Infectious Disease

The NJ heart focuses on post-acute COVID-19 syndrome

January 07, 2021

3 min read

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Healio interview

Disclosure:
Jacobs does not report any relevant financial information.

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One in 20 patients who are “COVID-19 free” will experience long-term health effects, according to a New Jersey-based health system.

Hackensack Meridian Health (HMH), badly hit by the first wave of the pandemic, has treated more than 15,000 patients with COVID-19. It recently became one of the first health systems in the country to set up a COVID-19 recovery center.

Healio Primary Care interviewed Laurie G. Jacobs, MD, FACP, AGSF, Director of the HMH COVID-19 Recovery Center and Chair of Internal Medicine at the Seton Hall-Hackensack Meridian School of Medicine on post-acute COVID-19 syndrome and the services the Recovery Center provides to patients.

Q: Tell us about the recovery center.

A: It’s kind of a virtual center as it spans all of New Jersey, where HMH provides care. Patients generally have a telemedicine visit to determine what their main ailments and symptoms are and what they are looking for. They can then be seen by GPs in certain offices who have experience with COVID-19 and chronic COVID. Doctors call me weekly to discuss care approaches and new developments in the literature.

The patient may be referred to a behavioral health professional if the primary symptoms are psychological, such as: B. Anxiety or depression. In addition to basic care, you can also be referred to a cardiologist, neurologist or pulmonologist, depending on the problem. Specific practices participating in the program have provided acute COVID care, have expertise, and are engaged in research in the area. Patients can also be referred for physical therapy. This referral is usually part of a treatment plan. Since these are usually outpatients, they take part in outpatient physiotherapy, pulmonary rehabilitation and / or cardiopulmonary programs.

So far our center has seen several hundred patients.

Q: According to the Infectious Diseases Society of America, there is currently no clear consensus definition for post-acute COVID-19 syndrome. What are the most common symptoms patients face and can you describe your approach to treatment?

A: The NIH convened a two-day conference on the matter to define the name and time. For our program, we call it chronic or post-acute COVID and identify persistent symptoms as part of this syndrome if they have been present for more than 3 months. It can take people weeks to recover from the acute illness. We don’t focus on that.

Symptoms include fatigue, malaise, anxiety, confusion, cognitive changes, difficulty concentrating, memory problems, shortness of breath, cough, chest pain, headache, and insomnia. There may be symptoms and syndromes due to blood clotting problems associated with acute COVID that cause subsequent strokes, leg or arm clots, pulmonary embolism, etc. These need urgent treatment, but are not part of the chronic COVID syndrome. They are a consequence of the acute illness.

Our approach is holistic and supportive. Treatments can be physical therapy, medication, etc., but there is currently no direct treatment. These symptoms can be separate syndromes or all parts of a syndrome with an underlying cause – possibly autoimmunity – with different manifestations, but we don’t yet know.

Q: Will you be doing research on post-acute COVID-19 syndrome at the center? If so, can you tell us what you hope to find?

A: We research. We hope to characterize clinical syndromes, epidemiology, and treatments, and we hope to link this to biological research.

All patients are asked whether they have given their consent for excess biological material (e.g. additional blood from a Blood draw) and used for basic research into chronic COVID-19 and clinical data.

Q: Is post-acute COVID-19 syndrome treatment complicated by health insurance? Is the refund a problem?

A: Not really – the symptoms are real and there are syndrome description diagnoses that can be used.

Q. Post-treatment Lyme disease syndrome (PTLDS) has been associated with a loose confederation of nonspecific symptoms. Are you concerned that post-acute COVID-19 syndrome will be the newest condition attributed to vague symptoms with no specific diagnosis?

A: I believe there is going to be a tremendous amount of research in this area – as we can see, the NIH is now collaborating with others around the world in initiating grant support efforts. Even when the prevalence is low – say 2% of those infected – millions of people have been infected worldwide. Therefore, we need to better understand this complex of symptoms, and I assume that we will do so in time.

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