“Before Covid, I was a 59-year-old, relatively healthy man,” said the Denver broadband technician. “If I had to say where I am now I would say about 50% of where I was, but when I first went home it was 20%.”
He attributes much of his progress to the “motivation and education” that emerged from a new program for post-Covid patients at the University of Colorado, a small but growing number of clinics aimed at treating and treating those investigate who had the unpredictable disease caused by this coronavirus.
As the US general Much attention is paid to daily infections or the rising death toll just before the election, but one other measure is important: patients who survive but continue to struggle with a range of physical or psychological effects including lung damage, cardiac or neurological problems, anxiety and depression.
“We need to think about how we can care for patients who may be recovering for years after the virus,”
Long distance patients need care
This need has given momentum to post-Covid clinics, which are bringing together a number of specialists into one one-stop shop.
One of the first and largest clinics of this type is located on Mount Sinai in New York City. However, programs have also been 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.
The general idea is to bring together healthcare professionals from a wide range, including doctors who specialize in lung diseases, heart problems, and problems with the brain and spinal cord. In addition to social workers and pharmacists, mental health specialists are also involved.
Many of the centers are also conducting research studies to better understand why the virus hits certain patients so hard.
“Some of our patients, even those at the door of death on a ventilator, will remain remarkably unharmed,” said Dr. Lekshmi Santhosh, Assistant Professor of Lung Critique and Head of the Post-Covid Program at UC San Francisco opened the OPTIMAL Clinic.
“Others, even those who have never been hospitalized, experience fatigue, persistent chest pain, and shortness of breath, and there is a spectrum in between.”
“Breathtaking” medical necessity
It is too early to know how long the ongoing medical effects and symptoms will last, or to make accurate estimates of the percentage of patients affected.
Some researchers and clinics say about 10% of US Covid patients who see them could have longer-lasting effects, said Dr. Zijian Chen, medical director of the Center for Post-Covid Care on Mount Sinai, which has so far attended 400 patients.
If this estimate is correct – and Chen stressed that further research is needed to ensure this – it will result in patients entering the medical system in droves, often with multiple problems.
How health systems and insurers react will be crucial, he said. More than 6.5 million US citizens have tested positive for the disease. If less than 10% – say 500,000 – have long-lasting symptoms, “the number is amazing,” said Chen. “How much medical care is required for this?”
Coordinated care can reduce expenses
Although startup costs could be a hurdle, the clinics themselves could ultimately generate much-needed revenue for medical centers by attracting patients, many of whom are insured, to cover some or all of the costs of repeat visits.
Chen from Mount Sinai said the specialized centers can help cut health spending by providing lower-cost, coordinated care that avoids duplicate testing that a patient might otherwise do.
“We saw patients who already had four MRI or CT scans and a stack of blood tests when they walked in,” he said.
The program will consolidate these previous results and determine if additional testing is required. Sometimes the answer to the causes of the patient’s long-lasting symptoms remains difficult to find. One problem for patients seeking help outside of dedicated clinics is that they may be presented with symptoms if there is no clear cause of their condition.
“I believe in the patients,” said Chen.
About half of the clinic’s patients have had test results showing damage, said Chen, an endocrinologist and internist. The clinic can develop a treatment plan for these patients. What is frustrating, however, is that the other half have inconclusive test results and still have a range of symptoms.
“That makes it harder to treat,” said Chen.
Services for long-term Covid patients
Experts see parallels with an effort over the past decade to set up specialized clinics to treat patients discharged from intensive care units who may have problems with long-term bed rest or the delirium that many in the hospital experience. Some of the current post-Covid clinics are modeled after the post-ICU clinics or are expanded versions of them.
For example, the ICU Recovery Center at Vanderbilt University Medical Center, which opened in 2012, accepts patients after Covid.
There are about a dozen post-intensive care clinics nationwide, some of which are now also working with Covid patients, said James Jackson, director of long-term outcomes at the Vanderbilt Center. Additionally, he has heard of at least a dozen other post-Covid centers in development.
Centers typically conduct an initial assessment, often via video call, a few weeks after a patient is diagnosed or discharged from hospital. Check-in and repeat visits are scheduled every month or so thereafter.
“In an ideal world, these post-Covid clinics allow you to identify the patients and take them to rehab,” he said. “Even if these clinics were primarily telling patients, ‘This is real, it’s not all in your head,” he added, “those effects would be important. “
A question of feasibility
Funding is the biggest obstacle, according to program managers. Many hospitals have lost significant revenue from being home-based ineligible elections.
“So this is not a good time to start a new activity that requires a start-up grant,” said Glenn Melnick, professor of health economics at the University of Southern California.
At UCSF, a select group of faculty members occupy the post-Covid clinics and some psychiatric professionals are volunteering their time, Santhosh said. Chen, from Mount Sinai, said he was able to recruit team members and support workers from among those whose elective patient load had decreased.
Vanderbilt’s Jackson said unfortunately not enough research has been done on the cost and clinical effectiveness of post-intensive care centers.
“In the early days there may have been questions about how much value this is,” he noted. “Well the question isn’t so much, is it a good idea, but is it feasible?”
Right now, the post-Covid centers are primarily a research effort, said Len Nichols, an economist and non-resident at the Urban Institute.
“If these people are good at managing long-term symptoms, it’s good for all of us,” said Nichols. “There aren’t enough patients out there to turn it into a business model, but if they get to the right place, when you get it, it could become a business model for some of the elite institutions.”
Kaiser Health News (KHN) is a non-profit intelligence service that deals with health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.