On 26 October 2020 I reported on details of a study undertaken by King's College on the condition of 'Long COVID'. I set out the potential implications of this condition on COVID employers' liability (EL)/public liability (PL) claims, which we anticipate will follow the pandemic. The potential prevalence of Long COVID - which in many cases involves debilitating symptoms of chronic fatigue, organ damage and other physical and psychological symptomology - gives rise to concerns that higher value and more complex COVID cases are likely to be faced by EL/PL insurers than was originally anticipated.
Long COVID is the collective name given for the myriad of ongoing symptoms suffered by some of those who contract COVID-19, which can occur regardless of the seriousness of the acute symptoms which initially arise. King's College, based on initial research undertaken, reported that up to 1 in 10 of those under the age of 50 who contracted COVID-19 were likely to have longer term symptoms beyond 12 weeks post-onset. Matt Hancock's briefing to the Commons, after the King's College study, confirmed that this condition was the focus of further medical and scientific research; there was a lack of robust evidence on the prevalence of these symptoms or conditions with which to inform government policy and the provision of treatment.
NHS England announced a £10 million investment in a network of hospital clinics to collect data and provide support to those struggling to recover from COVID-19, with a multi-disciplinary approach to treat the wide ranging symptoms being reported. The NHS has now opened 69 of these specialist clinics with a further 12 clinics to open in January 2021. They have also commissioned further studies from the Office for National Statistics (ONS) and the National Institute for Clinical Excellence (NICE) to try to secure a clearer picture as to the underlying pathology, consequences, sequelae and treatment of Long COVID.
The ONS was tasked to investigate the health complications and prevalence of Long COVID symptoms. The results, set out in the ONS interim report issued last week, re-affirmed the King's College findings, with the ONC reporting that 1 in 5 patients have symptoms for four weeks or more post onset, with 1 in 10 patients affected for 12 weeks or more.
The ONS reported that an estimated 186,000 people in private households were living with symptoms between 5 to 12 weeks post-onset; however investigations are ongoing on the underlying pathology and prevalence of symptoms persisting beyond 12 weeks post-onset. The ONS now plans to analyse data from the second wave of the infection, using new data collected from GP's; it is making amendments to its Infection Survey to capture an extended range of symptoms and the effect of such symptoms on day-to-day life. A further report is expected to be released early in the New Year.
NHS England also commissioned a report from NICE, to study and to advise upon a medical "case definition" of Long COVID, and provide guidance to medical practitioners on identification, assessment and management of this condition. On 18 December 2020 NICE released 'COVID-19 rapid guidelines: managing the long-term effects of COVID 19' for health and care practitioners. The guidance sets out the 28 most commonly reported symptoms and a clinical definition based on the period of symptomology. 'Acute COVID-19' defines symptoms up to four weeks in duration; 'Ongoing symptomatic COVID-19' defines signs and symptoms from 5-12 weeks and 'Post-COVID 19 syndrome' defines symptoms which continue for more than 12 weeks which are not explained by an alternative diagnosis.
NICE makes clear in the guidelines that specific action should be taken by medical professionals irrespective as to whether patients have been hospitalised or have tested positive for COVID-19. There is an initial requirement-on diagnosis for practitioners to provide key information on self-managing and recording symptoms. Referral to a specialist clinic can be made as early as four weeks post-onset based on the overall impact symptoms are having on the patient. The guidance confirms that support should be provided by practitioners to assist patients to discuss Long COVID issues with their employers and potential phased returns to the workplace.
The NICE guidance has attracted some criticism. Medical professionals writing in the Lancet [Robin Gorna et al. 21 December 2020] have suggested that the guidance does not sufficiently describe what is known about the underlying pathology and the natural history of Long COVID; and, that it does not sufficiently guide healthcare workers to identify cases and to manage the condition and the treatment/rehabilitation required. These, the Lancet sets out, are all extremely important issues as there is evidence in some recent studies that up to 66% of patients with Long COVID have organ damage and up to 25% have damage to multiple organs.
The World Health Organisation will shortly be updating its guidance on the clinical management of COVID-19; this will include a consideration of Long COVID from various international studies undertaken on patients with lived experience of this condition. The Lancet experts believe this will guide the management and treatment of this condition in the UK and deal with the deficiencies of the NICE report.
In addition to the government and public sector response to Long COVID, we have also seen a response from the private health sector. A number of private healthcare providers are offering private rehabilitation plans for individuals and employees with Long COVID. Legal & General has recently launched a new early intervention care package for employees in its group protection schemes who are displaying symptoms of Long COVID; the package is being delivered by rehabilitation experts, focusing on self-management to enable employees to get back to work and everyday life as soon as possible.
Long COVID is a relatively new condition and whilst a clearer picture is starting to emerge, inevitably, more empirical research is required to determine how this condition develops. This will help to determine the prevalence of significant debilitating symptoms and measure the success of rehabilitation treatments provided by both the public and private sectors to enable patients to resume day to day life and return to the workplace. It is these more debilitating types of case, which we anticipate may give rise to higher value and more complex EL/PL claims; for example, claims involving chronic fatigue. No doubt insurers and risk managers will be keeping a watchful eye on how this area of research develops.
Originally published 24 December 2020
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