[ad_1]
Find the latest COVID-19 news in counseling at Medscape’s Coronavirus Resource Center
This transcript has been edited for clarity.
Zijian Chen, MD: In May, when we were still seeing hundreds of COVID patients in the hospital every day, health system leaders established the Mount Sinai Center for Post-COVID Care, because they felt that given the number of sick patients in the hospital , it would be necessary to follow up. However, now that the center is installed, we see that more than 50% of the patients arriving at the center have not been hospitalized in the past for COVID.
Alejandro Comellas, MD: I began caring for COVID patients at the University of Iowa (UI) Healthcare Respiratory Disease Tracking Clinic in March of this year. We had a high percentage of patients who were admitted in late March and part of April. Around that time, we saw many outpatients; two thirds of them were diagnosed with COVID and were treated on an outpatient basis.
Range of symptoms associated with COVID-19
Eat them: When patients started coming to the clinic, many of their symptoms were related to fatigue. They described her symptoms as mental confusion, shortness of breath and cough. Some people reported having a disability in the ability to smell.
Chen: Symptoms vary from pulmonary to cardiac or neurological in nature, and even include persistent blood clots. Some patients report having psychiatric problems including increased anxiety and depression.
We are seeing symptoms in a variety of ways, many of which involve several different organ systems, sometimes without any relationship. The most common are pulmonary symptoms, in which patients tell us that they are short of breath.
Eat them: If we find any type of lung disease in these patients, we try to classify whether the disease is an obstructive disease, such as asthma or chronic obstructive pulmonary disease (COPD), or if it is rather an interstitial disease, such as pulmonary fibrosis.
Chen: On top of that, we are seeing many neurological symptoms, such as cognitive defects in memory and concentration, as well as peripheral neuropathy and chronic headaches.
With regard to cardiac symptoms, some patients have persistent chest pain, as well as unexplained paroxysms of tachycardia.
Eat them: People have talked about long-haul carriers having nonspecific symptoms of fatigue and malaise despite testing negative for lung and heart disease. It seems that the symptoms are more related to an inflammatory process and there are similarities with chronic fatigue syndrome.
This could clearly be part of an overlap of what we are describing as long carriers. We know that these are nonspecific symptoms, but one entity has been identified as a real disease with chronic fatigue.
Chen: Now that we have been operational for several months, we are learning that we can begin to segregate patients into two groups. Both groups report prolonged symptoms after COVID; however, only one group of patients have positive test results that are related to their symptoms.
Long-distance patients: skepticism and stigma persist
Chen: In our months of experience treating these patients, what we are seeing is that yes, there are long-term patients who had seen doctors before coming to our center. Your concern is that your doctors have not fully accepted your symptoms. At times, doctors have even dismissed what they feel.
Eat them: There is a stigma that some people feel they carry with them because they had COVID. Some people are not cared for in health care settings due to concerns of being infectious.
Another issue that caught our attention is the fact that some of these patients are women. There is a bias in society not to care when women report nonspecific symptoms.
Monitoring of Outpatients Recovering from COVID
Eat them: Depending on what we find in our evaluation, we try to tailor the therapies in the recovery clinic, or we refer them to specific areas within our division. Our goal is to be comprehensive and include physiotherapists and respiratory therapists, cardiologists, nephrologists, and other specialists, depending on the organ damage or deficiencies we find in patients who have recovered from COVID.
One of the unique situations we encountered during the months of March and April was a COVID epidemic in a meatpacking plant. Many of the workers are Hispanic and speak only Spanish. Some of the original challenges we faced were related to communication with families, because patients were unable to receive visitors. In our intensive care unit (ICU) division, we coordinated physicians, who are bilingual in Spanish, to communicate with families and keep them abreast of what was happening with patients.
This clinic, as we are preparing it, is not only trying to respond to some of your unmet needs in the community, but we are also inviting each patient to participate in a recovery registry.
Chen: At Mount Sinai, we have a research registry of patients seen at the center. The registry is used to keep track of baseline test results and symptoms, and to provide additional follow-up as treatment progresses.
Eat them: This is important, because if we identify certain disease patterns in patients recovering from COVID, we can think about whether we need to start clinical trials to have a better understanding of the disease process, as well as therapies that could be implemented and tested.
‘Is not sufficient’
Chen: My biggest concern right now about the response to medical treatment is that it is not enough. As we know, there are now more than 6 million patients in the United States infected with SARS-CoV-2. Even if we were to take 10% of these patients with long-lasting symptoms, we will inject 600,000 new patients into our healthcare system who need ongoing care.
Our ability to absorb this large number of patients must begin now. We need to start building more centers, we need to start learning more about this disease, and we need to start finding ways to improve these patients.
Follow Medscape on Facebook, Twitter, Instagram and YouTube
[ad_2]
