Infectious Disease

Multidisciplinary approach to long COVID leads to functional gains in patients

April 08, 2022

4 min read

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As of April 1, about 80 million cases of SARS-CoV-2 infection have been reported in the US, according to the CDC. Among them are rising incidences of long COVID, a condition that is still not completely understood by clinicians.

Several long COVID clinics have opened in the US to care for patients suffering from “lingering and oftentimes quite disruptive symptoms,” Caitlin McAuley, DO, a family medicine physician at Keck Medicine of USC and a specialist who works with patients with long COVID, described in a press release.

The COVID Recovery Clinic at Keck Medicine of USC is among the centers working to understand and treat patients with long COVID. The clinic has amassed a multidisciplinary team of clinicians to provide personalized treatment plans for patients with the elusive condition.

Healio spoke with McAuley to learn more about how the team at the COVID Recovery Clinic is approaching long COVID treatment.

Healio: How long has the clinic been open? How is it going so far?

McAuley: Keck Medicine of USC started seeing patients in December 2020, within months of long COVID starting to be recognized in patients who became ill initially in March 2020. We have seen many functional gains in patients by focusing on an interdisciplinary approach with physical therapy, occupational therapy , mental health providers and various specialists, including pulmonologists, cardiologists, neurologists, rheumatologists, social workers and more.

Healio: Will you enroll patients who likely have long COVID but don’t have the documented PCR test to prove it?

McAuley: In special circumstances we have seen patients who likely had the initial infection during a time that we did not have testing available to the general public, especially those not hospitalized. However, the challenge moving forward will be determining whether a possible future targeted treatment that is discovered will be appropriate for these patients or not.

Healio: How do you distinguish long COVID from other diseases?

McAuley: Post-acute sequelae of COVID-19 (PASC), also known as long COVID, is an umbrella term for multiple presentations and likely multiple conditions. We generally distinguish it with a positive COVID-19 test and symptom presentation starting in or around the acute phase, a positive antibody test 2 or more weeks after symptom start but lasting more than 12 weeks. We are seeing cross-over with chronic fatigue syndrome, post-viral syndrome, mast cell activation syndrome and postural orthostatic tachycardia syndrome. Some patients may have more than one of the above-mentioned conditions as part of their PASC diagnosis.

Healio: Post-treatment Lyme disease syndrome (PTLDS) has been associated with a loose confederation of nonspecific symptoms. Do you have concerns that long COVID will become the latest condition to which vague symptoms will be attributed without a concrete diagnosis?

McAuley: The challenge with PTLDS is reliable testing. Luckily COVID-19 PCR testing and antibody testing are more reliable than Lyme testing, though early testing and rapid tests result in false negatives potentially up to 25%. However, there are many patients who became ill with COVID-19 prior to testing being available, so we go off symptoms and timing. Beyond that, there are a lot of other inflammatory and immune tests that can be tested but do not meet the diagnosis of PASC.

Healio: In the absence of national guidelines for long COVID, how are you determining your line of treatment?

McAuley: We focus on symptom management, which has been part of interim guidance from the CDC, but also from earlier guidelines out of the UK Additionally, many universities and other PASC clinics have treatment guidance posted online. At this point, there is limited communication between clinics, other than sharing data through research articles and various virtual conferences. I like to see what my patients are reading so I will check sites such as Survivor Corps and We Are Body Politic to best address questions and concerns they may come to me with.

Healio: How will the clinic go about treating these patients?

McAuley: Keck Medicine of USC COVID Recovery Clinic is led by a core team of clinicians specializing in primary care, pulmonology and physical therapy. These experts connect patients with additional Keck Medicine specialists as patients’ unique needs require, including physical and occupational therapists, behavioral health specialists, cardiologists, neurologists, rheumatologists, social workers and more. The core team works together, simultaneously seeing patients in one visit if needed, to create an initial comprehensive workup while partnering with a nurse navigator to implement an integrated, personalized treatment plan.

We are able to help identify what potential additional testing is needed, but more often simply what treatments may help control symptoms better and which experienced specialists can guide care. For example, if a patient has developed a new headache disorder after COVID-19, we will start treatment with medications and physical therapy but also refer to our neurologist headache specialists.

Healio: Are you conducting any research in conjunction with the clinic?

McAuley: The Keck Medicine of USC COVID Recovery Clinic’s main goal is care management and coordination for patients with PASC. At this time, we are not researching experimental treatments or medications. Part of the reason is the extremely variable presentation of symptoms suggests there won’t be a one-size-fits-all solution. Unfortunately, experimental treatments always run the risk of doing more harm than good, so we prefer to work with symptom management with known medications and therapies.

Healio: Can physicians refer patients to the clinic?

McAuley: Physicians can refer to Keck Medicine, and patients can self-refer. They can start by visiting our website, calling 323-442-9209 or emailing [email protected].

Healio: Anything else to add?

McAuley: We’ve seen that a good primary care provider is essential in helping these patients long-term because they can help with initial work up, ongoing management and coordination with specialists.

References:

COVID data tracker weekly review. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html. Published April 1, 2022. Accessed April 5, 2022.

Keck Medicine of USC launches COVID Recovery Clinic to treat patients with long COVID-19. https://news.keckmedicine.org/keck-medicine-of-usc-launches-covid-recovery-clinic-to-treat-patients-with-long-covid-19/. Published March 29, 2022. Accessed April 5, 2022.

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