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Apr
16

COVID19 – how does it do its damage?

This week we’re attempting to figure out how much of an impact COVID19 will have on the country in general and workers’ comp in specific. That requires:

  • estimating the number of people infected;
  • determining how deadly it is;
  • assessing our ability to contain it;
  • evaluating other health effects of the disease; and
  • knowing if and where and how much liability will be assigned to workers’ comp.
This last is best left for later; there are obvious implications for workers’ compensation, however until there’s more clarity around the industry’s liability for COVID19 we won’t be able to even guess what that liability ultimately might be. Of note, several states have asserted WC will be presumed responsible for patients working in pubic safety, healthcare, and some retail establishments who become infected with coronavirus.
The work comp COVID19 coverage situation is fluid and evolving rapidly; Nancy Grover’s piece in workerscompensation.com provides excellent insights on the current status of state coverage from knowledgeable professionals and is well worth a read.  I’m sure Nancy and her experts will keep us informed.

Health effects

Big caveat here – as one of the articles cited below notes and as is true for pretty much everything you read about COVID19 (including this post), physicians interviewed “are speculating with much less data than is normally needed to reach solid clinical conclusions.” COVID19 is so new and so little is known that there’s very little credible research. What we’re relying on are ‘reports from the battlefield”, information from the front lines that’s coming in real time, not careful, methodological, rigorous research using controls.

Another caveat, from the LATimes –

Patients with disorders that affect the heart, liver, blood and lungs face a higher risk of becoming very sick with COVID-19 in the first place. That makes it difficult to distinguish COVID-19 after-effects from the problems that made patients vulnerable to begin with — especially so early in the game.

But for now, this is all we have. The faster we collect and assimilate information, the more able we will be to respond quickly and with the right solutions.

Broadly speaking, the physiological effects seem to vary widely between victims; women seem to fend off the virus better then men; and people with pre-existing conditions, especially hypertension, appear to be at particularly high risk. The recovery process, which at first seemed pretty straightforward (lungs get better after intubation) even for those on ventilators, appears to be more complicated and take longer than originally thought.

We are only now seeing indications that COVID19 may have long-term health effects, and its reach extends beyond just the lungs.  From an extensive piece this morning in the Washington Post:

coronavirus kills by inflaming and clogging the tiny air sacs in the lungs…clinicians around the world are seeing evidence that suggests the virus also may be causing heart inflammation, acute kidney disease, neurological malfunction, blood clots, intestinal damage and liver problems.

One study indicated some patients with relatively mild cases appeared to have significant warning signs of long-term health effects – in this instance impaired liver function.  Another study noted cardiac issues post-discharge, and a nephrologist at Yale’s School of Medicine reported that almost half of “the people hospitalized because of covid-19 have blood or protein in their urine, indicating early damage to their kidneys…”

How can this be happening?
The coronavirus attacks by attaching to the ACE2 receptor on cell surfaces. These receptors are on cells in the lungs and other organs as well. From the WaPo:
there is increasing suspicion that it is using the same doorway [ACE2 receptors] to enter other cells. The gastrointestinal tract, for instance, contains 100 times more of these receptors than other parts of the body, and its surface area is enormous.
In particularly bad cases, severe inflammation can occur, causing significant problems throughout the body. This has its own set of challenges as it appears to be driven by a hyper-active immune response. There appear to be some treatment approaches that are having positive results using lessons learned from prior viral outbreaks.
Again, this is so new that many treatments are being developed and tried on the fly as doctors scramble to learn what works and what doesn’t on which kind of patients exhibiting what signs and symptoms.
What does this mean for you?
As awful as this is, the more cases that physicians encounter, the greater the knowledge gained.
With much of our medical establishment and resident brain power focused on COVID19 and caring for its victims, things will improve.

7 thoughts on “COVID19 – how does it do its damage?”

  1. I’m getting a kick out of Joe’s posts consistently re-posting “guesswork” and hogwash as if it is in some way important (or relevant) to the issue at hand. What is your goal…CNN-type fear-mongering?

    1. Hey Rick – thanks for the question. The goal of the post was stated and obvious – here’s what front-line treaters are seeing, and here’s what the limited research we have so far shows. Fear of the unknown is the issue here, and the more we know the better off we are.
      Be well, Joe

  2. Joe, appreciate your professionalism responding to the recent post suggesting fear-mongering on your part. Not that you need viewer endorsement but I’ll offer it anyhow!

    I find your posts on the topic pretty straight forward and clear that there are a lot of unknowns, and an accumulation of thoughts and feedback gathered from a multitude of sources engaged in getting a better understanding of what the medical and scientific communities are facing.

    It is however understandable to be a skeptic of EVERYTHING when most of what is presented to us by media sources and government officials is speculation and self-interest based.

    1. Hello Jim – I appreciate you taking the time to comment, and thanks for the “endorsement.” I’ll do my best to keep it.

      I may be a bit more confident in some media outlets than you may be, but I always try to find multiple sources before I buy into any one outlet’s “reporting.”

      Be well – Joe

  3. I was diagnosed with something that I had never heard of – Vasculitis – in July, 2019. In my knowledge gathering after DX, I learned that is is a pretty unstudied auto-immune disease that actually affects a good number of people in various ways. They more that I read about COVID-19, the more it is starting to sound similar to what happens to the body in certain types of Vasculitis. We will all have to see how this plays out. Thanks Joe for another insightful post.

  4. Joe – please fix my typos 🙂 Haven’t been to get a manicure in weeks and my nails are too long. LOL

    1. Heck Paula you have far fewer typos with too-long nails than I do with my guy nails!

      be well, Joe

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Joe Paduda is the principal of Health Strategy Associates

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