Although the pandemic rages on, there may be some relief in sight for people with lingering effects from COVID-19 infection – or “long COVID” – as well as consequences for the physicians who treat and employ them.
The Biden administration in late July issued new guidance declaring long COVID a disability under the Americans with Disabilities Act under certain circumstances.
Long COVID can cause a wide range of symptoms – including fatigue, shortness of breath, heart palpitations, brain fog, and depression – that may impair physical or mental function. Up to 10 million Americans are likely to experience the condition, according to a resolution presented at the American Medical Association’s special meeting in June.
The guidance is expected to largely affect primary care physicians and some specialists, who may be called on to assess patients with long COVID, according to Texas Medical Association staff and physician experts.
Internist W. Michael Brode, MD, is the medical director of the Post-COVID-19 Program at UT Health Austin, the clinical practice of The University of Texas at Austin Dell Medical School. Since opening six weeks ago, the clinic has treated around 50 long COVID patients. Many are actively pursuing disability status, he says.
The process can be challenging. Without standardized diagnostic criteria or testing, it can be difficult to determine whether worsening mental health symptoms, for example, are caused by long COVID or secondary to it, Dr. Brode says.
“Long COVID is a problem with the wiring in the kitchen. It is sparking, and it is flickering, and it is causing problems,” he said. “But our testing is a fire alarm. It can only detect abnormalities when there’s a fire.”
Because of these testing limitations, physicians may have to take their patients at their word when it comes to the severity of their symptoms. But the new guidance could help people with long COVID access disability accommodations.
“It’s a good start, and it’s a realistic recognition of the public health crisis of people going through this,” Dr. Brode said.
The guidance also affects physician employers, who could have employees with a long COVID disability that entitles them to certain accommodations. For example, a person who experiences dizziness when standing may require a service animal in the workplace.
The guidance, which was jointly issued by the U.S. Department of Health Human Services (HHS) Office for Civil Rights and the U.S. Department of Justice (DOJ) Civil Rights Division, does not alter existing disability regulations but instead proactively applies those regulations to the new condition of long COVID, according to TMA staff.
The guidance also raises some questions, such as how much physicians will be paid for conducting assessments and how common long COVID disability will be.
TMA staff anticipate that as the public – including physicians – becomes more familiar with the new regulations, they likely will require clarifications from HHS and DOJ. Meanwhile, the Centers for Disease Control and Prevention and other health experts continue to study long COVID.