Severe respiratory disease in COVID-19 includes acute respiratory distress syndrome (ARDS) that may require ICU admission and mechanical ventilation. As a result, individuals may present with ongoing symptoms and complaints including reduced endurance and mobility, shortness of breath, and coughing.1
Radiological investigations may be of limited value as part of claims evidence, as studies have shown that high-resolution computed tomography (HRCT) may only reveal minor fibrotic changes, and it is thought that functional impairment is likely neuromuscular in nature, rather than due to structural lung changes.2
The 6-minute walk test (6MWT) is a good measure of exercise tolerance, particularly when determining the longer-term effects of ARDS. At the end of the 6MWT, the patient’s oxygen saturation percentage, heart rate, and dyspnea rating are recorded, and the total distance covered during the 6 minutes calculated. Predicted normal values consider gender, age, height, and weight.3 It is found to be more indicative of impairment when spirometry results are within normal limits and HRCT reveals few or no abnormal findings.4
Improvement in respiratory function can occur over a lengthy period, up to five years post-ARDS; however, the most noticeable improvement can be expected in the first year following hospital admission.
Individuals may present with ongoing symptoms and complaints including reduced endurance and mobility, shortness of breath, and coughing.1
The U.S. Centers for Disease Control and Prevention (CDC) states that several cognitive and mental health symptoms may be associated with long-term effects of COVID-19.5 To better understand the potential impairments, it is again relevant to consider evidence from non-COVID-19 ARDS patients as an indication of neuropsychiatric disability. Studies mention reduced attention and memory, as well as impaired general mental processing capabilities, especially high executive cognitive functioning. From a functional point of view and through the claims investigation process, the following may be reported by claimants or their family and caregivers:
- Difficulty remembering appointments
- Reduced ability to perform daily chores such as shopping (e.g., forgetting what to buy at the store)
- Compliance with medication (e.g., being unsure about whether medication has been taken)
- Difficulty remembering and following directions
Additional mental health symptoms such as anxiety, depression, and posttraumatic stress disorder (PTSD) are also widely reported in ARDS survivors. While PTSD is most prevalent upon ICU or hospital discharge, depression remains present for much longer.6
A study published in Lancet Psychiatry reported a doubling of risk in adults of being newly diagnosed with a psychiatric disorder post-COVID-19.7 The main three conditions were anxiety, insomnia, and dementia. The study considered “diagnosis” as anywhere between 14 and 90 days after a COVID-19 diagnosis.
Studies mention reduced attention and memory, as well as impaired general mental processing capabilities, especially high executive cognitive functioning.