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This transcript has been edited for clarity.
Zijian Chen, MD: In May, when hundreds of COVID patients were seen in the hospital each day, health system leaders set up the Mount Sinai Center for post-COVID care. At the hospital, they will need to follow up. However, now that the center has been established, it can be seen that more than 50% of the patients who come to the center have never been hospitalized for COVID in the past.
Alejandro Comeras, MD: I started meeting COVID patients at the University of Iowa (UI) Healthcare Respiratory Disease Follow-up Clinic in March of this year. The proportion of patients who visited the hospital at the end of March and part of April was high. At that time, we saw many outpatients. Two-thirds of them were diagnosed with COVID and managed as outpatients.
Range of symptoms associated with COVID-19
Quote: Many of their symptoms were associated with fatigue when patients began to come to the clinic. They described their symptoms as brain fog, shortness of breath, and cough. Some people reported impaired ability to smell.
Chen: Symptoms range from lungs to heart to neurological properties, including persistent blood clots. Some patients report having psychiatric problems, including increased anxiety, depression..
We see symptoms in different ways, many of which are related to several different organ systems and are sometimes completely unrelated. The most common are lung symptoms, where patients tell us shortness of breath.
Quote: If any type of lung disease is found in these patients, it will try to classify whether the disease is obstructive. asthma Or Chronic obstructive pulmonary disease (COPD), or whether it is an interstitial disease such as pulmonary fibrosis.
Chen: In addition, there are many neurological symptoms such as cognitive impairment of memory and concentration, peripheral neuropathy, and chronic headache.
With regard to heart symptoms, some patients have persistent chest pain as well as attacks of unexplained tachycardia.
Quote: People talked about long-haul carriers who have non-specific symptoms of malaise as well as discomfort, despite being negative for lung and heart disease.Symptoms appear to be related to the inflammatory process and have similarities Chronic fatigue syndrome..
This could obviously be part of a duplication of what we describe as a long haul carrier. Although these are known to be non-specific symptoms, the entity has been identified as a real illness with chronic fatigue.
Chen: Now that we’ve been in operation for a few months, we’re learning that we can start dividing patients into two groups. Both groups have reported prolonged symptoms after COVID. However, only one group of patients has a positive symptom-related test result.
Long-distance patients: skepticism and stigma gar
Chen: In our months of experience in treating these patients, what we see is, yes, that some long-distance patients have been seen by a doctor before coming to our center. is. Their concern is that their doctors do not fully accept their symptoms. Doctors sometimes even denied what they were feeling.
Quote: There are stigma of some people who feel they have with them because they had COVID. Some people are not seen in the medical setting due to concerns about infectivity.
Another topic that caught our attention is the fact that some of these patients are women. There is a social prejudice that women do not worry when they report non-specific symptoms.
Surveillance of outpatients recovering from COVID
Quote: Depending on what we find in our assessment, we will try to adjust the treatment at the recovery clinic or refer them to specific areas within our department. We aim to include a comprehensive, comprehensive physiotherapist, respiratory therapist, cardiologist, nephrologist, and other specialists, depending on the organ damage and dysfunction seen in patients who have recovered from COVID.
One of the unique situations encountered in March and April was the COVID epidemic at meat packaging factories. Many of the workers are Hispanic and can only speak Spanish. Some of the initial challenges we faced were related to family communication because patients were unable to welcome visitors. The Intensive Care Unit (ICU) department coordinated bilingual doctors in Spanish to communicate with family members and keep up with the patient’s situation.
Not only is this clinic trying to answer some of the unmet needs of the community, as we have established, but it also invites all patients to participate in the recovery registry.
Chen: Mount Sinai has a study registration for patients being examined at the center. The registry helps track baseline test results and symptoms and further tracks as treatment progresses.
Quote: Once you have identified a particular disease pattern in a patient recovering from COVID, you can think about whether clinical trials need to be initiated to better understand the disease process and what treatments can be implemented and tested. , This is important.
‘Not enough’
Chen: My biggest concern right now about the therapeutic response is that it is not enough. As we know, there are currently over 6 million US patients infected with SARS-CoV-2. Even if we accept 10% of these long-lasting patients, we will inject 600,000 new patients in need of continuous care into our healthcare system.
Our ability to absorb this large number of patients needs to 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 make these patients better.
