The idea was to collect information and maybe come up with the definition of Long COVID while looking at the data or being informed by the actual experiences that many of the patients have. And it turns out that there are some commonalities. Many workers had reported conditions that relate to their lungs, to their heart, but there are also many things that were not very common. And that’s what makes the diagnosis of Long COVID very difficult. For the first few years, CDC was primarily changing definition to include conditions that were more and more common among patients that they see. And that was just driven by studies that were done across the globe.

Alan Pierce: What are some of the symptoms or conditions that have sort of been brought into or under the umbrella of the term Long COVID?

Dr. Bogdan Savych: When the first reports of long COVID conditions came out, the medical community didn’t know what should be included. So CDC and the World Health Organization approached it from the perspective of, well, let’s collect information about patients’ experiences. Let’s see what experiences are and see if they are connected to initial COVID-19. The main condition was that patients did have to have COVID-19. They had to go through the acute stage of that disease. And in a post-acute stage, like months later or three months later, they’ll have some experiences that are not connected to anything else, but likely are connected to the COVID-19 infection that they have.

So those examples are chronic cough, ongoing shortness of breath on exertion, meaning like difficulty breathing when you exercise, extreme fatigue, chest tightness, chest pain, muscle pains, heart problems, problems sleeping. Some of those conditions that were more common. Some of those conditions were less common.

Alan Pierce: I’ve had some clients that have, as a result of the physical conditions, they’ve been complaining of what they’ve termed cognitive issues, brain fog, anxiety, memory concentration, and mental health issues. I imagine the physical symptoms don’t exist in a vacuum.

Dr. Bogdan Savych: Yeah. And these conditions are also included as part of the sort of broad definitions that CDC puts out, such as problem with memory concentration, as you said, brain fog, anxiety. These are part of the conditions that we see in our data also. They are not as common as we see for, say, heart problems or lung problems, but they’re still part of the experiences that many workers have. And it’s actually important to highlight is that some workers don’t have just one type of condition. Sometimes they have multiple conditions. And those type of experiences lead to longer duration of disability or longer recovery after COVID-19.

Judson Pierce: And of course, the problem for those of us who represent these people in workers’ compensation claims is being able to make the connection between symptoms and exposure and diagnosis.

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And as I think we all know as laymen that the people who are most adversely affected by COVID are people who had what’s known as morbidity pre-existing conditions, whether it’s age, overweight, lung impairment, cardiac, diabetes. And these are all people that seem to have had — whatever conditions they’ve had just sort of magnified or worsened. Before we take a break, I just want to ask you this question as a research analyst. Where do you get your data? Because workers’ comp spreads across all 50 states, various other jurisdictions. What type of data did you need to do this analysis and where are you able to get it?

Dr. Bogdan Savych: In our analysis, we examine Long COVID conditions by looking at billing data after work-related injuries. To be able to do that, we have to collect billing information on medical bills that are related to COVID-19 conditions. And WCRI, at the Workers’ Compensation Research Institute, we have data from many states. In this analysis, we include 34 states. And this data reflects billing information from workers’ compensation payers, large employers, State Funds in states where there are State Funds. And we are able to link up beginning of the claim where workers had COVID-19 to everything that happens later on, any care that they received, what type of diagnosis that they had, what type of services they received later on. That’s the type of data that we use. And we cover injuries in the first two years of the pandemic.

Alan Pierce: And I’m going to assume that this research is going to continue as the years continue unfold and we experience various variants of COVID-19 as well. So is this a continuing study do you expect for you folks at WCRI or others?

Dr. Bogdan Savych: Part of this research was funded by NIOSH. And NIOSH actually reach out to many workers’ comp state agencies; WCRI, and other research organizations to provide information about how workers fare after COVID-19. I’m sure that they’re interested more in exactly what you’re saying to learning more in the future how workers fare and what it means. But do we still see prevalence on Long COVID going forward?

Alan Pierce: And NIOSH, of course, is the National Institute of Occupational Safety and Health. That’s a governmental organization that also tracks health care issues, costs, et cetera. We’re going to be right back after a short break, and we’re going to be talking about the prevalence of Long COVID, the costs, what this research paper has uncovered, and what we can learn from it going forward. So we’ll be back after a short break with our guest, Dr. Bogdan Savych.

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Alan Pierce: Okay, welcome back. We’re talking with Dr. Bogdan Savych about Long COVID. Dr. Savych, can you give us your best data of all the patients who might have been diagnosed with COVID-19, what percentage might be termed suffering from long hauler or Long COVID?

Dr. Bogdan Savych: So in our study, we estimate that of workers who had COVID-19, about 6% continued receiving care that’s consistent with Long COVID conditions months after an injury.

Alan Pierce: And was that broken down between workers who had symptoms as opposed to workers who were hospitalized or intensive care or intubated? I would assume the more serious the beginnings of the disease, is it a fair statement that the more serious the effects would be long term?

Dr. Bogdan Savych: And that’s a really important observation.

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It turns out that experience early on after COVID-19 infections has a big impact on what happens to you later on. If you look at people who had very limited amount of care during the acute stage of the infection, meaning right after they were infected, the prevalence of Long COVID for them was about four to 5%. But if you look at people who had multiple visits to doctors, if you look at people who were hospitalized, and if you look at workers who had an ICU stay, for those workers, the prevalence of Long COVID conditions were much higher. If you look at those with ICU care, about 74% of them continued receiving treatment in the post-acute stages of the infection, and many of them continued receiving treatment year later or 18 months later.

Alan Pierce: And now we are deep into 2023 — so we’re heading into 2024. We’re coming up on four years since people started getting sick in this country. Have you been able to ascertain whether there are patients that you were studying or data from 2020, 2021, is there a group of patients that even two years after your study or year and a half study are still suffering from Long COVID?

Dr. Bogdan Savych: Yes, we do see that for some of the folks, there is a small percent of workers who are still receiving treatment two years in.

Alan Pierce: I remember the early talk in the industry once we were getting past the societal implications of dealing with a pandemic and everybody either being sick or being worried about being sick and to mask and not mask and to vaccinate and not vaccinate. A lot of folks in the industry were wondering whether this would bring down the workers’ comp market, whether the workers’ comp system as a whole could deal with a potential billions of dollars of unplanned floor losses. In terms of actual the payment history now, looking back, I would say our greatest fears were over exaggerated. But could you sort of give us an idea of the impact, cost wise, that COVID/Long COVID has had on the bottom line of insurers?

Dr. Bogdan Savych: So it’s really important to realize that there are very big differences between simple COVID cases. Well, if there is a such thing as a simple COVID-19 case. If workers do not develop Long COVID, the cost of the claims are really not that great compared to anything else we see in workers’ compensation system. The duration of disability for those cases are also sort of consistent between two and three weeks. That’s what you would expect from somebody who has a COVID-19. They quarantine for two weeks and then they go back to work. Once you start looking at Long COVID cases, that’s when the cost become higher.

For example, on average for cases with Long COVID, if you measure experiences or medical payments within 18 months you see that the average cost was about $29,000. So to put it into perspective, that’s actually higher than what we see for a typical workers’ comp claim that has indemnity benefits, meaning workers spend at least seven days away from work. When we look at typical workers’ comp claims in our comp studies that WCRI conducts, the median payment across multiple states is about $22-$23,000. So $29,000 is higher than what you see for typical workers’ comp claim.

But even then, there is big differences. If you have workers who had ICU stay, the medical cost for those claims would be in excess of $150,000. The workers who were just hospitalized with or without ICU, the costs were in excess of $50,000. So you have to take into account how many cases do you have that has ICU stay? It wasn’t very many of them, right? It’s only a small percent of sample of COVID-19 claims had ICU stay less than 1%. But they have an oversized impact on cost. But for majority of claims, majority of COVID-19 claims that did not end up as Long COVID claims, the costs were relatively minor. And I think that’s sort of typical what you see in many workers’ compensation fields where there are lots of claims that are not very expensive, but there are several outliers claims that will be driving your experience.

Alan Pierce: Yeah, there’s always that general rule of thumb 20% of the cases produce 80% of the cost. Perhaps in COVID it’s 5% of the cases might produce 95% of the cost. I did notice anecdotally in my practice —

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— that the so called quick in and out of COVID the three weeks out of work, the brief medical attention these people might have gotten may not have even gone through the workers’ comp system. First of all, there’s the issues of proving causal relationship and compensability.

For healthcare workers it’s a little easier, but for other public facing employees it’s much more difficult. But the people that are out of work three or four weeks, they either use sick time, they may have gotten unemployment benefits, there were other type of governmental benefits. So I think even though there might have been tens of thousands or more of those smaller cases, they may not have even gone through the workers’ comp system. Did you find any evidence of that?

Dr. Bogdan Savych: Well, we can only look at what we are able to observe. If there was no COVID-19 claim, we can’t really look at what happens to them. But we do have quite a large share of COVID-19 claims where workers only receive indemnity benefits, meaning that they were away from work for two weeks and that was it. That was the end of the claim. We also see quite a few claims where all that happened was maybe two weeks of indemnity benefits, maybe one or two visits to doctors and that’s it.  And it’s only a small share of workers. I think it’s less than 3% that had hospitalization that’s in terms of the market that we see.

Alan Pierce: Okay, we’re going to take another quick break, then we’ll come back and have some concluding questions and remarks from Dr. Bogdan Savych. We will be right back.

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Alan Pierce: Welcome back, Dr. Savych. What would you say is the biggest takeaway from this look back of 2020 and 2021 in terms of how the workers’ comp system dealt with the problem it was suddenly faced with dealing with COVID? What can you take away from your research?

Dr. Bogdan Savych: Thinking back three and a half years ago, we were facing new world. The workers’ compensation system did respond. Many of the infections were covered. The policymakers intervened, saying that, well, maybe we don’t have presumptions for coverage for this specific infection, but maybe we should have. They introduced COVID-19 coverage for many types of workers in their states and the workers’ compensation system sort of geared up to be part of the response. Workers were covered for COVID-19 and remain covered for Long COVID conditions. And that was a really quick response across many stakeholders, insurers, policymakers and employers.

Judson Pierce: Would you say that the experience of two years 2020 and 2021 was a major cost driver in the workers’ comp insurance market or was it just a less than feared, maybe greater than normal, but certainly not of a catastrophic nature in terms of costs in the bottom line to the carriers or these large employers or self-insurers?

Dr. Bogdan Savych: It’s a good question. So I didn’t study the impact on bottom line, but clearly that the catastrophic fears that some of the people had did not materialize. But COVID-19 did have a big impact on how the medical care is provided even beyond COVID-19 claims, right? So if you think back, many injured workers were told not to go back to the hospital because the hospitals are swamped.

So the question becomes, what happens to their recoveries afterwards? The medical doctors are busy or medical doctors cannot open their offices because they are closed by state mandates. What happens to the recovery of those injured workers? And I think some of those questions, we still don’t have a good understanding, too, like what actually happens and what was the impact?

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So it’s still important to do more analysis to figure out what was the impact on actual recovery of injured workers beyond even outside of the cost to the system.

Alan Pierce: Yeah, I agree. Again, from my perspective, representing these folks, of course, we had the usual issues of proving the nexus of the connection between workplace exposure and development of the symptoms. But we also had many jurisdictions don’t recognize or their definitions of occupational disease vary. The coverage for occupational disease varies. There’s a question of whether a pandemic is an occupational disease because it’s not a condition that is endemic to the employment, but it’s endemic outside of the employment.

And we also now have the onset of telemedicine and how the disease has impacted delivery of health care, all of which I think are being studied by a variety of folks. And I think those of us involved in the workers’ comp field are grateful that folks like WCRI are able to get the data in terms of costs, in terms of how these costs are allocated around the community of workers’ comp and taking a look at where the next time around, God forbid, if there is a next time, we can be better prepared and anticipate the costs. And anticipate the effects of those costs. So any closing words you’d like to share with our audience before we conclude other than my thanking you and WCRI for your important contributions to the always ongoing dialogue?

Dr. Bogdan Savych: Thanks for highlighting our work. We at WCRI are tasked with informing the public, informing the policymakers, and we are always glad to do that. And if anybody’s interested to seeing our research in person, please come to our Issues in Research Conference in March 5 and 6 in Boston.

Judson Pierce: And I assume on your website there are links to other materials that might be helpful that could lead to other areas of interest?

Dr. Bogdan Savych: And our website is wcrinet.org.

Alan Pierce: Okay, well, once again, on behalf of Legal Talk Network, I want to thank you, Dr. Bogdan Savych, and those of you who are listeners to Workers Comp Matters, please tune in again and go out and make it a day that matters.

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