September 15, 2020

While many Covid-19 patients recover relatively quickly, plenty of others are so-called "long-haulers" who face ongoing complications as a result of the disease. To help, hospitals nationwide have started establishing Covid-19 recovery programs to give patients access to a support system of specialists.

Q&As: How top health systems are tackling Covid-19

The difficult task of treating Covid-19 long-haulers

Amar Bukhari—chief of pulmonary, critical care, and sleep medicine at Saint Peter's University Hospital, which has launched a Covid-19 recovery program—said while some Covid-19 patients recover quickly, "there are others [who] are experiencing lasting symptoms," and "[t]o complicate matters, these symptoms can vary in intensity and duration from patient to patient; what we've noticed is that no two cases present the same."

Talya Fleming, medical director of the Aftercare Program and Stroke Recovery Program at Hackensack Meridian's JFK Johnson Rehabilitation Institute, added that, since the novel coronavirus impacts patients differently, "we use all of our expertise: neurologic, pulmonary, cardiac, medical, psychological, and social" to treat patients with Covid-19, the disease caused by the virus. She said, "For many people who have had Covid-19, the negative Covid test is the beginning of a new journey," as they will continue experiencing symptoms of the disease even though their coronavirus infection has cleared.

Michael Reagan, for instance, first began experiencing symptoms of Covid-19 on March 22 and spent two months receiving on and off care at Mount Sinai Hospital in New York City. Reagan had developed pneumonia, had scarring in his lungs, and was experiencing blood-clotting issues. At the end of those two months, Reagan felt well enough to try jogging. But after the exercise, Reagan began experiencing seizures, numbness, tremors in his left hand, and muscle weakness on the left side of his body, and he began noticing involuntary muscle movement on the left side of his face. Reagan also experienced confusion, elevated heart rate, joint pain, and memory loss.

"Before all this happened, I was always on the go," Reagan said, noting he "played the cello" and "was into biking, rock climbing, [and] horseback riding." But now, Reagan said, "some days I can't even get out of bed. Taking a shower and getting dressed feels like a superhuman effort."

How hospitals are helping Covid-19 long-haulers

To help patients like Reagan, hospitals nationwide are establishing Covid-19 recovery programs.

For instance, Mount Sinai is currently treating around 400 patients in its Covid-19 recovery program, according to Zijian Chen, who leads the program. When patients first enter the program, a primary care physician evaluates their symptoms and refers them to a specialist. Patients could be referred to cardiologists, neurologists, psychiatrists, pulmonologists, rheumatologists, or other specialists, depending on their conditions.

"Right now, we have almost every medical specialty working with the program," Chen said. "We're looking at a broad spectrum of disease. Some [patients] may have permanent lung fibrosis … that may last for the rest of their lives. Others have reactive airway or inflammatory problems that will subside over time. It's unpredictable. It's the same for cardiac symptoms and neurological symptoms."

Similarly, at a Covid-19 recovery center at JFK Johnson, primary care physicians screen patients, develop a care plan specific to each patient's needs,  and then refer the patients to appropriate specialists.

"Some post-Covid patients are severely debilitated," Fleming said. "They have arm and leg weakness and trouble with activities of daily living, such as dressing or bathing. They need continuous oxygen as well as physical and occupational therapy."

Sara Cuccurullo, VP and medical director of JFK Johnson, said Covid-19 rehabilitation programs can help some patients to regain strength and substantially improve their conditions.

"We train you like an athlete and help you strengthen and condition your peripheral musculature and build your endurance," she said. "We had one patient who was on a ventilator for seven weeks. His health was severely compromised, but we were able to help rehabilitate him and significantly improve his overall function."

Jeffrey Fine, of NYU Rusk Rehabilitation, said NYU Rusk also treats Covid-19 patients "like athletes" when helping them recover—though Fine noted that the goal isn't necessarily to get patients into the same shape as an athlete. "We're not training them to run a marathon, we're just trying to help them participate in their lives again without dyspnea being a limiting factor."

And long-term Covid-19 symptoms aren't always physical, as some patients can experience neurological symptoms, Fine said. Those patients "need rehabilitation and recovery as well," Fine explained. "They may not require a formal cardiac or pulmonary rehab, but they still need to work on focus, attention, and reconditioning."

Behavioral health care is also an important part of Mount Sinai's program. "The physical symptoms are important but we have to take a look at the mental toll Covid takes on these patients," as well, Chen said. "There's an increased incidence of depression among these patients, so our psychiatric and behavioral health services are important for them."

Ultimately, Fleming said it's important patients are aware that these Covid-19 recovery programs exist.

"People need to know they don't have to suffer in silence," Fleming said. "There is a place they can go to get help" (Fiore, MedPage Today, 9/10; Makin, Bridgewater Courier News, 8/22; Stainton, NJ Spotlight, 8/31).

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