{"id":270373,"date":"2020-09-30T06:17:20","date_gmt":"2020-09-30T10:17:20","guid":{"rendered":"https:\/\/canadianinquirer.net\/v1\/?p=270373"},"modified":"2020-09-30T06:17:20","modified_gmt":"2020-09-30T10:17:20","slug":"post-covid-clinics-get-jump-start-from-patients-with-lingering-illness","status":"publish","type":"post","link":"https:\/\/canadianinquirer.net\/v1\/2020\/09\/30\/post-covid-clinics-get-jump-start-from-patients-with-lingering-illness\/","title":{"rendered":"Post-COVID Clinics Get Jump-Start From Patients With Lingering Illness"},"content":{"rendered":"
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That need has jump-started post-COVID clinics, which bring together a range of specialists into a one-stop shop. (Pexels Photo)<\/figcaption><\/figure>\n

Clarence Troutman survived a two-month hospital stay with COVID-19, then went home in early June. But he\u2019s far from over the disease, still suffering from limited endurance, shortness of breath and hands that can be stiff and swollen.<\/p>\n

\u201cBefore COVID, I was a 59-year-old, relatively healthy man,\u201d said the broadband technician from Denver. \u201cIf I had to say where I\u2019m at now, I\u2019d say about 50% of where I was, but when I first went home, I was at 20%.\u201d<\/p>\n

He credits much of his progress to the \u201cmotivation and education\u201d gleaned from a new program for post-COVID patients at the University of Colorado, one of a small but growing number of clinics aimed at treating and studying those who have had the unpredictable coronavirus.<\/p>\n

As the election nears, much attention is focused on daily infection numbers or the climbing death toll, but another measure matters: Patients who survive but continue to wrestle with a range of physical or mental effects, including lung damage, heart or neurological concerns, anxiety and depression.<\/p>\n

\u201cWe need to think about how we\u2019re going to provide care for patients who may be recovering for years after the virus,\u201d said Dr. Sarah Jolley, a pulmonologist with UCHealth University of Colorado Hospital and director of UCHealth\u2019s Post-Covid Clinic, where Troutman is seen.<\/p>\n

That need has jump-started post-COVID clinics, which bring together a range of specialists into a one-stop shop.<\/p>\n

One of the first and largest such clinics is at Mount Sinai in New York City, but programs have also launched at the University of California-San Francisco, Stanford University Medical Center and the University of Pennsylvania. The Cleveland Clinic plans to open one early next year. And it\u2019s not just academic medical centers: St. John\u2019s Well Child and Family Center, part of a network of community clinics in South Central Los Angeles, said this month it aims to test thousands<\/a> of its patients who were diagnosed with COVID since March for long-term effects.<\/p>\n

The general idea is to bring together medical professionals across a broad spectrum, including physicians who specialize in lung disorders, heart issues and brain and spinal cord problems. Mental health specialists are also involved, along with social workers and pharmacists. Many of the centers also do research studies, aiming to better understand why the virus hits certain patients so hard.<\/p>\n

\u201cSome of our patients, even those on a ventilator on death\u2019s door, will come out remarkably unscathed,\u201d said Dr. Lekshmi Santhosh, an assistant professor of pulmonary critical care and a leader of the post-COVID program at UC-San Francisco, called the OPTIMAL clinic. \u201cOthers, even those who were never hospitalized, have disabling fatigue, ongoing chest pain and shortness of breath, and there\u2019s a whole spectrum in between.\u201d<\/p>\n

\u2018Staggering\u2019 Medical Need<\/strong><\/p>\n

It\u2019s too early to know how long the persistent medical effects and symptoms will linger, or to make accurate estimates on the percentage of patients affected.<\/p>\n

Some early studies are sobering<\/a>. An Austrian report released this month found that 76 of the first 86 patients studied had evidence of lung damage six weeks after hospital discharge, but that dropped to 48 patients at 12 weeks.<\/p>\n

Some researchers and clinics say about 10% of U.S. COVID patients they see may have longer-running effects, said Dr. Zijian Chen, medical director of the Center for Post-COVID Care at Mount Sinai, which has enrolled 400 patients so far.<\/p>\n

If that estimate is correct \u2014 and Chen emphasized that more research is needed to make sure \u2014 it translates to patients entering the medical system in droves, often with multiple issues.<\/p>\n

How health systems and insurers respond will be key, he said. More than 6.5 million U.S. residents have tested positive for the disease. If fewer than 10% \u2014 say 500,000 \u2014 already have long-lasting symptoms, \u201cthat number is staggering,\u201d Chen said. \u201cHow much medical care will be needed for that?\u201d<\/p>\n

Though startup costs could be a hurdle, the clinics themselves may eventually draw much-needed revenue to medical centers by attracting patients, many of whom have insurance to cover some or all of the cost of repeated visits.<\/p>\n

Chen at Mount Sinai said the specialized centers can help lower health spending by providing more cost-effective, coordinated care that avoids duplicative testing a patient might otherwise undergo.<\/p>\n

\u201cWe\u2019ve seen patients that when they come in, they\u2019ve already had four MRI or CT scans and a stack of bloodwork,\u201d he said.<\/p>\n

The program consolidates those earlier results and determines if any additional testing is needed. Sometimes the answer to what\u2019s causing patients\u2019 long-lasting symptoms remains elusive. One problem for patients seeking help outside of dedicated clinics is that when there is no clear cause for their condition, they may be told the symptoms are imagined.<\/p>\n

\u201cI believe in the patients,\u201d said Chen.<\/p>\n

About half the clinic\u2019s patients have received test results showing damage, said Chen, an endocrinologist and internal medicine physician. For those patients, the clinic can develop a treatment plan. But, frustratingly, the other half have inconclusive test results yet exhibit a range of symptoms.<\/p>\n

\u201cThat makes it more difficult to treat,\u201d said Chen.<\/p>\n

Experts see parallels to a push in the past decade to establish special clinics to treat patients released from ICU wards, who may have problems related to long-term bed rest or the delirium many experience while hospitalized. Some of the current post-COVID clinics are modeled after the post-ICU clinics or are expanded versions of them.<\/p>\n

The ICU Recovery Center at Vanderbilt University Medical Center, for instance, which opened in 2012, is accepting post-COVID patients.<\/p>\n

There are about a dozen post-ICU clinics nationally, some of which are also now working with COVID patients, said James Jackson, director of long-term outcomes at the Vanderbilt center. In addition, he\u2019s heard of at least another dozen post-COVID centers in development.<\/p>\n

The centers generally do an initial assessment a few weeks after a patient is diagnosed or discharged from the hospital, often by video call. Check-in and repeat visits are scheduled every month or so after that.<\/p>\n

\u201cIn an ideal world, with these post-COVID clinics, you can identify the patients and get them into rehab,\u201d he said. \u201cEven if the primary thing these clinics did was to say to patients, \u2018This is real, it is not all in your head,\u2019\u201d he added, \u201cthat impact would be important.\u201d<\/p>\n

A Question of Feasibility<\/strong><\/p>\n

Financing is the largest obstacle, program proponents say. Many hospitals lost substantial revenue to canceled elective procedures during stay-at-home periods.<\/p>\n

\u201cSo, it\u2019s not a great time to be pitching a new activity that requires a startup subsidy,\u201d said Glenn Melnick, a professor of health economics at the University of Southern California.<\/p>\n

At UCSF, a select group of faculty members staff the post-COVID clinics and some mental health professionals volunteer their time, said Santhosh. Mount Sinai\u2019s Chen said he was able to recruit team members and support staff from the ranks of those whose elective patient caseload had dropped.<\/p>\n

Jackson, at Vanderbilt, said unfortunately there\u2019s not been enough research into the cost-and-clinical effectiveness of post-ICU centers.<\/p>\n

\u201cIn the early days, there may have been questions about how much value does this add,\u201d he noted. \u201cNow, the question is not so much is it a good idea, but is it feasible?\u201d<\/p>\n

Right now, the post-COVID centers are foremost a research effort, said Len Nichols, an economist and nonresident fellow at the Urban Institute.<\/p>\n

\u201cIf these guys get good at treating long-term symptoms, that\u2019s good for all of us,\u201d said Nichols. \u201cThere\u2019s not enough patients to make it a business model yet, but if they become the place to go when you get it, it could become a business model for some of the elite institutions.\u201d<\/p>\n

Kaiser Health News<\/a> (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation<\/a> which is not affiliated with Kaiser Permanente.<\/em><\/p>\n

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