Addressing the Lasting Medical Effects of COVID-19

COVID-19 has hit our country and city hard while exposing deep underlying gaps in accessibility of care. While we have made significant strides in developing treatment paradigms and deploying population level vaccination campaigns to combat COVID-19, there are lasting effects on our people and our healthcare ecosystem. A small number of individuals suffering from Covid-19, sometimes referred to as “long-haulers,” will experience symptoms lasting far longer than the typical 2-week duration for mild illness. Roughly 10% of Covid-19 patients experience significant symptoms lasting longer than 3 weeks--months in rare cases--presenting a serious challenge for healthcare providers and policymakers. Although the NIH recently launched a new initiative to better understand these post-acute sequelae of SARS-CoV-2 infection (PASC), there are few comprehensive studies of persistent Covid-19 symptoms in the medical literature. Most current scholarship includes: practice guidelines/recommendations based on current understanding, perspective and viewpoint articles summarizing current understanding, research letters and studies with small sample sizes. 

As a COVID-19 survivor himself, Andrew Yang will listen to the experts, doctors and scientists as medical knowledge evolves on the complex consequences of COVID-19. The city recently announced an Aftercare program, using NYC Test & Trace Corps to engage people who had or were suspected of having COVID-19, but more can be done. To support these individuals, a Yang administration will target three key issues: better understanding the epidemiology, improving treatment, and ensuring insurance coverage. The Yang administration will also spur COVID-19 targeted clinical, biomedical, and public health research, and expand COVID-related social support services.

I) Improve policy recommendations through classifying and identifying “long haulers” 

Classify long-haulers. 

There is no uniform diagnostic criteria for “persistent COVID-19” and one will be needed to accurately screen and identify these individuals.  Defining persistent COVID-19 is also important for targeting related employment discrimination and protecting the rights of disabled individuals. Andrew Yang will work with labor groups, individuals suffering from persistent COVID-19, medical professionals, long-trusted public health institutions and other stakeholders to ensure that our city is appropriately classifying the syndrome amongst variable groups and presentations of symptoms. We will advocate at the state and federal level to ensure these individuals are covered by employment and disability protections.

Identify long-haulers by setting up a COVID-19 registry. 

Andrew Yang will encourage screening for persistent COVID-19 symptoms as part of the application process for city social services, and at medical visits where appropriate for anyone who tested positive for COVID-19. We will support efforts to educate primary care providers about the phenomenon, educate the public and connect them with city resources, and explore the use of screening apps. We will also encourage local health departments to contact COVID-19 survivors at intervals after recovery.

And there is precedent here for establishing a registry. The World Trade Center Health Registry, is now the largest registry in U.S. history to track the health effects of a disaster. Enrollment in the Registry was voluntary for people who lived, worked or went to school in the area of the WTC disaster, or were involved in rescue and recovery efforts. A Yang administration will use best-practices from the WTC registry to model the COVID-19 registry. This would help healthcare professionals catalogue symptoms, procedures and outcomes related to COVID to be used for enhancing clinical care and made available to support clinical research and recovery. Patient privacy and data security is paramount. Only healthcare professionals will have access to the registry and adequate safety measures will be put in place to ensure the protection and integrity of the information. Further, a Yang administration would create a health registry of medical professionals capable of addressing COVID-19 long haulers to address the supply side of the equation and ensure adequate medical professional capacity when needed.

Study PASC (aka “long-hauler”) epidemiology through grant funding for studies. 

Reported prevalence data is quite variable and many individuals with long-haul COVID-19 symptoms have never received a positive antibody, PCR or rapid test. Andrew Yang will create a grant program to encourage large, well-controlled epidemiologic studies, in partnership with state and local health departments, NYC academic medical centers and community-based organizations to define cross-sectional prevalence estimates. This research will also shed light on the best way to “live with COVID” in future years. There are still many unknowns about COVID-19. For example, will it become seasonal like the flu? Will we need vaccine boosters to combat variants? How many boosters would we need, and when would we need them? When are economic shut-downs absolutely necessary for public health and what should they look like?) Investing in scientific research coupled with the NYC registry will put NYC on the cutting edge of data collection and dissemination to inform future response and mitigation efforts.

II) Improve treatment of long-haulers 

Study long-hauler clinical course, prognosis, and treatment. 

Andrew Yang’s administration will encourage studies at both public and private hospitals via a targeted grant program discussed above, and will seek federal funds to support such studies, collaborating with national and international bodies to define consensus. This must also include constant educational efforts for patients and providers. 

Mobilize treatment to marginalized communities. 

Treatment of persistent COVID-19 symptoms often requires frequent interaction with health care professionals. This may be challenging for individuals who can’t take time off of work or who don’t live close to their providers. Symptoms may also involve psychiatric symptoms that make it challenging to travel or hard to seek treatment because of stigma. Specialists like neurologists may also be concentrated in inconvenient locations. Andrew Yang will fund the creation of dedicated post-COVID-19 treatment centers with co-located specialists in communities of need, some of which are already popping up at hospital systems, currently through three COVID-19 Centers of Excellence. Expanding on these sites, a Yang administration will coordinate efforts across the city as part of a larger practice of care. We will also advocate for the loosening of telemedicine laws to improve access to remote care, in particular psychiatric services.

Ensure adequate insurance coverage

Treatment of persistent COVID-19 could be very costly for patients (no federal law currently requires insurers to pay for Covid-19 treatment). Currently uninsured patients and those with high-deductible or catastrophic plans will face high out of pocket costs.  Long-haulers may also lose employment-based insurance as a result of their illness.  To ease the financial burden on these patients, a Yang administration will:

• Offer free assistance enrolling those suffering from persistent COVID-19 in insurance and finding appropriate plans via a Helpline.
• Provide financial support in the form of deductible and co-payment assistance.
• Vigorously enforce pre-existing conditions protections.
• Create a COVID-19 relief fund to facilitate financial support, which might also create incentives and financial relief in the event that a booster vaccine might be required each year forthcoming.

Provide social support

Chronic illness of any kind is a tremendous strain on patients and their support systems. Many individuals with persistent COVID-19 will experience neuropsychiatric symptoms that may act as additional stressors. To support long-haulers, a Yang administration will:

• Create a Mental Health Corps that engages regularly with those suffering from persistent COVID-19.  We will explore app-based check-ins, leverage telemedicine, and utilize community health centers for in-person visits. H+H will also facilitate support groups and refer identified individuals to available City resources. And we will explore the use of home visits and mobile clinics.
• Facilitate the creation of an online social community that long haulers could use for sharing their stories and connecting with others who may be suffering through similar circumstances.
• A Yang administration will advocate with private employers and at the state and federal levels for increased paid sick leave requirements, additional employment protections and/or disability insurance, and incentivized work-from-home arrangements.
• We will launch efforts to specifically educate the public about disability discrimination and workplace rights related to COVID-19.