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Covid-19 Long Term Effects and FAA Medicals

Old 12-13-2020, 01:57 PM
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Default Covid-19 Long Term Effects and FAA Medicals

CDC: Covid-19 Long Term Health Effects

There doesn't seem to be a thread discussing the risks of contracting Covid-19 and the prevalence of long term health effects that could affect Class I/II/III medical issuances in the future.

A lot of it is unknown, and long term studies are being conducted. Any pilots on here who have contracted covid and still having health issues?

As more information comes out about pulmonary and cardiovascular issues arising from even asymptomatic cases, I could see this being a reportable event or requiring special issuances for certain cases.

Thoughts?
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Old 12-13-2020, 02:27 PM
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A LOT of infections can cause reportable problems. Nothing unique about that so far for COVID-19.

https://www.webmd.com/heart-disease/myocarditis#1

https://academic.oup.com/rheumatolog...86981#27063482


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089740/


Generally, the FAA judges you on the presence or absence of the condition, not which bug caused it.
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Old 12-13-2020, 03:27 PM
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Originally Posted by Excargodog View Post
A LOT of infections can cause reportable problems. Nothing unique about that so far for COVID-19.

https://www.webmd.com/heart-disease/myocarditis#1

https://academic.oup.com/rheumatolog...86981#27063482


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089740/


Generally, the FAA judges you on the presence or absence of the condition, not which bug caused it.
Fair enough. Not Covid alone, but the long term pulmonary and cardiovascular issues that could arise from an infection could very well be disqualifying.
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Old 12-13-2020, 03:36 PM
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Originally Posted by Cloud5urfer View Post
Fair enough. Not Covid alone, but the long term pulmonary and cardiovascular issues that could arise from an infection could very well be disqualifying.
There are a lot of looming threats out there that could impact your ability to hold a medical cert (obesity, COVID, hypertension, getting hit by a truck, etc). This is why own occupation LTD insurance is a such a valued benefit.
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Old 12-13-2020, 04:08 PM
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I've heard rumblings about FAA medical concerns with some lingering covid symptoms in some people. Too early to really know the prevalence or duration of these issues. Might be worth it for pilots to avoid covid until you can get the vaccine... I admit I'm probably more afraid of FAA paperwork than covid itself.
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Old 12-13-2020, 05:46 PM
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Neurological issues are surfacing too. Haven’t seen any studies yet, but have heard from multiple providers that some of those hit hard that were left with ‘long covid’ are experiencing memory loss.

Scary.
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Old 12-13-2020, 06:56 PM
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Originally Posted by firefighterplt View Post
Neurological issues are surfacing too. Haven’t seen any studies yet, but have heard from multiple providers that some of those hit hard that were left with ‘long covid’ are experiencing memory loss.

Scary.
It still appears there is nothing SPECIAL about COVID in that regard. If you get sufficiently ill - FOR ANY REASON - you can have the same problems.

Two unrelated COVID-19 studies across the globe–a German post-mortem study and one following hospitalized patients at the peak of the epidemic in New York City—found neuropathological changes in patients with the virus, but no evidence that the SARS-CoV2 virus itself causes these changes in the central nervous system. Instead, both studies concluded that injuries to the brain were likely sequelae of severe systemic illness caused by the virus

Morbidity Analysis

Neurological complications occurred in just over 13 percent of 4,491 hospitalized patients in New York City with COVID-19 between March and May 2020, according to data appearing in the Oct. 5 online edition of Neurology. Furthermore, these neurological injuries raised patients' risk of death by 38 percent while in the hospital. However, in patients who were tested, cerebrospinal fluid specimens were negative for SARS-CoV-2 on real-time reverse transcription polymerase chain reaction (RT-PCR tests).
“The results of our study showed no signs that the coronavirus directly attacks the nervous system,” lead investigator Jennifer A. Frontera, MD, professor of neurology at NYU Grossman School of Medicine, told Neurology Today. “The neurological complications seen in COVID-19 are predominately the secondary effects of being severely ill and suffering from low oxygen levels in the body for prolonged periods of time,” she said.In comments to Neurology Today, Dr. Liotta remarked that historically, based on the literature, between 20 and 30 percent of patients admitted to the ICU are considered delirious or are diagnosed with some type of encephalopathy.
Commenting on the German postmortem study, Dr. Mukerji noted that it is important to note that the neuroinflammation located in the brainstem was not associated with identifying SARS-CoV-2. “While brainstem inflammation has been identified in other COVID-19 autopsy cohorts, we and others caution about overinterpreting this finding. Many patients included in autopsy cohorts had respiratory failure and were intubated, and findings may not apply to patients who did not experience critical illness. It is absolutely critical to compare COVID-19 brain autopsies with COVID-19-negative autopsy studies from patients who have had systemic inflammatory/septic shock to understand the possible direct effects of the virus versus consequences of critical illness.”
Dr. Frontera, who was not involved with the study from Germany, commented that “the areas where they identified the virus was not located in the spots with the most pathological abnormalities.” She also noted that the number of RNA copies at 4,500 was low and “raises the specter of blood contamination.” She speculated that it could be possible for “brain injury from hypoxia, for instance, which caused the blood-barrier breakdown, thus enabling the virus can pass through and possibly worsen the hypoxia or perhaps be an innocent bystander because it's not sitting near the worse pathological areas.”
“When you are dealing with virus and infections, you must ask whether the virus is directly affecting the brain structure or the spinal cord or the nerves, or are these all factors associated with the systemic infection that impacts the brain or spinal cord,” said Carlos A. Pardo, MD, professor of neurology and pathology at Johns Hopkins University. “The answer is the latter in COVID-19. The SARS-CoV2 is producing is causing systemic infection resulting in systemic inflammation.” This, he noted, is demonstrated somewhat in both the New York study as well as the German post-mortem study.
“The neurologic problems practitioners are seeing are due to systemic complications such as strokes, coagulation problems, or systemic inflammation. There is no evidence that this disease is producing encephalitis in the strict sense of the word, which could cause coma and produce damage of neurons or brain structure. But the situation we are seeing with COVID- 19 is a dramatic effect of the systemic effects of patients' illness,” Dr. Pardo said.

https://journals.lww.com/neurotodayo...sights.13.aspx
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Old 12-13-2020, 07:32 PM
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Originally Posted by Excargodog View Post
It still appears there is nothing SPECIAL about COVID in that regard. If you get sufficiently ill - FOR ANY REASON - you can have the same problems.




https://journals.lww.com/neurotodayo...sights.13.aspx
Long-covid isn't just about neurological issues. Cardiovascular and Pulmonary issues are the most common. As high as 32% of cases are still experiencing symptoms 6 weeks later. It's unknown how long those will last.

One-third of patients may experience ‘long COVID’

I've seen a lot of downplaying on this forum in regards to Covid, which surprises me considering our careers are contingent on being healthy.
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Old 12-13-2020, 09:14 PM
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Originally Posted by Cloud5urfer View Post
Long-covid isn't just about neurological issues. Cardiovascular and Pulmonary issues are the most common. As high as 32% of cases are still experiencing symptoms 6 weeks later. It's unknown how long those will last.

One-third of patients may experience ‘long COVID’

I've seen a lot of downplaying on this forum in regards to Covid, which surprises me considering our careers are contingent on being healthy.
Not downplaying COVID at all. Just that there are serious cases and a symptomatic/trivial cases. Seriously Ill people on respirators in ICUs DO NOT DO WELL. Many of them die, and many who do survive have long term residuals, EVEN BEFORE COVID:

Examples:

A recursive partitioning model showed that disability is determined by age and ICU length of stay (LOS) based on the Functional Independence Measure (FIM) at 7 days post ICU discharge, independent of admitting diagnosis and severity of illness. Four distinct disability risk groups were identified [Young Short LOS (age <42 years, ICU stay <2 weeks); Mixed-age Variable LOS (≥42 years, <2 weeks and ≤45 years, ≥2 weeks); Older Long LOS (46-66 years, ≥2 weeks), and Oldest Long LOS (> 66 years, ≥14 days)]. These groups were characterised by different outcomes and post-ICU healthcare utilisation, with increasing disability from the Young Short LOS to the Oldest Long LOS. In the latter group, only 19% were discharged home directly from hospital, and over one-third required hospital readmission in the year after ICU discharge. Forty percent of this group died within the first 12 months after ICU discharge, and the surviving patients had severe and persistent functional dependency. Cognitive dysfunction, including problem solving and memory, was affected uniformly across risk groups.
https://healthmanagement.org/c/icu/i...s-and-families

Results Of the 15 757 patients admitted, a total of 5183 (33%) received mechanical ventilation for a mean (SD) duration of 5.9 (7.2) days. The mean (SD) length of stay in the intensive care unit was 11.2 (13.7) days. Overall mortality rate in the intensive care unit was 30.7% (1590 patients) for the entire population, 52% (120) in patients who received ventilation because of acute respiratory distress syndrome, and 22% (115) in patients who received ventilation for an exacerbation of chronic obstructive pulmonary disease. Survival of unselected patients receiving mechanical ventilation for more than 12 hours was 69%. The main conditions independently associated with increased mortality were (1) factors present at the start of mechanical ventilation (odds ratio [OR], 2.98; 95% confidence interval [CI], 2.44-3.63; P<.001 for coma), (2) factors related to patient management (OR, 3.67; 95% CI, 2.02-6.66; P<.001 for plateau airway pressure >35 cm H2O), and (3) developments occurring over the course of mechanical ventilation (OR, 8.71; 95% CI, 5.44-13.94; P<.001 for ratio of PaO2 to fraction of inspired oxygen <100).

Conclusion Survival among mechanically ventilated patients depends not only on the factors present at the start of mechanical ventilation, but also on the development of complications and patient management in the intensive care unit.
https://jamanetwork.com/journals/jam...article/194560


Procedure: We reviewed a 5-year experience with mechanical ventilation in 383 men with acute respiratory failure and studied the impact of patient age, cause of acute respiratory failure, and duration of mechanical ventilation on survival. Survival rates were 66.6 percent to weaning, 61.1 percent to ICU discharge, 49.6 percent to hospital discharge, and 30.1 percent to 1 year after hospital discharge. When our data were combined with 10 previously reported series, mean survival rates were calculated to be 62 percent to ventilator weaning, 46 percent to ICU discharge, 43 percent to hospital discharge, and 30 percent to 1 year after discharge. Of 255 patients weaned from mechanical ventilation, 44 (17.3 percent) required an additional period of mechanical ventilation during the same hospitalization
https://pubmed.ncbi.nlm.nih.gov/8404197/

All three of these articles described ICU and respirator outcomes BEFORE COVID-19.

Basically, if you are sick enough to spend 10 days in an ICU or a week on a ventilator FOR ANY REASON you are likely to survive (if indeed you do survive) with damage it might take you months to recover from - if you recover at all. That statement was true before COVID and it is still true. Nobody is denying COVID can do that to people. What I’m saying is that there is nothing specific to COVID doing that. It’s always been that way. COVID is just one more thing that can trigger it.
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Old 12-14-2020, 07:01 AM
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Originally Posted by Excargodog View Post
Basically, if you are sick enough to spend 10 days in an ICU or a week on a ventilator FOR ANY REASON you are likely to survive (if indeed you do survive) with damage it might take you months to recover from - if you recover at all. That statement was true before COVID and it is still true. Nobody is denying COVID can do that to people. What I’m saying is that there is nothing specific to COVID doing that. It’s always been that way. COVID is just one more thing that can trigger it.
Yes, true of other pathogens as well. I'm more worried about an FAA over-reaction than what are probably rare or short-lived symptoms in my demographic.

My elderly mom had some of those things going on after an ICU stint a couple years ago. She recovered but it took while.

Last edited by rickair7777; 12-14-2020 at 07:59 AM.
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