Speakers

Michael Choo, MD, FACEP, FAAEM, Chief Medical Officer, Paradigm
Kathy Galia, RN, BSN, COO, Paradigm Catastrophic Care Management
Lawrence Lottenberg, MD, FACS, Paradigm Medical Director
Joseph K. Choo, MD, FACC, Paradigm Medical Specialist Consultant
Tiffany Morvari, MA, LPCC, Director of Clinical Programming, AiRCare Health

The first cases of COVID-19 were confirmed in the United States back in January. At that time, not much was known about the virus. Almost seven months later our knowledge has increased, and researchers continue to discover new findings almost every day.

On Thursday, July 30th, Paradigm and a panel of experts conducted a live webinar with continuing education credit to explore what we have learned about COVID-19 and the implications for workers’ compensation patients. Central to this was an in-depth discussion on how to evaluate and diagnose the virus, as well as updates on medication and treatment with a focus on psychosocial components of recovery. This webinar was attended by more than 2,600 people and now holds the record as the highest number of attendees for a single event in the history of the CEU Institute. Paradigm provided almost 2,100 hours of continuing education credit for this webinar.

To start the session, Kevin Turner, CEO of Paradigm Catastrophic Care Management highlighted a previous webinar held in April and shared how much Paradigm and the larger medical community have learned about COVID-19 in the interim. He then introduced the speakers and reviewed the objectives for the presentation, which focused on the respiratory, cardiac, neurological, and behavioral perspectives on the disease. The webinar also aimed to discuss emerging treatments while exploring the importance of recovery and rehabilitation from the perspective of injured workers.

Coronavirus basics: Why this virus is unique and dangerous

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 since the outbreak earlier this year. He began by reviewing how the virus has been discovered to mutate and how this could affect the contagiousness of the disease. Dr. Choo also confirmed the asymptomatic and presymptomatic carrier states, noting that these states account for nearly 62% of infection transmissions.

Dr. Choo also reviewed epidemiology of the virus, discussing global infection rates as well as the numbers in the United States before touching on transmission routes, infectivity periods, and development of immunity. He stated that despite long-term immunity being unknown, there is currently no definitive evidence of reinfections occurring within the first few months following recovery. He also reiterated support by current evidence for the “80/20” rule, meaning that 80% of patients experience mild or no symptoms, with 20% experiencing more serious illness up to and including the need for intensive care.

Dr. Choo then went on to explore the demographics and risk factors for severe and more critical illnesses associated with COVID-19. Patients with cardiovascular disease, diabetes, chronic obstructive pulmonary disease (COPD), and obesity are at a particularly high risk for developing severe complications and higher morbidities with the disease. The current state of testing was a topic, with Dr. Choo talking about some of the difficulties associated with different types of testing, including false positives, false negatives, and availability. To conclude, Dr. Choo discussed what we are now observing with post-acute COVID-19 symptoms in both severe and mild cases, stating that they can be persistent and serious for a long duration of time.

Pulmonary concerns and acute care for COVID-19

Dr. Lawrence Lottenberg, a Paradigm Medical Director who specializes in multiple trauma and critical care, then took over to show how the coronavirus affects the lungs, and why it results in such severe breathing problems. In addition, he emphasized that coronavirus is a systemic disease condition that involves hyper-inflammatory response that leads to acute respiratory distress syndrome (ARDS) inhibiting the ability for the body to receive oxygen as well as multiple blood clots leading to significant organ damage.

He then highlighted some of the breakthroughs in treatment that have allowed for a very significant reduction in mortality among the most severe 5% of cases. While there is currently no “silver bullet” for treating COVID-19, effective treatments now seem to include remdesivir, steroids, anticoagulants, IL-6 pathway inhibitors, and convalescent plasma infusions. These and other treatments are primarily designed to reduce the need for patients to be put on a ventilator, which can lead to complications and associated behavioral health difficulties.

The search for a vaccine and cardiovascular perspectives

Next up was Paradigm Medical Specialist Consultant and interventional cardiologist Dr. Joseph Choo, who started with a deeper discussion of the search for a COVID-19 vaccine. He stressed that despite some significant progress, there are still many challenging steps remaining before a vaccine could be brought to market. One of the caveats he stressed was that most of the leading candidates currently require at least two inoculations, creating logistical difficulties. Additionally, there are still unknowns about the ability of candidate vaccines to create durable immunity, as well as the existence of potential side effects. Because of this, Dr. Choo stated that he would be very surprised if an effective vaccine would be available by the end of 2020.

Dr. Choo then moved on to the cardiovascular problems that are associated with COVID-19. The virus has been documented to directly infect the heart cells, causing significant injury and inflammation, while the resulting immune response, or cytokine storm, can exacerbate the heart function by causing heart attacks and heart arrhythmias. Heart issues associated with COVID-19 include myocarditis, blood clots, congestive heart failure, and arrhythmias. To treat this damage, supportive care is key, including pharmacological treatments, stints, and mechanical interventions. He stressed that a third of hospitalized COVID patients have myocardial damage and that this results in a higher mortality rate of up to 40 to 50%. He also discussed the risk among all patients with the disease for long-term heart damage.

Neurological and behavioral issues

The presentation then returned to Dr. Michael Choo for a brief overview of the neurological symptoms of COVID-19. The most severe issues, affecting around 10% of hospitalized patients, include encephalitis, seizures, and stroke complications resulting in significant neurological impairments needing extensive neuro-rehabilitation needs. Another key challenge is the increasing frequency of “post-intensive care syndrome,” or PICS, among COVID-19 critical illness survivors, which is a term that describes complications that develop from extended stay in an intensive care unit (ICU). According to Dr. Choo, PICS can cause severe cognitive impairment that can mimic traumatic brain injury along with severe physical debility as well as psychological dysfunctions in many ways.

Tiffany Morvari, Director of Clinical Programs for AiRCare Health, then spoke about what to expect and how to best approach some of the most important psychological effects resulting from severe COVID-19 illnesses. One of the most difficult aspects is the complete isolation and lack of interactions with human support systems while sick with COVID-19. This circumstance leads to significant behavioral health problems including post-traumatic stress disorder, depression, and anxiety. Morvari emphasized the importance of virtual platforms and clear communication with caregivers to improve mental health outcomes for those hospitalized with COVID-19, as well as their family members. It is also essential for discharged patients to have access to comprehensive behavioral health services, and a calm and stable home environment.

Rehabilitation and recovery practices for COVID-19

Paradigm’s Catastrophic Care Management Chief Operations Officer, Kathy Galia, closed the session by discussing new guidelines for discharge and recovery. For mild-to-moderate and severe illness, she says patients should have 24 hours of fever resolution, combined with 10 to 20 days since onset of symptoms, depending on severity. The CDC is recommending a system-based approach that limits spread while minimizing prolonged isolation and the need to use limited testing resources.

Next, Galia shared some of the insights Paradigm has so-far experienced in treating work-related COVID-19 cases. Many of the patients are front-line health care workers, aged 50 to 60, with a 50-50 male and female split. As mentioned above, a significant portion had a compounding condition or comorbidity. For treatment, these patients are commonly being admitted to newly created specialty rehabilitation centers for COVID patients. She stresses that interdisciplinary teams, with the aid of new technologies, are helping to contribute to positive outcomes. According to Kathy, telemedicine and telepresence are playing a key role in extended treatment upon discharge. Costs for treatment are being shown to vary widely depending on the severity of the case.

Webinar resources

Download a replay of the webinar, the presentation slides, and webinar FAQs here.