Long COVID is a colloquial term for the condition whose scientific name is post-acute sequelae of SARS-CoV-2 infection, or PASC. It’s also sometimes referred to as long-haul COVID, long-term COVID or post-COVID conditions/syndrome.

Long COVID is an umbrella term that encompasses cases in which people experience symptoms related to COVID-19 long after the standard expected recovery period.

Research findings on the prevalence of long COVID vary greatly. Some estimate that fewer than 10% of those who had COVID are experiencing long-term symptoms, while others have found it to be as many as half of research participants. One study hypothesizes that up to 80% of COVID patients will experience at least one long-term, persistent symptom. Because the condition is still quite new, reliable longitudinal data is not yet available.

Theories regarding the causes of long COVID vary, with some speculating that it arises from immune activation and others projecting that it stems from damage caused by the virus or a low-level presence of the virus. Based on early studies, risk factors associated with developing long COVID include initial disease severity and other pre-existing comorbidities like advanced age, being female, high blood pressure, smoking, diabetes, obesity and psychiatric disorders.

While most employees who contract COVID can return to work at full capacity within a week or two, those experiencing long-haul symptoms may have functional impairments that significantly affect productivity.

The extreme fatigue associated with long COVID can leave workers with little stamina to meet job demands. “Brain fog” can impede reaction time, memory and the ability to assimilate new information; performing simple tasks and finding the right words to communicate may become difficult.

In addition, previously healthy individuals carrying the mental burden of their long-haul symptoms – and suddenly having difficulty focusing, concentrating and thinking at work – may experience anxiety, stress, depression and even trauma as a result of not being able to perform as they once did. Further compounding these cognitive and emotional challenges is the fact that symptoms can come and go, so employees often can’t predict how they will feel or perform at any given time.

As with any significant health concern affecting the workforce, monitoring workers’ compensation, disability and leave of absence claim counts and durations is essential to grasping the scope of the organizational impact of long COVID. However, there are a few challenges worth noting with regard to tracking long COVID:

– – For now, there is no true diagnostic category for long COVID. (The ICD-10 code for post-COVID conditions is, as of the time of this publication, awaiting final approval.) Tracking COVID claims lasting at least a certain number of days may not yield completely accurate data on long COVID, as they will also include extended hospital stays and debilitating symptoms associated with the original bouts of COVID.
– – Because the symptoms of long COVID are sporadic and often differ from those that people experienced when first contracting the virus, the resulting health challenges are not always accurately identified as being associated with COVID.
– – Workers’ compensation data may not tell the whole story of long COVID. Even in U.S. states where COVID-19 diagnoses among certain categories of workers are presumed to be work-related and thus covered under WC, individuals with long-term complications have a new burden of proof to show that their lingering symptoms are directly associated with their original COVID claims. Extended durations between claim incidents can further complicate this burden of proof and the ability to demonstrate compensability.

For more information, download and read the full paper: Sedgwick: COVID-19: In it for the long haul.

AF Group, a nationally recognized holding company whose affiliated brands provide specialty and workers’ compensation insurance solutions across the United States, has entered into a definitive agreement through its subsidiary Accident Fund Insurance Company of America to purchase AmeriTrust Group from Fosun.

Headquartered in Southfield, Mich., AmeriTrust offers specialty insurance programs and products including workers’ compensation, commercial package and automotive business coverages, and comprehensive product offerings in various industry segments. AmeriTrust is rated “A-” (Excellent) by A.M. Best.

The acquisition is expected to be completed after obtaining regulatory approvals.

“This exciting acquisition aligns two world-class organizations toward a common goal of providing exceptional, customer-focused insurance products and services through our valued agents,” said Lisa Corless, president and CEO of AF Group. “The reputation and performance of AmeriTrust is proven in the marketplace, and we’re excited to welcome their exceptional team to our award-winning organization as we work together toward even greater success.”

With this acquisition, AF Group welcomes AmeriTrust’s expertise in the property and casualty space to its enterprise and further enhances its successful specialty and workers’ compensation products and its capabilities in other lines of insurance.

The investment also reinforces AF Group’s increasingly prominent position and reputation in the property and casualty insurance market, which has grown significantly over the last decade.

AF Group is recognized for its financial strength as a Ward’s 50 company and has earned an “A” (Excellent) rating by A.M. Best.

Stonybrook Capital acted as advisors to AF Group and Deutsche Bank were advisors to Fosun.

Following eight years of litigation, an Orange County Superior Court judge threw out a major insurance fraud case. According to the report in the Orange County Register, all charges of involuntary manslaughter and felony insurance fraud-related counts were dismissed against Kareem Ahmed, Andrew Robert Jarminski and Michael Rudolph, according to court records.

Back in 2014, an Orange County Grand Jury initially indicted 15 people – including 10 doctors and a pharmacist – for their alleged involvement in a multi-million dollar workers compensation fraud scheme. The alleged ringleader was Kareem Ahmed, president and CEO of Landmark Medical Management, an Ontario California company.

Ahmed allegedly paid physicians a total of more than $25 million to dispense the compound creams between June 15, 2010, and Dec. 31, 2012. The amounts individual doctors received between 2010 and 2013 ranged from $600,000 to more than $2.5 million, it alleged. Among those Ahmed allegedly paid were Daniel Capen, M.D. (more than $2.5 million); Andrew Jarminski, M.D. (more than $1.9 million); pharmacist Michael Rudolph (more than $1 million); and Rahil Kahn, M.D. (more than $1 million), according to the indictment.

Challenges to the procedures used in the indictment eventually were elevated to the Court of Appeal in the case of Kareem Ahmed v Superior Court, which agreed with some the challenges made by the defendants, and thus reversed the trial court, and remanded the case.

Instead of returning to the Grand Jury, the Orange County District Attorney then re-filed a felony complaint against Kareem Ahmed, Andrew Jarminski, Michael Rudolph and Norma Garner instead.

The case had another setback in 2019, when Orange County Superior Court Judge Sheila Hanson ruled that prosecutors violated the defendants’ Sixth Amendment rights to counsel and Fifth Amendment rights to due process, invaded the attorney-client privilege, and ordered that prosecutors purge all privileged materials from their computer servers and that on the servers at the Orange County Regional Forensics Lab. And that going forward, she would exclude all evidence that was privileged or derived from privileged evidence.

This ruling obviously made it difficult for prosecutors to go forward with the case. Since that ruling, the attorneys have been working through what evidence was not tainted and could still be used in the case. There apparently was not enough evidence left. All charges of involuntary manslaughter and felony insurance fraud-related counts were dismissed this month against Kareem Ahmed, Andrew Robert Jarminski and Michael Rudolph, according to court records.

Courthouse News reports that federal judge cleared the way last week for San Francisco’s opioid lawsuit against Walgreens and a number of pharmaceutical companies to head to trial, which is set to begin on April 25.

Thousands of states, cities and counties have sued pharmaceutical companies over their role in the opioid epidemic, which is believed to have been caused by the marketing and overprescription of prescription drugs like Oxycontin. Many patients who were prescribed an opiate later switched over to using illegal narcotics like heroin. According to the CDC, nearly half a million people died from opiate overdoses between 1999 and 2019.

The biggest culprit was Purdue Pharma, which manufactured and marketed Oxycontin, and which entered bankruptcy in 2020. That proceeding hit the pause button on all lawsuits against Purdue, and eventually lead to a massive settlement, in which cities and states will effectively take over ownership of Purdue. The former owners of the company, the Sackler family, contributed $6 billion to the settlement, a good deal of which went to the governmental entities, in exchange for immunity from future lawsuits.

The drugmaker Johnson & Johnson and three pharmaceutical distributors agreed to a $26 billion settlement with states and municipalities in February.

But that still leaves a multitude of other opioid-related lawsuits in active litigation.

San Francisco filed its suit in 2018 against a panoply of defendants, including Purdue, nine members of the Sackler family and a host of other companies. Some of those defendants, like Purdue, have been released from the case thanks to settlements. But some parties remain, including Walgreens, Actavis, Teva Pharmaceuticals and Endo Pharmaceuticals, the latter two of which specialize in making generic versions of drugs.

The city’s suit made a number of what were at the time novel allegations, including public nuisance and racketeering. In 2020, U.S. District Judge Charles Breyer dismissed the racketeering claims, but allowed the public nuisance claims to go through.

Last week, Judge Breyer further whittled down the list of defendants. In a 9-page decision, Breyer dismissed claims against parent company Endo International, writing, “evidence fails to suggest that Endo subsidiaries are ‘merely an instrumentality’ of Endo International.” He also dismissed claims against a subsidiary, Par Pharmaceuticals. But Endo Pharmaceutical and Endo Health Solutions must still stand trial.

San Francisco has made two claims about the company – that it “made false and misleading statements about the safety and risks of opioids,” and that it “failed to design and operate effective systems to identify suspicious orders of opioids and to prevent diversion of opioids.” Both of those failures, the city claims, amounted to a public nuisance.

In another, much shorter decision, Breyer dismissed motions for summary judgment from five other defendants, including Teva and Walmart.

The strategy of suing opioid companies by alleging public nuisance has had a mixed track record. An Orange County Superior Court Judge, in November 2021, ruled in favor of four pharmaceuticals (including Endo and Teva) after a bench trial in a lawsuit brought by the counties Santa Clara, Los Angeles and Orange and the city of Oakland. That same month, an Oklahoma Supreme Court overturned a $465 Million ruling against Johnson & Johnson, rejecting the public nuisance argument.

Other lawsuits against drugmakers alleging public nuisance are still pending, including a trial in West Virginia, which started this week.