The Science of Aging Well: How Your Beliefs Affect Your Health
Editor’s Note: I never get the chance to “sit in the audience” of a Council for Disability Awareness podcast. But this time was different. My colleague, Fred Schott, moderated a must-listen-to discussion on long Covid and its impact on people who work – from a “whole person” perspective. Fred’s guests were Kerri Wizner, an epidemiologist at MDGuidelines, and Dr. Jonathan Torres, medical director at UnitedHealthcare Financial Protection Services, Specialty Benefits and an occupational medicine physician.
Special Note: Both Wizner and Torres are members of The CDA’s research committee, which is led by Schott.
What follows is an annotated and abbreviated transcript drawn from the original podcast.
You can listen to the full podcast here.
Setting the Stage About Long Covid
[02:43] Kerri Wizner kicked off the discussion with a clarification of the official name for long Covid: post-acute sequela of SARS-CoV-2 or PASC. Wizner noted that the definition is a little bit different for the World Health Organization versus the Centers for Disease Control and Prevention.
Essentially, long Covid represents a variety of symptoms. They include shortness of breath, fatigue, brain fog, chest pain, headache, and sleep issues. These symptoms generally appear two or more months after a Covid infection when there’s no alternative diagnosis available.
[04: 19] Wizner further added that, as of right now, some studies found that 30 percent to 50 percent of Covid survivors have at least one symptom three to six months later.
[04:42] The Brookings Institute pulled together numbers from publicly available data and estimated that long Covid could account for 1.1 million unfilled jobs. That’s about 15 percent of the numbers quoted in the Great Resignation.
[05:35] Fred Schott noted that the author of the Brookings Institute assessment said their analysis was based on a stacking of assumptions. Schott believes these assumptions are reasonable.
The Impact of Occupational Medicine Specialists on Long Covid Patients
[09:19] Dr. Jonathan Torres explained that there are three important principles of occupational medicine – and all three of them are important when it comes to long Covid:
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- [09:40] Occupational medicine specialists understand the importance of work and how it impacts an individual’s sense of connectedness, purpose, and routine. This allows the occupational medicine physician to focus on helping return the individual back to work and, hopefully, to full function as soon as possible.
- [10:09] The occupational medicine specialist focuses on function and return to work as soon as possible. This physician works as part of a team that could include different types of therapists, behavioral health professionals, and the employer on a plan that often includes modified duty and transitional work.
- [10:13] The third piece is the ‘whole person approach.” What factors might be slowing the patient’s recovery, and are there mental health factors at play; are psychosocial factors involved; and is the patient/employee experiencing restorative sleep?
- Addressing and treating the whole person, and facilitating, coordinating, and helping that individual get the care they need from a whole person perspective has been so important for the occupational medicine specialist and their impact on overall patient recovery and restoration of function of the patients they treat.
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[12:07] The last comment Dr. Torres made about the occupational medicine approach is that these physicians rarely look at cases as an all-or-nothing phenomenon. There’s a strong movement – if a patient cannot return to work without accommodations – of helping that individual return to the workplace initially with a plan that could include partial hours, transitional work, or restrictions.
How Do You Make a Medical Determination if a Person Can Return to Work?
[14:33] Dr. Torres laid the groundwork: Diagnosis does not equal disability. A claim is typically triggered when the employee’s condition meaningfully impacts an individual’s ability to do their job.
[15:00] A determination comes down to:
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- the severity of symptoms,
- the severity of the individual’s underlying conditions, and
- the treating care provider’s opinion.
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What’s Important to Keep in Mind with Employees with Long Covid?
Meet the Individual Where They Are
[17:35] Wizner believes it is important to be flexible and empathetic with what the individual is experiencing. Some employees have described symptoms that last for a short while and then they improved. Others were challenged by severe symptoms.
[18:27] Employers and physicians need to be flexible, supportive, and provide frequent check-ins to see how the individual is responding to their return-to-work plan.
[20:09] Dr. Torres pointed out that creativity is another important skill to apply to the care of individuals with long Covid. The employees may benefit by a whole person approach that dovetails integrated strategies into the overall plain, including assistance with modified work schedules, providing clinical case management resources, and helping employees coordinate their care appointments and expert consultations – hopefully working to close gaps in care.
Additional Resources
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- The latest Covid-19 guidelines (April 29, 2022) from the American College of Occupational and Environmental Medicine.
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- The National Institutes of Health created the RECOVER Initiative to learn about the long-term effects of Covid. The RECOVER Initiative brings together patients, caregivers, clinicians, community leaders, and scientists from across the nation to understand, prevent, and treat PASC, including long COVID. This group is called the RECOVER Consortium.
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You can listen to the full podcast here.
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