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Program treats “constellation of symptoms” in recovering COVID-19 patients

Months into the COVID-19 pandemic, clinicians are seeing many patients emerge with medical problems that often require care for weeks, even months after the onset of illness.

A few weeks into the pandemic, while inpatient teams were still caring for numerous acutely ill patients, the post-COVID population was beginning to emerge, including patients recovering after hospitalization and those who went through the illness at home.

“We realized that though we didn’t know exactly what post-COVID-19 recovery would look like for patients, this journey was not going to end at the hospital door,” said Jennifer Possick, MD, medical director of YNHH’s Winchester Chest Clinic. “Yale New Haven Health and Yale School of Medicine had the foresight to recognize the impact this was going to have on the ambulatory realm and supported development of a pulmonary clinic to address the ongoing issues facing COVID-19 survivors.”

Within weeks of the virus’ first appearance in Connecticut, a blueprint for the RECOVERY program (Comprehensive post-COVID-19 Center at Yale) was developed in the Winchester Chest Clinic to follow post-COVID-19 patients.

The program initially focused on the minority of patients who experience severe disease, but there has been an increasing need to care for those who did not require hospitalization, but still suffer months after becoming infected.

Hospitalized COVID-19 patients who spend weeks in the intensive care unit or on a ventilator typically need rehabilitation to regain mobility and strength after discharge, said Denyse Lutchmansingh, MD, a pulmonologist at YNHH and assistant director of the Winchester Clinic. However, persistent fatigue and exercise intolerance are also frequently reported by patients who had more mild COVID-19 symptoms.

Besides causing the respiratory issues that are COVID-19’s hallmark – shortness of breath, cough, chest discomfort and exercise intolerance – the virus can affect many other organ systems. Recovering patients report lingering symptoms such as dizziness, profound fatigue, difficulty concentrating, memory deficits, difficulty sleeping, palpitations, muscle weakness and pain and mood changes, Dr. Possick said. These can prevent people from resuming normal home and work activities.

“It’s really a constellation of symptoms that are different with each patient,” she said. “We’re seeing patients who are 30, 60, even 90 days into their illness and are still limited by residual symptoms.”

Rehabilitation leadership has been an essential partner in developing the RECOVERY program clinical evaluation model, Dr. Lutchmansingh said.

“We are also working closely with Cardiology, since there is considerable overlap between pulmonary and cardiac symptoms, and cardiac complications from COVID-19 can be quite serious,” she said. “The symptoms patients are reporting are variable, though, so our network of collaborators is growing to include more subspecialties and disciplines. We are grateful for the response across the institution.”

“We are first and foremost a pulmonary clinic, but because our patients have additional symptoms, we mobilized to become the hub for multidisciplinary evaluation,” Dr. Possick added. “This pandemic has broken down a lot of barriers between departments. It has facilitated dialogue and expedited change — because there is no alternative.”

The RECOVERY program at the Winchester Chest Clinic accepts referrals for all post-COVID-19 patients experiencing persistent respiratory symptoms. Patients should speak with their primary care physician for a referral. More information about post-COVID-19 evaluation is also available by calling 203-785-4198.

“Every day is a discovery, and our patients are our partners in shaping what will be needed,” Dr. Possick said. “The path to recovery for post-COVID-19 patients is still unproven territory, so we must be nimble and prepared to adapt. The road map for their care is likely to span many months and involve a lot of people. The saying is ‘it takes a village’ – thankfully we have a very willing village.”