POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”

“…The Center for Post-COVID Care, opened May 13, will help patients hospitalized for COVID-19 transition from the hospital to their homes. The center is also open to patients who were never hospitalized but need help during their recovery.

At the center, patients will be offered a personalized treatment plan that will include input from several specialties, including primary care, pulmonary medicine, cardiology, infectious disease and physiatry, as well as social workers and pharmacists.

The center will also focus on evaluating the long-term effects of the disease, which are largely unknown. Mount Sinai will create a COVID-19 registry and collect information on sociodemographics, behaviors, underlying conditions, mental health conditions and medications from patients with the disease.

“This center will provide a unique opportunity to follow this population and systematically evaluate the long-term impact of COVID-19,” said Dennis S. Charney, MD, president for academic affairs at Mount Sinai Health System.” (A)

“Because the Center for Post-COVID Care was established to conduct research on the potential long-term health outcomes of COVID-19 in addition to providing care, it has so far prioritized patients who have tested positive for COVID-19 or for antibodies, which can develop as part of the immune system’s response to the disease. But Chen acknowledges that it’s a flawed system and says he is working on getting appointments for people who were waitlisted by the Center because they lacked a positive test.

“Initially, what we were designed to do was take care of patients we knew had COVID-19, meaning they had a positive PCR test or had a positive antibody test, so we’re sure these are [COVID-19-related] symptoms and can enroll them in research,” Chen said. “But even from the beginning, we realized you have patients who didn’t get tested in New York and around the country and there are patients who may have had a not-so-good test because testing was not perfect.”

COVID-19 diagnostic tests were harder to access early in the pandemic and many patients were simply told to stay home if they were sick in order to conserve resources and prevent the spread of the disease. Meanwhile, the reliability of antibody tests has been called into question and experts have said they are more useful on a population level than for determining whether an individual has had COVID-19…

The inclination to put certain criteria in place to identify long-haul patients for the purpose of research is understandable. The symptoms COVID-19 long-haulers report are extremely wide-ranging and there is a risk that some people may think they fall into that group, but are, in fact, suffering from an unrelated health issue.

“Part of the challenge is separating out these patients from patients who had COVID-19,” Chen said.

Adina Gerver, a Washington Heights resident, still suffers from extreme fatigue as well as ear, throat, and chest pain months after getting sick with COVID-19 in March. She says she was able to get an appointment at Mount Sinai’s Center for Post-COVID Care in about three weeks when she reached out in mid-July and appreciates that the model combines research and care.

“I feel like Mount Sinai is a little bit helping people and a little bit studying people and all of it is fine with me because I feel like they’re going to learn things that will help everyone,” Gerver said…. (B)

“Michael Reagan first got sick with COVID-19 on March 22 and spent the next 2 months in and out of Mount Sinai Hospital in New York City. He had pneumonia, scarring in his lungs, and blood clotting issues, and while he was never put on a ventilator, he came close.

By the end of May, the 50-year-old felt well enough to go for a jog — but that unexpectedly set him back severely. He started having seizures, tremors in his left hand, numbness, and muscle weakness on the left side of his body, and involuntary muscle movements on the left side of his face.

He also suffered memory loss and even had trouble navigating around his neighborhood. Then there was the debilitating joint pain in his elbows and knees, and his heart rate would sometimes skyrocket to 200 beats per minute with the slightest exertion.

“Before all this happened, I was always on the go,” Reagan told MedPage Today. “I played the cello, I was into biking, rock climbing, horseback riding. Now some days I can’t even get out of bed. Taking a shower and getting dressed feels like a superhuman effort.”

Reagan is among a growing number of COVID-19 “long-haulers” who suffer with long-term and often varied consequences from the virus. These patients often require care from a gamut of specialists, including pulmonologists, cardiologists, neurologists, rheumatologists, and psychiatrists.

That’s why health systems in the hard-hit greater New York area have launched COVID-19 rehabilitation and recovery programs, to serve as a medical home for patients with myriad complications who require coordinated care.

Reagan is a patient at the Center for Post-COVID Care at Mount Sinai…

“Right now, we have almost every medical specialty working with the program,” Chen told MedPage Today. “We’re looking at a broad spectrum of disease. Some 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.”..

Mount Sinai is creating a registry of COVID long-haulers for further study. Chen said his team spoke with the health system’s World Trade Center victims program when they were developing the COVID recovery center. Between 7,000 and 8,000 COVID patients were treated in the Mount Sinai system, and Chen’s team is assessing symptom surveys to determine which of those patients may benefit from their post-COVID care program.”  (C)

“Mount Sinai has been in the forefront of understanding and treating COVID-19. We were among the first to develop an antibody test to identify individuals who have recovered from COVID-19. We were then able to use plasma from these individuals to help critically ill patients recover. Researchers at the Icahn School of Medicine at Mount Sinai have been helping our frontline physicians treat all the varied aspects of the disease—from thrombosis to the sudden inflammatory response known as a “cytokine storm.” Because COVID-19 behaves so differently in many patients, we have created this multi-disciplinary team working together for your recovery to health.

Experts from Every Specialty, Working for Your Care

The long-term effects of COVID-19 are not clear yet. The virus can affect many different systems within the body—from the lungs to the heart to the kidneys. But by bringing in specialists who have been on the frontlines of the outbreak, you will have the most knowledgeable experts available. Your team and clinical staff may include disciplines such as:

Primary Care; Pulmonary Medicine; Cardiology; Infectious Diseases; Nephrology; Physiatry; Physical and Occupational Therapy; Radiology; Neuropsychiatry; Behavioral Health; Social Workers; Pharmacists

Treating the Whole Person, Not Just the Disease

This time has caused all of us anxiety—and some, more than others. The Center has the resources to help you manage anxiety and depression, PTSD, and other emotional issues. Getting “back to normal” may require physical therapy, occupational therapy, or other types of support—whether in groups or one-on-one. Whatever your needs, the Center is a compassionate, holistic source of care.

You Can Help Us Understand COVID-19

To understand the long-term effects of COVID-19, we are offering patients the opportunity to participate in the Mount Sinai COVID-19 Registry. Participation is voluntary, and you don’t have to register to get care at the Center. However, by being part of the Registry, you will help us understand the effects of COVID-19 on long-term health and well-being. Together, we will overcome COVID-19.” (D)

Note: I have been a proud member of the Mount Sinai faculty since the mid 1970’s (currently voluntary Adjunct Professor of Environmental Medicine and Public Health). I am not involved with the new Center. JMM

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