Addressing persistent symptoms following COVID-19: Physicians from the Post COVID Recovery Program at the Winchester Center for Lung Disease available for interviews

The Centers for Disease Control and Prevention estimates that a third of non-hospitalized people who contract COVID-19 experience symptoms weeks to months after the initial infection.

Although the numbers and demographics will shift with more research, a prevailing theme remains that people struggling with a constellation of symptoms several weeks after tests indicate they have cleared their COVID-19 infection will need support in their recovery.

A review in the Journal of American College of Chest Physicians from physicians at the Post COVID Recovery Program at the Winchester Center for Lung Disease describes their experience building a successful clinical model to address the needs of these COVID-19 survivors. The paper highlights the importance of multidisciplinary care for a growing population whose symptoms can include cardiac, neurologic and neuromuscular complications.

“We don’t have all the data we’d like to have,” said Jean Paul Higuero-Sevilla, MD, a pulmonologist at the Post COVID Recovery Program. “What we can focus on is creating a network of providers who collaborate to serve these patients.”

Creating a program

Traditional multidisciplinary models include many specialists in one place. However, the Post-COVID-19 Recovery Program, which launched in July of 2020, needed to adhere to pandemic-related demands on the healthcare system along with requirements around social distancing.

Patients undergo standard pulmonary function testing and evaluation with both a physician and physical therapist on their first visit. Based on symptoms, they may also be referred for additional evaluation to one of their collaborating subspecialty physicians.

The Program includes anyone who has had COVID-19 with persistent symptoms more than 6 weeks after their initial infection and is not limited to those who have had intensive care unit stays.

“Our clinical model is constantly evolving as we learn more from our patients,” said Denyse Lutchmansingh, MD, lead author of the study and associate director of the Post-COVID-19 Recovery Program. “We were fortunate with the speed in which we were able to get resources in the middle of the pandemic, including collaborations with physicians in other subspecialties and engagement from both social work and physical therapy to care for our patients.”

Learning from other post-viral conditions

Post-viral conditions have also been recorded in cases of swine flu, bird flu and Ebola. A 2009 study in Hong Kong found that psychiatric problems and chronic fatigue impacted SARS-1 survivors up to four years later.

“Some people who are sick with any infection can go on to develop chronic symptoms,” said Isabel Bazan, MD, a pulmonologist at the Post-COVID Recovery Program.

“We are working towards an explanation as to why. These past experiences with SARS and MERS inform how we approach post-COVID symptoms, for example our early integration of physical therapy,” said Dr. Bazan.

Listening to survivors

“The pandemic has been isolating for everyone and becoming infected with COVID-19 compounds that isolation,” said Dr. Bazan. “Talking with people about what their recovery might look like and sharing that we have seen and treated people in a similar situation can provide relief and ease some of that frustration and loneliness.”

The future of post-COVID-19 care

Through the Program, both Dr. Bazan and Dr. Higuero-Sevilla have learned that the severity of post-COVID symptoms someone experiences is not related to how sick they were with COVID-19. They have seen many people who had mild cases before their longer lasting post COVID symptoms set in. Additionally, both physicians have seen patients make considerable gains in their recovery and say that best practices for post-COVID patients are constantly being refined including specific cognitive and physical exercises.

“Some symptoms we are seeing, such as fatigue, are difficult to objectively measure but still debilitating,” said Dr. Higuero-Sevilla. “The Program is part of a research effort looking at duration of symptoms and therapeutic options. We are here to treat patients, but we also hope to leverage what we are learning to inform our future selves.”

Post-COVID symptoms and the vaccine

There are anecdotal reports of post-COVID symptoms improving following COVID-19 vaccination. As of May 2021, there is not robust data on how the COVID vaccine impacts post-COVID symptoms and further study is needed.

One such study on the effect of vaccination on post-COVID symptoms is being led by Akiko Iwasaki Ph.D., immunologist at Yale School of Medicine and Harlan Krumholz, MD, director, Yale New Haven Hospital Center for Outcomes Research and Evaluation (CORE). The research team is looking for participants 18 years and over who have had COVID-19 symptoms for more than two months since initial infection and have not gotten the vaccine, but plan to get it. Learn more about this study here.