Post-COVID Blues

Editor's note: This article was updated June 29.

Last time, I wrote in After the Storm about the actions taken by the FAA to address the expiration of medical certificates during the COVID-19 shutdown with the publication of the non-enforcement policy.

The FAA later took more sweeping action to address a wide range of certificates, proficiency requirements, and knowledge test expirations with the publication of a special federal aviation regulation (SFAR). With the ongoing uncertainty of COVID-19’s stealth and an early summer spike of new cases in many areas of the country, the FAA just expanded the extensions to the SFAR; that update includes a bit of good news for holders of medical certificates that expire after the original June 30 date.

With the July 4 holiday upon us, much of the country is still under some degree of “abnormality” with ongoing local and state governments and businesses shut down, increasing job losses, school closings, takeout-only food, masks or face coverings in public, and more congressional debate about federal government stimulus bills. In short, things are still a mess, but despite the summer spike we're seeing now, we are getting closer to recovery in some form, although just what “form” that will be is still a political/scientific hot potato.

As with all things in life, unintended or unanticipated consequences are absolutes we can be sure of. Already, the anecdotal observations through social and mainstream media reveal the emotional toll that isolation from family and friends, financial stress, and the general sense of “mandated imprisonment” that goes against our human-based need to “get out and do stuff” is having on our collective psyches. Most of us have not experienced a pandemic of this dimension in our lifetimes, and to some degree, historical data about the impact of such an event is unavailable; but what is certain is that there will be potentially long-term adverse effects. Psychiatric, psychological, and neurological issues may spike in months following our return to a post-virus environment. Depression, despair, drug and alcohol abuse, relationship conflicts, and suicides may become more prevalent as the toll grows. Some evidence is already emerging—much higher call volumes to mental health helplines, increased episodes of domestic violence, and increased firearms sales (one of the most common means of suicide in the United States).

Not only is all the mystery surrounding this disease concerning from a clinical and epidemiological standpoint, but for pilots who have been directly affected by COVID-19 with significant symptoms, there are implications down the road when the time comes to complete an application for a medical certificate. The FAA Office of Aerospace Medicine, I’m sure, is closely watching this evolving crisis from a regulatory medicine viewpoint. Psychiatric and psychological visits may begin to show up on medical applications, along with the other assorted situations related to the virus, including chronic pulmonary symptoms in survivors.

Considering the 120,000-plus U.S. deaths so far, some estimates indicate that over 70 percent are in the age 65 and older group. And that subset of older Americans also has more underlying health challenges that increase the risk for morbidity and mortality. Carrying that data over into the cohort of pilots in the United States, it can be expected that FAA medical applications down the road may well show an increase in reports of visits to health care providers and hospitalizations related to COVID-19.

The constellation of symptom presentations with this disease just seems to keep increasing, and another concern is neurocognitive impairment along with all the other complications that are present. Cognition is a huge deal in the FAA’s world of medical certification qualification. As the FAA begins to formulate policy as to what will be required in evaluating pilots who report treatment for this illness, neurocognitive testing may be a part of that evaluation.

Until we are “after the (cytokine) storm,” please stay safe and play it smart as the activity restriction orders start to come down across the country. Not unlike presidential TFRs during campaign season, those restrictions may be on again/off again and vary from state to state.

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
Frederick, MD USA
Gary Crump
Gary is the Director of AOPA’s Pilot Information Center Medical Certification Section and has spent the last 32 years assisting AOPA members. He is also a former Operating Room Technician, Professional Firefighter/Emergency Medical Technician, and has been a pilot since 1973.
Topics: Pilot Health and Medical Certification, Pilot Health and Medical Certification

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