An odyssey of months called covid-19 4:06
(CNN Spanish) -
Clarence Troutman survived a two-month hospital stay with covid-19, and returned home in early June.
But he is far from overcoming the disease: he still has difficulty breathing and his hands become swollen and stiff.
For him, the option could be a post-covid clinic.
"Before the covid, he was a relatively healthy 59-year-old man," said the Denver, Colorado cable and internet technician.
"If I had to say where I am now, I would say about 50% of my potential, but when I came home it was at 20%."
LOOK: The long road to recovery for some covid-19 patients
Troutman attributes his progress in large part to the "motivation and education" of a new program for postcovid patients at the University of Colorado, one of a small but growing number of clinics whose goal is to treat, and study, those who have had the unpredictable disease caused by the new coronavirus.
Postcovid Clinics: Long-Term Care
As the US presidential election approaches, much attention is being paid to the daily numbers of infections or the growing number of deaths.
But another measure is important: patients who survive but continue to struggle with a variety of physical or mental effects, such as lung damage, heart or neurological problems, anxiety and depression.
“We need to think about how we are going to provide care for patients whose recovery from the virus can take years,” said Dr. Sarah Jolley, a pulmonologist at UCHealth University of Colorado Hospital and director of the UCHealth Post-Covid clinic, where Troutman is seen.
That need has driven post-covid clinics, which bring together a variety of specialists in one place.
One of the first and largest clinics of its kind is at Mount Sinai in New York City, but programs have also been launched at the University of California-San Francisco, Stanford University Medical Center, and the University of California. Pennsylvania.
The Cleveland Clinic plans to open one early next year.
An odyssey of months called covid-19 4:06
And it's not just about academic medical centers: St. John's Well Child and Family Center, part of a network of community clinics in south central Los Angeles, recently said it aims to continue evaluating thousands of its patients who have been diagnosed. with covid since March to analyze the term effects.
The general idea is to bring together medical professionals from a broad spectrum: pulmonologists, cardiologists, and spinal cord specialists.
Also to mental health experts, social workers and pharmacists.
Research on persistent symptoms of covid-19
Many of the centers also conduct research, with the aim of better understanding why the virus affects certain patients so strongly.
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"Some of our patients, even those with a ventilator on the verge of death, will be remarkably unscathed," said Dr. Lekshmi Santhosh, assistant professor of pulmonary critical care and leader of the OPTIMAL clinic, the post-covid program at UC San Francisco.
"Others, even those who were never hospitalized, have disabling fatigue, ongoing chest pain and shortness of breath, and there's a big spectrum in between."
It is too early to know how long the symptoms and persistent physical effects will last, or to make accurate estimates of the percentage of patients affected.
Some early studies give clues.
An Austrian report published in September found that 76 of the first 86 patients studied had evidence of lung damage 6 weeks after discharge, a number that dropped to 48 patients at 12 weeks.
LOOK: What is known about the consequences after overcoming covid-19?
Some researchers and clinics say that about 10% of covid patients in the United States may have long-term effects, said Dr.Zijian Chen, medical director of the Post-Covid Care Center at Mount Sinai, who has enrolled to date 400 patients.
If that estimate is correct, and Chen stressed that more research is needed to ensure this, it will translate into patients entering the medical system in droves, often with multiple problems.
How much medical care will be needed for these patients?
How health systems and insurers respond will be key, he said.
More than 6.5 million Americans have tested positive for the disease.
If less than 10%, say 500,000, already have persistent symptoms, "that number is staggering," Chen said.
"How much medical attention will be needed?"
Although upfront costs could be a hurdle, the clinics themselves can eventually generate revenue, which medical centers need, by attracting patients, many of whom have insurance to cover some or all of the cost of these long-term visits.
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Chen of Mount Sinai said specialty centers can help reduce healthcare spending by providing more cost-effective, coordinated care that avoids duplication of tests that a patient might otherwise undergo.
"We have seen patients that when they are admitted, they have already had four MRIs or CT scans and a number of blood tests," he said.
The program consolidates those previous results and determines if additional testing is needed.
Sometimes the answer to the causes of long-lasting symptoms in patients remains difficult to obtain.
One problem for patients seeking help outside of specialized clinics is that when there is no clear cause for their condition, they can be told that the symptoms are imaginary.
"I believe in patients," Chen said.
About half of the clinic's patients have received test results showing damage, explained Chen, an endocrinologist and internal medicine specialist.
For those patients, the clinic can develop a treatment plan.
But frustratingly, the other half have inconclusive results even though they have a variety of symptoms.
"That makes it more difficult to deal with," Chen said.
The post-intensive post-therapy model: an option for post-covid patients
Experts see parallels with a push in the past decade to establish special clinics to treat patients discharged from intensive care, who may have problems related to long-term bed rest or the delirium that many experience while hospitalized.
Some of the post-covid clinics follow the post-intensive post-therapy model or are expanded versions of this model.
For example, the Intensive Care Recovery Center at Vanderbilt University Medical Center, which opened in 2012, is accepting post-covid patients.
There are about a dozen of these clinics nationwide, some of which are also now working with covid patients, said James Jackson, director of long-term outcomes at the Vanderbilt center.
At least a dozen other postcovid centers are in development.
Centers generally conduct an initial evaluation a few weeks after a patient is diagnosed or discharged from the hospital, usually with a video call.
Then one visit per month is scheduled.
The challenges facing postcovid clinics
"In an ideal world, with these post-covid clinics, patients can be identified and taken to rehab," he said.
"Even if the main thing these clinics did was tell patients, 'This is real, this is not an invention,' that impact would be significant," added Jackson.
Financing is the biggest obstacle.
Many hospitals lost substantial revenue from canceling elective procedures during quarantines.
"So this is not a good time to launch 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 are on staff at post-covid clinics and some mental health professionals volunteer their time, Santhosh said.
Chen of Mount Sinai said he was able to recruit health professionals from those with the most free time in the absence of elective procedures.
Jackson, at Vanderbilt, said that sadly there hasn't been enough research 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 added," he said.
"Now, the question is not so much if it is a good idea, but if it is feasible."
Right now, the post-covid centers are primarily a research effort, said Len Nichols, an economist and non-resident fellow at the Urban Institute.
"If these patients improve with long-term symptom management, that's good for everyone," said Nichols.
"There aren't enough patients yet to make it a business model, but if it becomes the go-to place after discharge, it could turn out to be a business model for some of the elite institutions."
