In late August we read of a British geriatrician having what was called a “bleak epiphany” about older adults who had recovered from COVID-19. Having treated a patient just six months prior for COVID, Dr. David Strain was pained to see the man back in the hospital with a stroke and delirium. “His brain had dramatically aged,” said Strain.
Strain’s takeaway from this encounter? The physician thinks COVID generated what he calls an “epidemiological aftershock leaving people susceptible to a huge range of other conditions, threatening global health systems already struggling with insufficient resources and ageing populations,” according to the Financial Times.
We know in the United States that we need to prepare for what are likely to be large increases in cardiovascular, neurological and mental health disorders stemming from COVID, never mind the ongoing effects of those who already know they have Long COVID.
That’s why it was a relief to see the Biden Administration taking concrete steps this past April to continue preparing for the long-term effects of the pandemic with a Memorandum on Addressing the Long-Term Effects of COVID-19; a FACT SHEET: The Biden Administration Accelerates Whole of Government Effort to Prevent, Detect, and Treat Long COVID; and Services and Supports for Longer-Term Impacts of COVID-19.
In combination, this is a robust action plan, briefly summarized below.
The Memorandum details policies put in place to address long COVID, to ensure the federal government is “accelerating scientific progress and providing individuals with the support and services they need.” The Administration has made significant investments in mental health and substance use disorder prevention, treatment and recovery, which in real life means expanding community-based behavioral health services.
The government’s plan will accelerate scientific progress and provide individuals with the support and services they need.
The Secretary of Health and Human Services (HHS) heads the governmental response and will report on the Long-Term Effects of COVID-19 within 120 days of April 5, 2022 (see details on report below); outlining services and supports across agencies to help Americans and develop a National Research Action Plan on Long COVID, advancing progress in prevention, diagnosis, treatment and provision of services. An interagency effort between HHS and the secretaries of Defense, Energy and Veterans Affairs, the plan builds upon the existing RECOVER Initiative previously implemented by the National Institutes of Health.
Substantial FACT SHEET
The FACT SHEET describes actions that will be taken to build upon the Administration’s ongoing work to implement recommendations from the Presidential COVID-19 Health Equity Task Force established in July, 2021.
Action 1: Deliver high-quality care for individuals experiencing Long-COVID, especially in hardest hit communities (i.e., low income, Black and Brown), via launching Centers of Excellence and promoting evidence-based care models, investing $20 million in 2023 to investigate how healthcare systems can best organize and deliver care to people with long COVID. The CDC, FDA, SAMSHA and NIH, in partnership with the Agency for Healthcare Research and Quality (AHRQ) will build on existing interim clinical guidance to help providers and patients get all the information they need.
Long COVID clinics across the country will be expanded and strengthened, including multiple (right now there are 18) Department of Veterans Affairs (VA) facilities. Such programs will serve as a source of rapid learning and long-term research on best practices and new therapies. The Office of the Assistant Secretary for Health will launch a Health+ project to garner insights into patient experiences to better inform care and standardize practices.
The Administration will continue sharing resources to providers through its Centers for Medicare & Medicaid Services, Medicare Learning Network and Indian Health Service. And it will launch a code to support diagnosis, billing and tracking of Long COVID, which is as of yet inactive. Telementoring programs for rural networks will be bulked up.
Health insurance coverage for long COVID will be bolstered to make care as accessible as possible. This means an expansion of Medicare coverage for pulmonary rehab services for long COVID and includes increased awareness of long COVID among Federal Employee Health Benefit Program carriers.
‘Health insurance coverage for long COVID will be bolstered to make care as accessible as possible.’
Action 2: The long-term disability aspect of long COVID is addressed via making more services and supports available for individuals experiencing long COVID, raising awareness of long COVID as a potential disability to protect people who have it from job discrimination; translating research into inclusive disability policy via the Social Security Administration’s collaboration with research agencies to clarify and update policies; connecting people to resources, including incorporating multilingual information and support into the CDC Call Center.
Finally, the Equal Employment Opportunity Commission and the Department of Labor released guidance on access to equitable employment opportunities for people with long COVID, and they will support ADA enforcement of any discrimination.
Action 3: The last major push on the Fact Sheet is to advance the nation’s understanding of long COVID by accelerating research, better identifying and characterizing long COVID and taking steps to advance our scientific understanding of long COVID to prevent, detect and treat the disease. The federal government is launching a National Research Action Plan on Long COVID; accelerating enrollment into the RECOVER Initiative; investing more to advance research and surveillance; leveraging the power of federal data; and identifying workplace interventions that help keep working people connected.
Massive Resource Document
The final prong of this Administration’s response is the 124-page Services and Supports for Longer-Term Impacts of COVID-19, which is the HHS’s report generated from the initial Memorandum’s demand. The report is a resource and guide for anyone experiencing long COVID or their families and caregivers to find the supports, services and “reasonable modifications to receive healthcare and treatment, go to work, go to school, and stably live in the community.” It aims to assist people in healthcare, public health agencies and anyone else working with those experiencing long COVID. Guided by health equity principles, it builds upon recommendations made by the Presidential COVID-19 Health Equity Task Force.
It covers disparities in COVID-19, bereavement, mental health and substance use, long COVID and disabilities from long COVID. There is an extensive list of where to go if one is a provider, or someone who has long COVID and needs help, as well as chapters covering work issues, housing, job assistance, rights around disabilities, caregiver and family support, healthcare coverage and access, legal help, financial help, food and nutrition help, childcare—really the list of resources is not just exhaustive but impressively so and well-organized.
Another chapter covers “enabling health care personnel to improve treatment of people experiencing long COVID,” again with extensive links to resources. Toward the end there are more resources on mental health, substance use and bereavement, and finally a laying out of future action plans from the HHS.
Our members would be wise to download this report to have it handy for anyone who harbors doubt about the existence of long COVID, or more practically to help what is certain to be an increasing number of patients and older adults who desperately need services to address the lingering symptoms.
Alison Biggar is ASA's Editorial Director.