A New Pre-Existing Condition

Let’s start with a basic reality, from WebMD: “Some people with COVID-19 continue to have lingering symptoms for weeks or months after they begin to recover. You might know this as ‘long COVID.’ Experts have coined a new term for it: post-acute sequelae SARS-CoV-2 infection (PASC)… Research says about 10% of people with COVID-19 get long COVID. But it can happen to anyone whether you’re young, old, healthy, or have chronic illness. You can get it even if your early COVID-19 symptoms were mild to moderate, or regardless of whether or not you went to the hospital for them.” 

And we still are not sure if perhaps there might not be other post-infection manifestations that produce no immediate symptoms but generate genuine long-term risks. Here is one recent example: if a serious COVID infection, usually one that has required hospitalization, has spread a flood of “micro blood clots” throughout the body, there is a potential impact of those potentially dangerous short-term and perhaps permanent manifestations: strokes, pulmonary embolisms, organ failure, etc. 

“The culprit: An autoimmune antibody that's circulating in the blood, attacking the cells and triggering clots in arteries, veins, and microscopic vessels. Blood clots can cause life-threatening events like strokes. And, in COVID-19, microscopic clots may restrict blood flow in the lungs, impairing oxygen exchange…

“Outside of novel coronavirus infection, these clot-causing antibodies are typically seen in patients who have the autoimmune disease antiphospholipid syndrome. The connection between autoantibodies and COVID-19 was unexpected, says co-corresponding author Yogen Kanthi, M.D., an assistant professor at the Michigan Medicine Frankel Cardiovascular Center and a Lasker Investigator at the National Institutes of Health's National Heart, Lung, and Blood Institute.

“‘In patients with COVID-19, we continue to see a relentless, self-amplifying cycle of inflammation and clotting in the body,’ Kanthi says. ‘Now we're learning that autoantibodies could be a culprit in this loop of clotting and inflammation that makes people who were already struggling even sicker.’

“Co-corresponding author Jason Knight, M.D., Ph.D., a rheumatologist at Michigan Medicine, has been studying antiphospholipid syndrome antibodies in the general population for years… ‘Half of the patients hospitalized with COVID-19 were positive for at least one of the autoantibodies, which was quite a surprise,’ says Knight, also an associate professor of internal medicine and a leading expert on diseases caused by autoantibodies.” MedicalXpress.com, November 20th. 

Even in less serious cases, these generally undetectable micro clots may cause other symptoms. “These tiny blood clots could also be responsible for one of the unique symptoms of COVID-19: a sudden loss of smell, said Dr. Jeanne Marrazzo, a professor of infectious diseases with the University of Alabama at Birmingham. It also might explain why patients who seem to be doing well suddenly crash.” CBSNews.com, 4/27/20

But at some level, this long tail becomes so sufficiently serious – even after mild infections – that it rises to the level a bona fide disability. Writing for the March 11th Los Angeles Times, Michael Hiltzig takes a look at this unexpected COVID consequence: “Long-haul COVID patients tend to exhibit the kinds of symptoms about which disability case reviewers have historically been skeptical, if not downright hostile. These include chronic fatigue, nonspecific body and nerve pain, headaches and persistent confusion known as ‘brain fog.’

“Those living with these symptoms have had little opportunity to apply for disability benefits because Social Security field offices have been shuttered as an anti-pandemic measure since March 17. Although some are eligible to apply online, applicants often need face-to-face help navigating the complexities of the disability program.

“It also has been a problem for applicants for Supplemental Security Income, a low-income assistance program that is funded by the government separately from Social Security but is administered by it. The vast majority of SSI applicants are disabled, and many don’t qualify for online applications… SSI applications have fallen by more than 30% over the last year, a drop attributed almost exclusively to the office closures…

“No one has been able to estimate the size of the wave that may be building. Medical experts say 10% of COVID patients develop long-term symptoms. Some studies place the figure higher — with up to 15% exhibiting ‘significant pulmonary/cardiac damage’ and 5% suffering from long-term symptoms related to treatment in intensive care units.

“If that were true of the 29 million U.S. COVID cases thus far, and all applied for disability, it would suggest that as many as 5.8 million new disability cases would appear. Spouses and children of disabled workers account for about 15% of disability rolls, bringing the total to as many as 6.7 million new cases… That would be an extreme development. But even a portion of that would overwhelm the disability program, which currently serves more than 8.1 million workers and 1.5 million of their dependents.

“One saving grace is that the White House is no longer occupied by an administration displaying outright hostility to those seeking disability benefits… Back in March 2017, President Trump’s budget director, Mick Mulvaney, appearing on CBS’ ‘Face the Nation,’ questioned whether the disability program was even a legitimate part of Social Security, though it was enacted in 1956, under President Eisenhower. Mulvaney called it Social Security’s fastest-growing program and labeled it ‘wasteful.’... These were both lies: Disability rolls were actually falling, and its error rate of less than 1% was among the lowest in government.” 

With the likelihood of herd immunity to be a lot farther out there than we had hoped, the notion of dealing with these roiling aftereffects could easily be a very long-term issue. Lost productivity coupled with the increased cost of prolonged medical care may put an additional and significant on a Social Security/SSI system that is rapidly running out of money. 

What further complicates this reality is a combination of vaccine shortages, particularly outside of the developed world, mutating strains of the virus that may resist existing vaccines, vaccine skepticism and the almost certain expectation of most biologists and virologists that the world needs to be on red alert for nascent signs of what could become the next pandemic if not immediately addressed and contained. 

Aside from a more focused and robust international cooperative effort to detect percolating threats, it seems clear that some form of universal healthcare is no longer a luxury. The United States cannot continue being the only developed nation on earth without such a program. People without medical coverage, avoiding doctors, are not only sitting ducks for new diseases, but they can also rapidly become the incubators of the next pandemic. As climate change forces human and insect migration, disease patterns will shift as well. Population growth, especially in second and third world nations, is only a disease accelerant. 

I’m Peter Dekom, and it is time to shift American health and environmental policies from reactive to a vastly less expensive preventative approach.