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MFPRSI. Municipal Fire & Police Retirement System of Iowa

COVID-19 Update 4/10/20

TO OUR CITY OFFICIALS REGARDING COVID-19

The recent COVID-19 pandemic has raised questions as to whether a firefighter or police officer who is infected with this virus would meet the “heart disease or any disease of the lungs or respiratory tract” presumptions under Chapter 411.

MFPRSI has communicated with Dr. Patrick G. Hartley, the leading physician on MFPRSI’s Medical Board at the University of Iowa Hospitals and Clinics, on how to consider COVID-19 infections under the Chapter 411 lung and respiratory tract presumption.

Dr. Hartley states that with widespread transmission of this virus in virtually all communities in Iowa, it is becoming increasingly difficult to determine if a first responder acquired the infection during the course of their work duties versus a non-work-related community exposure. The specific details, and particularly if there was a clearly-documented exposure without the use of appropriate personal protective equipment (PPE) to a known COVID-19 positive source within the recognized incubation period, are important factors to consider. Therefore, if a firefighter or police officer was to have a prolonged temporary or permanent disability as a result of a coronavirus infection, whether it would be deemed an accidental disability or not, would depend on the particular manifestations of the disease in that individual.

The virus itself is thought to be transmitted by infected droplets (generated by coughing, sneezing, speaking) and by contact with surfaces on which infected droplets may have settled. The virus can then be transmitted to the person’s airway when they touch their face without washing hands. There are some higher risk procedures, known as "aerosol generating procedures" that pose a higher risk, and for which higher levels of PPE is recommended. Aerosol generating procedures include CPR and airway intubation and can be performed at a scene where police officers and firefighters are present and need to administer one or both procedures.

Regarding the cardiac and respiratory tract presumptions, a COVID-19 infection does cause respiratory tract symptoms including cough, shortness of breath, altered sense of smell and/or taste that may progress to viral pneumonia, acute respiratory distress syndrome (ARDS) needing respiratory support including oxygen and in severe cases, mechanical ventilation. Cardiac manifestations of a COVID-19 infection are rare but inflammation of the heart muscle (myocarditis) and cardiac arrhythmias have been described. Additionally, there have been rare cases described of individuals who exhibit symptoms suggestive of myocardial infarction (heart attack), but whom on further examination are found to have normal coronary arteries yet are infected with COVID-19 that mimics the symptoms/signs of a heart attack. In other cases, the severe manifestations of a COVID-19 infection are not borne by either the respiratory tract or heart, and severe neurological or renal impairments have resulted. To this point, there is no definition of a COVID-19 experience that acts as an umbrella covering all those infected. It is very much a condition that needs to be considered on a case-by-case basis.

This is a rapidly evolving field of study but based on current knowledge, Dr. Hartley supports an approach where each case should be examined on its own merits and is fact-specific to each particular case. If a firefighter or police officer was to become permanently disabled or pass away as a result of a COVID-19 infection, the facts of the case should be carefully reviewed and a determination could be made with regard to whether the medical facts suggest that the disease caused significant impairment of the lungs, respiratory tract, or heart which would then meet the presumption under Iowa Code Chapter 411.

 

4/10/20