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Mayor's Committee for People with Disabilities – March 13, 2026

Item 4: Long COVID Disability Presentation — original pdf

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MARCH 2026 Long COVID & Disability W. MICHAEL BRODE MD FACP ASSISTANT PROFESSOR OF MEDICINE MEDICAL DIRECTOR OF POST-COVID-19 PROGRAM WILLIAM.BRODE@AUSTIN.UTEXAS.EDU Terms and Definitions Settled on: Long COVID Also known as: Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) Post-COVID syndrome Post-COVID conditions Chronic COVID-19 COVID “Long-Haulers” No consensus diagnostic criteria Stage 1 (Early Infection) Viral Phase Remdesivir Monoclonal Antibodies Nirmatrelvir/Molnupiravir Acute COVID-19 Disease Course Stage 2 (Pulmonary Phase) Stage 3 (Thrombo-inflammatory Phase) Host Inflammatory Response Phase Dexamethasone Anticoagulation Tocilizumab/Baricitinib Fever, Myalgia, Anosmia, Ageusia, Dry Cough, Diarrhea, Headache, Orthostasis Dyspnea, Encephalopathy, Hypoxemia, Bilateral Chest Infiltrates Pulmonary Embolism, Refractory Hypoxemia, Myocarditis, Shock Lymphopenia Transaminitis Elevated Inflammatory Markers (CRP, LDH, IL-6, D-dimer, ferritin) Severe D-dimer Elevation Multiorgan Failure (elevated troponin, creatinine, lactate) Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10 Day 11 Day 12 Day 13 Day 14 Day 15 Day 16 Day 17 Day 18 Day 19 Day 20 Nasal PCR Positive Hospital Admission ARDS Mechanical Ventilation Acute Kidney Injury Secondary Infection Death Treatment s s e n l l I f o y t i r e v e S Clinical Findings Lab Findings Day -5 Exposure Pre-symptomatic Phase Day 0 Symptom Onset WM Brode MD, G Lazuta (2022) Post-COVID-19 Disease Course Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase s s e n l l I f o y t i r e v e S Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 Post-COVID-19 Symptoms Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase s s e n l l I f o y t i r e v e S Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Lopez-Leon et al. Sci Rep. 2021;11(1):16144. 203 Symptoms in 10 Organ systems Day 120 Day 84 Day 180 Post-COVID-19 Disease Course Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase End Organ Damage s s e n l l I f o y t i r e v e S Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 ARDS Acute Kidney Injury Acute Cardiac Injury Post-COVID-19 Disease Course Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase End Organ Damage s s e n l l I f o y t i r e v e S • Pulmonary Fibrosis • Chronic Kidney Disease • Post-ICU Syndrome • Diastolic heart failure • PTSD Metanalysis of Hospitalized Patients • Any persistent symptom: 45% • Fatigue: 28% • Diffuse pain: 28% • Sleep difficulties: 23% • Abnormal chest imaging: 45% • Decreased DLCO: 32% • Lung Fibrosis: 26% • Smell disorder: 6% Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 ARDS Acute Kidney Injury Acute Cardiac Injury O’Mahoney LL et al. eClinicalMedicine. 2023;55. doi:10.1016/j.eclinm.2022.101762 Post-COVID-19 Disease Course Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase End Organ Damage New or exacerbated chronic diseases Day 14 Day 28 Day 84 Day 120 Day 180 s s e n l l I f o y t i r e v e S Pre-symptomatic Phase Day 0 Symptom Onset Post-COVID-19 Disease Course Subacute COVID (4-12 weeks) Increased Risk of New Disease or Adverse Outcome PASC ( > 12 weeks) Host Inflammatory Response Phase • Type 2 Diabetes: HR 1.46 • New cardiovascular disease: RR 5.82 • Pulmonary embolism: RR 11.51 • Rheumatologic disorder: HR 1.25 • Overall mortality: HR 1.59 End Organ Damage New or exacerbated chronic diseases Acute Infection (0-4 weeks) Viral Phase s s e n l l I f o y t i r e v e S • Type 2 Diabetes • VTE • Myocardial infarction • Stroke • NAFLD • Autoimmune disease • Mortality Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 Rezel-Potts E et al. PLOS Medicine. 2022;19(7):e1004052. Xie Y et al. The Lancet Diabetes & Endocrinology. 2022;10(5):311-321. Al-Aly Z et al. Nature. 2021;594(7862):259-264. Kim Mset al. . Ann Intern Med. Published online March 5, 2024. doi:10.7326/M23-1831 Post-COVID-19 Disease Course Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase s s e n l l I f o y t i r e v e S End Organ Damage New or exacerbated chronic diseases Long COVID Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 Komaroff AL, Lipkin WI. Frontiers in Medicine. 2023;10. Post-COVID-19 Disease Course Acute Infection (0-4 weeks) Viral Phase Subacute COVID (4-12 weeks) PASC Systematic review of 57 studies with 250,351 ( > 12 weeks) participants (79% hospitalized) Host Inflammatory Response Phase • Any persistent symptom at > 6 months: 55% • Cough, SOB • Headaches • Chronic Anosmia • Sleep disorders • Chest pain • Myalgia/arthralgia s s e n l l I f o y t i r e v e S – Fatigue or exhaustion: 38% – Shortness of breath: 30% – Generalized Anxiety Disorder: 30% – Sleep disorders or insomnia: 29% – Difficulty concentrating: 24% – Anosmia/Ageusia: 11% – Chest pain and palpitations: 13% Post Viral Symptoms Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 Groff D et al. JAMA Network Open. 2021;4(10):e2128568. Post-COVID-19 Disease Course Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase s s e n l l I f o y t i r e v e S Pre-symptomatic Phase Day 0 Symptom Onset Post Viral Symptoms Dysregulated Immune Response and Dysautonomia Day 14 Day 28 Day 84 Day 120 Day 180 Post-COVID-19 Disease Course Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase l l I s s e • Tachycardia, POTS n • GI Dysmotility f o • Sensory neuropathy y t • Urticaria and rash i r e v • Tinnitus e S • Dizziness and balance issues • Anxiety • Fevers End Organ Damage New Chronic Diseases Post Viral Symptoms Dysregulated Immune Response and Dysautonomia Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 Davis HE et al. Infectious Diseases (except HIV/AIDS); 2020. Post-COVID-19 Disease Course Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase s s e n l l I f o y t i r e v e S Post Viral Symptoms Dysregulated Immune Response and Dysautonomia Fatigue, “Brain Fog”, Post-Exertional Malaise Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 Komaroff AL, Lipkin WI. Frontiers in Medicine. 2023;10. Post-COVID-19 Disease Course Acute Infection (0-4 weeks) National Academy of Medicine definition for Myalgic Encephalitis/Chronic Fatigue Syndrome Viral Phase • Profound Fatigue > 6 months • Post-Exertional Malaise • Unrefreshing sleep s s e n l l I Plus 1 of the following: – Cognitive Impairment – Orthostatic Intolerance f o y t i r e v e S Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Host Inflammatory Response Phase Post Viral Symptoms Dysregulated Immune Response and Dysautonomia Fatigue, “Brain Fog”, Post-Exertional Malaise Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 Komaroff AL, Lipkin WI. Frontiers in Medicine. 2023;10. Post-COVID-19 Disease Course Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase End Organ Damage New Chronic Diseases Post Viral Symptoms Dysregulated Immune Response and Dysautonomia Fatigue, “Brain Fog”, Post-Exertional Malaise Day 14 Day 28 Day 84 Day 120 Day 180 s s e n l l I f o y t i r e v e S Pre-symptomatic Phase Day 0 Symptom Onset Post-COVID-19 Disease Course Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase s s e n l l I f o y t i r e v e S End Organ Damage New or exacerbated chronic diseases Long COVID or PASC Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 Komaroff AL, Lipkin WI. Frontiers in Medicine. 2023;10. Post-COVID-19 Disease Course Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase Post-ICU Syndrome New/worsening chronic disease Long COVID/PASC • Post-Viral Chronic Fatigue Syndrome • Neuro-Inflammatory Syndrome Day 14 Day 28 Day 84 Day 120 Day 180 s s e n l l I f o y t i r e v e S Pre-symptomatic Phase Day 0 Symptom Onset WM Brode MD, G Lazuta (2022) Infection-Associated Chronic Conditions Characterized by: • Fatigue, exertional intolerance • Brain fog • Diffuse pain Choutka J et al. Nat Med. 2022;28(5):911-923. Long COVID Epidemiology Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Thaweethai T et al. JAMA. 2023;329(22):1934-1946. Host Inflammatory Response Phase s s e n l l I f o y t i r e v e S Rate of LC from new Omicron infections: PASC • 1 infection: 10% • >1 infection: 20% Vaccination Reduces PASC risk by ~50% RECOVER trial: 9.7% of breakthrough infections result in LC Day 120 Day 180 Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Al-Aly Z et al.. Nat Med. 2022;28(7):1461-1467 Ayoubkhani D, et al. BMJ. 2022;377:e069676 Notarte et al. EClinicalMedicine. 2022;53:101624 Long COVID Epidemiology Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase s s e n l l I f o y t i r e v e S Proportion of US Adults experiencing PASC PASC • Ever: 17.9% = ~46 million • Currently: 5.3% = ~14 million Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 National Center for Health Statistics. U.S. Census Bureau, Household Pulse Survey, 2022–2024. Long COVID. Generated interactively 11/4/2024: from https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm Long COVID Epidemiology Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase s s e n l l I f o y t i r e v e S Proportion of Texans experiencing PASC PASC • Ever: 17.9% = ~4 million • Currently: 5.3% = ~1.17 million Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 National Center for Health Statistics. U.S. Census Bureau, Household Pulse Survey, 2022–2024. Long COVID. Generated interactively 11/4/2024: from https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm Long COVID Epidemiology Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase s s e n l l I f o y t i r e v e S Proportion of Austinites experiencing PASC PASC • Ever: 17.9% = ~143,000 • Currently: 5.3% = ~42,000 Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 National Center for Health Statistics. U.S. Census Bureau, Household Pulse Survey, 2022–2024. Long COVID. Generated interactively 11/4/2024: from https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm Long COVID Recovery & Prognosis Acute Infection (0-4 weeks) Subacute COVID (4-12 weeks) PASC ( > 12 weeks) Viral Phase Host Inflammatory Response Phase l l I s s e n • 50% of people with LC have high symptom burden and do not improve – Chronic disabling illness in this group – 80% remain symptomatic at 1yr f o y t i r e v e S Long COVID or PASC Pre-symptomatic Phase Day 0 Symptom Onset Day 14 Day 28 Day 84 Day 120 Day 180 Thaweethai et al. Nat Commun 16, 9557 (2025). Post-COVID-19 Health Burden Disproportionate Impact on At Risk Communities: • Higher rates of LC in women (RR 1.5), Black and Hispanic persons • Decreased access to care of low-income and rural individuals Economic Cost & Disability: • ~$1 trillion globally, annually • Lost earnings, healthcare expenses, reduced quality of life • 10% less likely to be employed and work 25-50% fewer hours Al-Aly Z et al. Nat Med. 2024;30(8):2148-2164 Bach K. Brookings. Published August 24, 2022. JAMA. 2023;329(9):701-702. doi:10.1001/jama.2023.0157 UT Health Austin Post-COVID-19 Program • 1,301 unique patients seen with 3,991 total visits June 2021 through November 2025 • Averaging 35-45 new referrals per month – Symptoms at Baseline • Patients have complex multisystem disease, our published data from clinic shows: – Patients present with median 18 new symptoms due to Long COVID UT Health Austin Data: • 73% rate their health as fair to poor • 72% stating it has affected ability to work • 46% mild cognitive dysfunction • 20% report having unmet social needs (food, transportation) o 12% report housing instability Thank you! WILLIAM.BRODE@AUSTIN.UTEXAS.EDU Patient Education Videos