The Future of COVID-19—Vaccines and the Trajectory of Care

Speakers
Michael Choo, MD, FACEP, FAAEM, Chief Medical Officer, Paradigm
Kathy Galia, RN, BSN, Senior Vice President & General Manager, Clinical Solutions
Lawrence Lottenberg, MD, FACS, Paradigm Medical Director
Steven M. Gordon, MD, Chairman of the Department of Infectious Diseases, Cleveland Clinic Foundation

It has now been more than a year since the initial cases of COVID-19 were confirmed in the United States. As the pandemic remains an ongoing health emergency, the approval and rollout of the COVID-19 vaccine and continued development of treatments represent significant milestones in overcoming the disease. However, there are still many questions regarding the long-term trajectory of the virus and its effects on society that our industry is working to understand.

On Thursday, March 4, 2021, Paradigm and a panel of clinical experts conducted a live webinar (with continuing education credit) to explore the current state of COVID-19 and the implications for the workers’ compensation industry. Of particular interest this year is the rollout of the vaccines and the continuing development of treatment. Paradigm delivered nearly 2,300 hours of continuing education credit for this webinar, setting yet another record for Paradigm and the CEU Institute.

To start the session, Kevin Turner, Chief Clinical Solutions Officer for Paradigm, highlighted previous panels held in April and July of 2020 and noted nearly 4,000 people registered to attend this latest event. He then introduced the speakers and laid out the objectives for the presentation. Specifically, he remarked that the session would cover the current state and societal impacts of COVID-19, the ongoing development of treatment and vaccines, the long-term effects of the virus, and the impact on workers’ compensation (as demonstrated through two case studies).

The current state of COVID-19

The first speaker was Dr. Michael Choo, Paradigm’s Chief Medical Officer, who provided an overview of the coronavirus and what the medical community has learned over the first year of the pandemic. He began with optimistic news regarding the administration of the vaccine and declining rates of infection, hospitalization, and fatalities.

However, Dr. Choo also stressed that there is still a lot of work to be done before the government and public health officials can declare an end to the pandemic. He called out mixed compliance with safety precautions, problems with vaccine rollouts, and the emergence of COVID variants as all contributing to a potential fourth wave of the pandemic in the fall of 2021.

Dr. Choo then provided a review of current global infection rates as well as the numbers in the United States, where total cases have surpassed 29 million.

As stated in Paradigm’s previous sessions on COVID-19, Dr. Choo reiterated that the majority of patients experience few to no symptoms and require minimal care, while a smaller portion require hospitalization, including the need for intensive care.

To conclude the overview, Dr. Choo discussed thresholds for the development of immunity and stressed that the relatively high levels of immunity among patients so far was a positive sign as the vaccination program begins to roll out.

The emerging picture of outpatient treatments and vaccines

Dr. Steven M. Gordon, a staff physician and chair for the Cleveland Clinic Foundation’s Department of Infectious Disease, then began a more in-depth discussion on the current state of treatments and vaccines.

According to Dr. Gordon, the coronavirus was almost perfectly designed to develop into a global pandemic, as it was a novel virus with no preexisting immunity in the population. Additionally, people can be asymptomatic carriers, which further facilitates widespread infection.

This has created many obstacles to treating the virus on both an inpatient and outpatient basis. Dr. Gordon explained that typical inpatient treatments have included oxygen, fluids, placing patients on their stomachs to improve ventilation, steroids, and administration of the antiviral remdesivir. However, he emphasized that remdesivir has not proven to be as effective as many had anticipated. On the outpatient side, he reviewed monoclonal antibodies, which are proteins that mimic the body’s immune response to fighting viruses, including COVID-19.

Finally, Dr. Gordon discussed the ongoing development and rollout of vaccines for COVID-19. This included a review of standards for efficacy, the various vaccine platforms, vaccine administration, and information on how widespread immunity develops. Dr. Gordon explained that society can anticipate the declaration of the end of the pandemic when 60% to 90% of the population has either been vaccinated or infected naturally.

COVID-19 long-haulers and the lasting effects of the coronavirus

The next presenter was Dr. Lawrence Lottenberg, a Paradigm Medical Director and trauma surgeon. In his presentation, he discussed the long-term complications that many patients are experiencing after a COVID-19 infection, also known as “long COVID.” He explained that there are four areas of long term complications that patients may encounter after recovering:

Respiratory issues
Cardiovascular problems
Neurological problems
Behavioral health concerns

There is also a spectrum of persistent problems that can be difficult to diagnose and treat because they are often not associated with explicit organ dysfunctions. These include symptoms of severe fatigue, brain fog, headache, dizziness, and many others.

Dr. Lottenberg then reviewed studies surrounding long-term COVID-19 patients and the development of specialized treatment centers across the United States. He emphasized the importance of treating these cases from a workers’ compensation standpoint because in a large number of cases, long-term symptoms are preventing the return to work for those who have been infected with COVID-19.

COVID-19 case studies highlight the impact on workers’ compensation

Paradigm’s Senior Vice President & General Manager of Clinical Solutions, Kathy Galia, closed the session by sharing two actual cases that represent Paradigm’s experience with work-related COVID-19 infections. While these are considered “extreme” cases, Paradigm is starting to run into these types of cases more frequently.

The first case involved a 53-year-old male from New York who is a frontline health care worker. Galia explained that after being admitted to the emergency room with fever and shortness of breath due to COVID, he experienced a stroke that would require prolonged ventilator support. After referral, Paradigm team members worked to coordinate care and set meaningful treatment goals. The injured worker was eventually discharged to home in February and is performing daily activities and receiving ongoing biopsychosocial care.

In the second case, a 32-year-old male, also from New York and a frontline worker, was diagnosed with COVID-19 and severe acute respiratory distress syndrome requiring nine weeks of intensive care. After being referred to Paradigm, the patient received highly specialized acute rehabilitation from a clinic in Atlanta and has since been discharged to a handicap-accessible apartment.

The webinar concluded with closing remarks from Kevin on successfully achieving the objectives of the presentation and a promise that the panelists would answer each question from the audience via an FAQ document in the coming weeks.