Government data reveals that by 22 January 2021, 3.62 million people in the UK had tested positive for COVID-19; a figure which continues to increase every day. Among those testing positive, there appears to be a stark increase in those suffering from what is termed ‘long COVID’ - the collective name given for the myriad of ongoing symptoms suffered by some of those who contract COVID-19.
According to a King’s College report published in October 2020, 1 in 10 of those contracting COVID-19 have experienced longer term symptoms beyond 12 weeks post-onset. These figures were reaffirmed by the Office of National Statistics (ONS) in December 2020.
The ONS also published the results of its Infection Survey; estimating, based on antibody data, that at least 1 in 8 people in England had contracted COVID-19 by December 2020. The ONS say that these figures equate to 5.4 million people in private households having previously had the infection.
Long COVID and the public health crisis
Symptoms of long COVID include joint and muscle pain, breathlessness, chest pain, chronic fatigue, organ damage and other physical and psychological symptomology. Looking at these statistics, it is understandable why some experts warn that Long COVID will be a highly significant facet of this ongoing public health crisis. Studies continue both nationally and internationally to gain a better understanding of the underlying pathology, consequences, sequelae and treatment required to tackle this chronic condition.
A study by the University of Cambridge of 207 COVID patients with a range of disease severity, published on 15 January 2021, has provided important insights into the role played by the immune system in both preventing and increasing the severity of a COVID-19 infection. The focus of the Cambridge study was to compare the immune response of those with few- or no- symptoms against those who experienced the severe disease. Further, the study looked at how rapidly the immune system recovers and how this may be linked to long COVID.
The report states that whilst some patients responded to the infection with an early, robust and adaptive immune response (resulting in mild or no symptomology), in a minority of patients, there is evidence of the immune system overreacting to the virus, leading to chronic inflammation and damage to multiple organs.
The recent research indicates that profound alterations in many immune cells often persist for weeks or months even after systemic inflammation has resolved. The Cambridge authors state: “It is these populations of immune cells that still show abnormalities, even when everything else seems to have resolved- that might be of importance in Long COVID.” It is thought by the researchers that key molecular signatures of this inflammation process could potentially be used to predict the severity of a patient’s disease, and that prediction could be made immediately after infection or at the time they begin to show symptoms. In light of that, it is to be hoped that early identification of such markers associated with severe COVID symptoms and /or long COVID will inform the management and early treatment of patients, so as to minimise the severity and longevity of symptoms.
A global perspective
Internationally, more empirical research has now become available following the largest and longest follow-up study conducted to date, investigating the persisting effects of COVID-19. The Chinese study - published in the Lancet on 8 January 2021 - studied 1733 patients discharged from Jin Yin-tan Hospital in Wuhan, China. The study found that six months post-onset, 76% of patients reported at least one symptom that persisted. The most common persisting symptoms were muscle weakness and fatigue. It was also reported that 50% of patients presented with residual chest imaging abnormalities six months on. The data was not unexpected: similar long term symptoms and lung damage has also been seen in patients recovering from the SARS outbreak in 2002-2004 - also a coronavirus. Indeed, some of the data gathered following the 2002-2004 SARS outbreak can give some insight as to what potentially lies ahead. Studies following the recovery of SARS patients have confirmed that 38% of the patients had reduced lung diffusion capacity 15 years post infection. It seems that for some people beating the initial infection is just the beginning.
More research and awareness required?
In a debate in the commons on long COVID, on 14 January 2021, Layla Moran MP (who is leading an all-party inquiry into the Government’s handling of coronavirus), raised concerns that over 300,000 people in the UK were experiencing long COVID and made calls to the government to provide more funding for research. Moran has been chairing the cross-party evidence hearings which have heard from medical professionals and others suffering from debilitating symptoms of Long COVID, preventing a return to work. Moran spoke about the lack of public awareness of long COVID despite the alarming statistics and expressed concerns that “many long COVID sufferers have no formal diagnosis, as they never had a test because tests were not available in the first wave” and “that long COVID can emerge months after a bout of the initial virus and long after antibodies remain, so even an antibody test may not tell the whole story.” She pressed for guidance to be issued to employers so they know how they should be supporting people with long COVID and urged the Government to commit to recognising long COVID as an occupational disease and to create a long COVID compensation scheme for health and social care staff and key workers.
Whilst the research undertaken to date provides optimism for early identification and treatment of those patients who may develop a severe COVID-19 illness or long COVID in the future and the Government’s vaccination plan aims to deliver vaccines to tens of millions by spring, the statistics show high numbers of people currently living with long COVID, which are concerning. The submissions made by Moran in the commons debate highlight the challenges that insurers will face when giving consideration to diagnosis, symptomology and prognosis of injury claims presented, particularly in the absence of a positive COVID-19 infection or antibody test.
Considering the latest statistics and recent research it now seems inevitable that insurers will be faced with higher value and more complex COVID employers' liability and public liability claims following this pandemic. At BLM we are now beginning to see long COVID claims coming through and each claim is set against a unique set of facts raising inevitable complex questions of liability and in particular causation.