Post-COVID Clinics / Long Haulers

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trader32176
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Post-COVID Clinics / Long Haulers

Post by trader32176 »

Post-COVID Clinics Get Jump-Start From Patients With Lingering Illness

9/30/20

https://khn.org/news/post-covid-clinics ... ronavirus/


Clarence Troutman survived a two-month hospital stay with COVID-19, then went home in early June. But he’s far from over the disease, still suffering from limited endurance, shortness of breath and hands that can be stiff and swollen.

“Before COVID, I was a 59-year-old, relatively healthy man,” said the broadband technician from Denver. “If I had to say where I’m at now, I’d say about 50% of where I was, but when I first went home, I was at 20%.”

He credits much of his progress to the “motivation and education” gleaned from a new program for post-COVID patients at the University of Colorado, one of a small but growing number of clinics aimed at treating and studying those who have had the unpredictable coronavirus.

As the election nears, much attention is focused on daily infection numbers or the climbing death toll, but another measure matters: Patients who survive but continue to wrestle with a range of physical or mental effects, including lung damage, heart or neurological concerns, anxiety and depression.

“We need to think about how we’re going to provide care for patients who may be recovering for years after the virus,” said Dr. Sarah Jolley, a pulmonologist with UCHealth University of Colorado Hospital and director of UCHealth’s Post-Covid Clinic, where Troutman is seen.

That need has jump-started post-COVID clinics, which bring together a range of specialists into a one-stop shop.

One of the first and largest such clinics is at Mount Sinai in New York City, but programs have also launched at the University of California-San Francisco, Stanford University Medical Center and the University of Pennsylvania. The Cleveland Clinic plans to open one early next year. And it’s not just academic medical centers: St. John’s Well Child and Family Center, part of a network of community clinics in South Central Los Angeles, said this month it aims to test thousands of its patients who were diagnosed with COVID since March for long-term effects.

The general idea is to bring together medical professionals across a broad spectrum, including physicians who specialize in lung disorders, heart issues and brain and spinal cord problems. Mental health specialists are also involved, along with social workers and pharmacists. Many of the centers also do research studies, aiming to better understand why the virus hits certain patients so hard.

“Some of our patients, even those on a ventilator on death’s door, will come out remarkably unscathed,” said Dr. Lekshmi Santhosh, an assistant professor of pulmonary critical care and a leader of the post-COVID program at UC-San Francisco, called the OPTIMAL clinic. “Others, even those who were never hospitalized, have disabling fatigue, ongoing chest pain and shortness of breath, and there’s a whole spectrum in between.”

‘Staggering’ Medical Need

It’s too early to know how long the persistent medical effects and symptoms will linger, or to make accurate estimates on the percentage of patients affected.

Some early studies are sobering. An Austrian report released this month found that 76 of the first 86 patients studied had evidence of lung damage six weeks after hospital discharge, but that dropped to 48 patients at 12 weeks.

Some researchers and clinics say about 10% of U.S. COVID patients they see may have longer-running effects, said Dr. Zijian Chen, medical director of the Center for Post-COVID Care at Mount Sinai, which has enrolled 400 patients so far.

If that estimate is correct — and Chen emphasized that more research is needed to make sure — it translates to patients entering the medical system in droves, often with multiple issues.

How health systems and insurers respond will be key, he said. More than 6.5 million U.S. residents have tested positive for the disease. If fewer than 10% — say 500,000 — already have long-lasting symptoms, “that number is staggering,” Chen said. “How much medical care will be needed for that?”

Though startup costs could be a hurdle, the clinics themselves may eventually draw much-needed revenue to medical centers by attracting patients, many of whom have insurance to cover some or all of the cost of repeated visits.

Chen at Mount Sinai said the specialized centers can help lower health spending by providing more cost-effective, coordinated care that avoids duplicative testing a patient might otherwise undergo.

“We’ve seen patients that when they come in, they’ve already had four MRI or CT scans and a stack of bloodwork,” he said.

The program consolidates those earlier results and determines if any additional testing is needed. Sometimes the answer to what’s causing patients’ long-lasting symptoms remains elusive. One problem for patients seeking help outside of dedicated clinics is that when there is no clear cause for their condition, they may be told the symptoms are imagined.

“I believe in the patients,” said Chen.

About half the clinic’s patients have received test results showing damage, said Chen, an endocrinologist and internal medicine physician. For those patients, the clinic can develop a treatment plan. But, frustratingly, the other half have inconclusive test results yet exhibit a range of symptoms.

“That makes it more difficult to treat,” said Chen.

Experts see parallels to a push in the past decade to establish special clinics to treat patients released from ICU wards, who may have problems related to long-term bed rest or the delirium many experience while hospitalized. Some of the current post-COVID clinics are modeled after the post-ICU clinics or are expanded versions of them.

The ICU Recovery Center at Vanderbilt University Medical Center, for instance, which opened in 2012, is accepting post-COVID patients.

There are about a dozen post-ICU clinics nationally, some of which are also now working with COVID patients, said James Jackson, director of long-term outcomes at the Vanderbilt center. In addition, he’s heard of at least another dozen post-COVID centers in development.

The centers generally do an initial assessment a few weeks after a patient is diagnosed or discharged from the hospital, often by video call. Check-in and repeat visits are scheduled every month or so after that.

“In an ideal world, with these post-COVID clinics, you can identify the patients and get them into rehab,” he said. “Even if the primary thing these clinics did was to say to patients, ‘This is real, it is not all in your head,’” he added, “that impact would be important.”

A Question of Feasibility

Financing is the largest obstacle, program proponents say. Many hospitals lost substantial revenue to canceled elective procedures during stay-at-home periods.

“So, it’s not a great time to be pitching a new activity that requires a startup subsidy,” said Glenn Melnick, a professor of health economics at the University of Southern California.

At UCSF, a select group of faculty members staff the post-COVID clinics and some mental health professionals volunteer their time, said Santhosh. Mount Sinai’s Chen said he was able to recruit team members and support staff from the ranks of those whose elective patient caseload had dropped.

Jackson, at Vanderbilt, said unfortunately there’s not been enough research into the cost-and-clinical effectiveness of post-ICU centers.

“In the early days, there may have been questions about how much value does this add,” he noted. “Now, the question is not so much is it a good idea, but is it feasible?”

Right now, the post-COVID centers are foremost a research effort, said Len Nichols, an economist and nonresident fellow at the Urban Institute.

“If these guys get good at treating long-term symptoms, that’s good for all of us,” said Nichols. “There’s not enough patients to make it a business model yet, but if they become the place to go when you get it, it could become a business model for some of the elite institutions.”
curncman
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Re: Post-COVID Clinics Get Jump-Start From Patients With Lingering Illness

Post by curncman »

Trader! Great Article to throw light on post covid19 Patient world. Unfortunately it will be new NORM.

TSOI PRODUCTS are focused to treat the post covid19 virus effects across the full spectrum in all patients
trader32176
Posts: 1535
Joined: Fri Jun 26, 2020 5:22 am

Re: Post-COVID Clinics Get Jump-Start From Patients With Lingering Illness

Post by trader32176 »

curncman,
thanks !

This is the first time I have seen anyone mention post-covid clinics .
trader32176
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Joined: Fri Jun 26, 2020 5:22 am

Re: Post-COVID Clinics Get Jump-Start From Patients With Lingering Illness

Post by trader32176 »

Scientific responses can build resilience and support health in wake of COVID-19

10/22/20


https://www.news-medical.net/news/20201 ... ID-19.aspx


It is about way more than a vaccine: scientific responses for building resilience and supporting health and sustainability in the wake of COVID-19.

The COVID-19 pandemic has disrupted economic and social life across the globe, causing over 800,000 deaths worldwide so far. The pandemic and our responses to it raise fundamental questions about sustainability: how can we redesign our health, social, and economic systems to be resilient in the face of eminent crises? How can we make our societies more resilient to cope with severe threats?

In our event we will explore these questions and the role that science can play in offering solutions - solutions that go far beyond the development of a vaccine.

Whether it be the next pandemic or the climate crisis, our global society is increasingly confronted with so-called wicked problems: complex phenomena characterized by uncertainties in causal relationships, ambiguities in interpretation of the problem itself and possible solutions, and often related to issues that are highly controversial.

Facing these challenges requires integration of knowledge from many academic disciplines as well as from non-academic practitioners (e.g., from civil society and politics), an idea which is encompassed in the concept of transdisciplinary research. Our event provides diverse perspectives on the complex interconnections between human health, the health of the planet, and the societal structures support and hinder the sustainability of both.

Source:


Institute for Advanced Sustainability Studies e.V. (IASS)
trader32176
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Re: Post-COVID Clinics Get Jump-Start From Patients With Lingering Illness

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Correlations found between 'long-COVID' patients and preexisting health conditions

11/4/20


https://www.news-medical.net/news/20201 ... tions.aspx


The ongoing coronavirus disease 19 (COVID-19) pandemic has claimed over 1.2 million lives worldwide and impacted economies in unprecedented ways. Although many COVID-19 patients survive the illness, there are increasing numbers of patients who are "cleared" of the virus but still experience symptoms and require hospitalization.

The hospitalization and re-admission of COVID-19 patients after viral clearance has been a topic of significant interest in minimizing mortality as well as healthcare costs. Previous studies focused on hospitalization and re-admission post recovery from other illnesses like influenza, heart failure, and pneumonia have concluded that most re-admissions resulted from complex interactions between the host's recovering immune system and the inflammatory response. Minimal data is currently available on the long-term effects of COVID-19 in those who are cleared of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The current gold standard for determining the clearance of SARS-CoV-2 from patients recovering from COVID-19 is two consecutive negative results in a real-time reverse transcription-polymerase chain reaction (RT-PCR) test. Patients requiring hospitalization due to protracted COVID-19 complications, despite confirmed viral clearance, present a clinical conundrum.

Using retrospective analysis to study patients re-admitted after viral clearance

Researchers from the nference (a biotech information firm) in Cambridge, MA, USA, the Mayo Clinic in Rochester, MN, USA, and nference Labs based in Bengaluru, India, recently performed a retrospective analysis of 266 COVID-19 patients. This analysis compared those admitted or re-admitted after viral clearance with those who were hospitalized before viral clearance but did not require hospitalization after viral clearance. Their study has been published on the preprint server, medRxiv*.

To differentiate these two study cohorts, they used neural network models to curate comorbidities and complications from the physician notes in these patients' health records. The physician notes of the hospitalized post-viral clearance group showed acute kidney injury (n=15 (16.1%)), anemia (n=20 (21.5%)), and cardiac arrhythmia (n=21 (22.6%)) in the year preceding the onset of COVID-19.

Preexisting health conditions increase the risk of post-COVID hospitalization


This is the first study carried out at a major healthcare center that analyzes the risk factors behind post-viral clearance hospitalization in some COVID-19 patients. This study used augmented curation to gather complications and comorbidities from patients' health records instead of relying on the international classification of diseases (ICD) codes for data. The statistical analysis performed in this study identified comorbidities that existed a year before confirmed diagnosis of SARS-CoV-2 infection by PCR testing. Preexisting conditions were associated with higher rates of hospitalization post-viral clearance.

The results of this study showed that preexisting conditions play a key role in hospitalization risk in COVID-19 patients after confirmed SARS-CoV-2 viral clearance. Their findings say that pre-COVID anemia increases the risk of post-COVID hospitalization, which is concerning because of the endemic nature and high prevalence of anemia in many under-developed and developing countries, which are currently seeing a huge number of COVID-19 cases and related mortality.

"Finally, this study also emphasizes the need for detailed curation of structured and unstructured clinical data to better understand the dynamics of viral clearance, underlying conditions, and long-term complications."

Findings highlight the need for follow-up research into specific risk factors for post-COVID hospitalization

The authors believe that their study will motivate further follow-up research into specific risk factors they have identified that seem to predispose some patients with preexisting conditions to long-lasting adverse effects of COVID-19. They hope that their findings of possible long-term effects of SARS-CoV-2 infection inspire more studies that will help find effective prophylactic and therapeutic interventions to treat COVID-19.

"Overall, our finding of the long-term adverse effects of COVID-19 motivates the need to understand the biological and mechanistic underpinning of the SARS-CoV-2 driven long-term adverse effects in order to find appropriate prophylactic and therapeutic interventions."

The authors also discuss some limitations of their study. The dataset used by this study is from a single healthcare system, so the clinical characteristics of the study cohort may be biased and may reflect clinical characteristics of individuals receiving treatment in some regions of the USA such as Arizona, Florida, or Minnesota. They also use the first of two consecutive negative PCR test results to measure viral clearance for each patient, but the actual viral clearance date is unknown.

*Important Notice


medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:


Pawlowski, C. et al. (2020) Preexisting conditions are associated with COVID patients' hospitalization, despite confirmed clearance of SARS-CoV-2 virus; https://doi.org/10.1101/2020.10.28.20221655, https://www.medrxiv.org/content/10.1101 ... 20221655v2
trader32176
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Re: Post-COVID Clinics Get Jump-Start From Patients With Lingering Illness

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Persistent and extensive lung damage seen in COVID-19 patients

11/5/20


https://www.news-medical.net/news/20201 ... ients.aspx


As the coronavirus disease 2019 (COVID-19) pandemic continues to wreak havoc across the globe, some people who recover from the infection have reported persistent symptoms surrounding the lungs, such as difficulty breathing. A small fraction of people have also reported having other lasting symptoms; these individuals have been dubbed "long haulers" or "long-COVID” patients.

COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a respiratory illness that primarily targets the lungs. However, many other organs can be affected, especially in severe cases.

A team of researchers at the University of Trieste in Italy aimed to determine the extent and the causes of lung damage from COVID-19 to better understand the pathological correlates of the disease.

The study


To arrive at the study findings, which appeared in the journal EBioMedicine, the researchers performed a systematic analysis of 41 consecutive post-mortem samples from people who succumbed to COVID-19. The team conducted a histological analysis for cellular and viral antigens and to detect the presence of viral genomes.

The researchers reported that of the 41 cases analyzed, six required intensive care, while 35 were hospitalized until they died. The average age of the patients was 77 for males and 84 for females. The common comorbidities seen in the patients were hypertension, chronic cardiac disease, dementia, diabetes and cancer. All of the patients died of acute respiratory distress syndrome (ARDS), a condition caused by severe SARS-CoV-2 infection.

Study findings

When the team conducted a pathological examination, all cases manifested lung damage. When assessed physically, the lungs appeared congested. In 4 out of the 41 cases, the team observed thrombosis in large pulmonary vessels. Further, tissue analysis showed vast damage to the normal lung anatomy, consistent with a condition of diffuse alveolar damage with edema, bleeding, and intra-alveolar fibrin deposition with hyaline membranes.


"It could very well be envisaged that one of the reasons why there are cases of long COVID is because there is a vast destruction of the lung (tissue)," Mauro Giacca, a professor at King's College London who co-led the work.

"Even if someone recovers from COVID, the damage that is done could be massive," he added.

He added that almost 90 percent of the 41 patients experienced many characteristics unique to COVID-19 compared with other forms of pneumonia. Meanwhile, the researchers said that the heart, liver and kidney presented common features of age-related tissue degeneration in all the patients, but the tissue integrity was essentially preserved.

In a nutshell, the team detected additional hallmarks that can characterize the COVID-19 disease process. First, there is the presence of massive lung thrombosis, persistent viral infection, endothelial dysfunction, as well as the presence of dysmorphic cells in the lungs.

"In light of the persistence of virus-infected cells in the lungs of infected individuals and the peculiar molecular features of the SARS-CoV-2 Spike protein we propose that several of the clinical characteristics that set COVID-19 apart from other interstitial pneumonia are not attributable to pneumocyte death as a consequence viral replication, but to the persistence of virus-infected, Spike-expressing cells in the lungs of the infected individuals," the researchers concluded in the study.

The coronavirus disease often affects the elderly and those with comorbidities and underlying medical conditions. Across the globe, there more than 47.67 million cases, and of these, about 1.21 million have died. The United States remains the nation with the highest number of infections, topping 9.40 million, followed by India, with at least 8.31 million cases.

It has been 11 months since the emergence of the virus in Wuhan City in China. As yet, there is still no cure or vaccine against the virus. The best way to reduce the risk of being infected remains the usual preventative measures: washing the hands regularly, practicing social distancing, and wearing masks.

Source:

Bussani, R., Schneider, E., Zentilin, L., Collesi, C., Ali, H., Braga, L. et al. (2020). The Lancet. https://www.thelancet.com/journals/ebio ... lltext#%20

Journal reference:

COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) - https://gisanddata.maps.arcgis.com/apps ... 7b48e9ecf6
trader32176
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Re: Post-COVID Clinics / Long Haulers

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Delirium common after hospital discharge in critically ill COVID-19 patients

11/8/20


https://www.news-medical.net/news/20201 ... ients.aspx


Anesthesiologist and other researchers from Michigan Medicine, Ann Arbor, New York Medical College, Valhalla and Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, have reported a case series of critically ill coronavirus disease 2019 (COVID-19) patients who have developed neuropsychological symptoms after having been discharged from the hospital.

Their study titled, "Delirium and Post-Discharge Neuropsychological Outcomes in Critically Ill Patients with COVID-19: an Institutional Case Series," is now available on the preprint server medRxiv.*

Background

We are in the middle of a pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – the causative agent of COVID-19 – as declared by the World Health Organization (WHO) in March 2020. The pandemic has infected over 50 million people worldwide, which has resulted in over 1.25 million deaths. Hundreds of thousands of individuals with the infection have developed critical COVID-19, necessitating hospitalization and even intensive care treatment.

Neurological complications of COVID-19


COVID-19 has been known to cause several neurological symptoms and complications such as encephalopathy (inflammation of the brain), delirium, strokes, seizures, and abnormal movements called ataxia.

One of the most common complications of severe COVID-19 is delirium, explain the researchers. It has been reported in 65 to 80 percent of those patients who needed intensive care unit (ICU) hospitalization. This is usually caused by the virus's attack on the central nervous system and associated inflammatory responses that cause cognitive damage. The risks are raised due to associated factors such as social isolation and sedation during ICU stay.

Questions remain about delirium

Despite such a high incidence of delirium among patients with severe COVID-19, this condition's actual clinical course is not clearly understood. The authors of this study speculate several contributing factors such as the use of multiple medications, associated inflammation, strokes, and vascular events within the brain. They write that these factors need to be clearly understood in their contribution to neurological effects in severe COVID-19.

Study design

This was a retrospective chart review of cases at a single center at Michigan Medicine. Chart details were collected from critically ill patients with COVID-19. After their discharge from the hospital, these patients were interviewed via telephonic surveys to detect neurological deficits. The data was collected between 1st March and 31st May 2020.

Some of the main questions asked were:

Presence of delirium at any point during admission
Duration of delirium (in days)
Clinical course of the delirium
Use of antipsychotic drugs
Duration of hospital stay
Duration of ICU stay
Days requiring ventilator support
Laboratory values including white blood cell count, C-reactive protein, ferritin, lactate dehydrogenase, d-dimer and interleukin-6.
New psychiatrist consultation
New use of antidepressants
Final outcome after discharge, including stay at home, stay at long term care facilities or death.
All data on neuroimaging studies
Telephonic interviews within 30 to 60 days after hospital discharge to check for subjective or objective signs of cognitive impairment. The tests used were, "Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function Abilities 4a, Short Blessed Test (score 0-4 = normal cognition, score 5-9 = questionable impairment, score ≥10 = impairment consistent with dementia),28 Family Confusion Assessment Method for delirium, and the Patient Health Questionnaire-9 (scores ≥10 were considered positive screens for depression)".

Prevention strategies for delirium, including "ABCDEF ICU liberation bundle," were also assessed. Some of the prevention strategies of delirium among the patients were:


Assess and treat for pain
Discontinue physical restraints
Structured mobility exercises
Removal of temporary medical lines or devices
Place familiar objects from home at the bedside
Family education and reassurance
Promote use of visual and hearing aids
Sleep promotion protocols (e.g., lights off at night, melatonin tablets)
Spontaneous awakening trials

Findings

Most of the patients presenting with delirium and neuropsychological impairments after severe COVID-19 were African-American and non-Hispanic. They commonly had comorbidities such as hypertension, Diabetes mellitus, and obesity. Overall results of this study were:

Delirium incidence was seen among 107 of the total 148 patients (72 percent)
The median duration of delirium was 10 days (ranging between 4 and 17 days)
The most common delirium prevention measure was assessment and treatment for pain; the least commonly used measures were providing objects familiar to the patient and using spontaneous awakening trials
New antidepressant use was seen commonly among those with delirium (24 percent patients or 26 among 107 patients) compared to those without delirium (4 out of 41 or 9.8 percent)
Psychiatry consultation was needed by 20 percent of those with delirium and 0 percent among those without delirium.
Improvement in delirium was not seen among any patients during their hospital stay
Median duration of hospital stay was 25 days and median duration of ICU stay was 15 days
Length of hospitalization, ICU stay, and need for mechanical ventilation lengthened the duration of delirium in patients
Sedative-hypnotic drug use was among those with delirium
These delirium patients had higher markers for inflammation such as WBC, CRP, LDH and d dimer.
The final disposition of 38 percent of delirium patients was a skilled care facility after discharge.
23 percent of patients had cognitive impairment after discharge from the hospital
12 percent of patients with delirium tested positive for depression after discharge

Conclusions and implications


The authors of the study suggest the delirium is a serious and common complication seen among those with severe COVID-19. This was likely to be prolonged, especially with a prolonged ICU stay. Authors conclude, "Further research should aim to identify independent risk factors in this population and novel, effective prevention strategies."

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:

Delirium and Post-Discharge Neuropsychological Outcomes in Critically Ill Patients with COVID-19: an Institutional Case Series Jacqueline Ragheb, Amy McKinney, Mackenzie Zierau, Joseph Brooks, Maria Hill-Caruthers, Mina Iskander, Yusuf Ahmed, Remy Lobo, Phillip E. Vlisides medRxiv 2020.11.03.20225466; doi: https://doi.org/10.1101/2020.11.03.20225466, https://www.medrxiv.org/content/10.1101 ... 20225466v1
trader32176
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Re: Post-COVID Clinics / Long Haulers

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Post-COVID hospitalization has lasting impact on health, work

11/12/20


https://www.news-medical.net/news/20201 ... -work.aspx


Surviving a case of COVID-19 that's bad enough to land you in the hospital is hard enough. But life after the hospital stay - and especially after an intensive care stay - is no bed of roses, either, according to a new study.

Within two months of leaving the hospital, nearly 7% of the patients had died, including more than 10% of the patients treated in an ICU. Fifteen percent had ended up back in the hospital. The data come from more than 1,250 patients treated in 38 hospitals across Michigan this spring and summer, when the state was one of the earliest to experience a peak in cases.

When researchers interviewed 488 of the surviving patients by phone around 60 days after their hospitalization, they heard a litany of health and life woes. They've published their findings in the Annals of Internal Medicine.

" These data suggest that the burden of COVID-19 extends far beyond the hospital and far beyond health. The mental, financial and physical tolls of this disease among survivors appear substantial."

- Vineet Chopra, M.D, MSc, Study Lead Author and Chief of Hospital Medicine, Michigan Medicine- University of Michigan

Lasting effects

More than 39% of the patients interviewed said they hadn't gotten back to normal activities yet, two months after leaving the hospital. Twelve percent of the patients said they couldn't carry out basic care for themselves anymore, or as well as before.

Nearly 23% said they became short of breath just climbing a flight of stairs. One-third had ongoing COVID-like symptoms, including many who still had problems with taste or smell.

Of those who had jobs before their bout with COVID-19, 40% said they couldn't return to work, most because of their health and some because they'd lost their job. And 26% of those who had gone back to work said they had to work fewer hours or have reduced duties because of their health.

Nearly half of those interviewed said they'd been emotionally affected by their experience with COVID-19 - including a minority who said they'd sought mental health care.

More than a third - 37% -- of those interviewed said their experience with COVID-19 had left them with at least a minor financial impact. Nearly 10% said they'd used up most or all of their savings, and 7% said they were rationing food, heat, housing or medications because of cost.

"The sheer number of people struggling after COVID brings new urgency to developing programs to better promote and support recovery after acute illness," says Hallie Prescott, M.D., M.Sc., senior author and pulmonary/critical care physician at University of Michigan and the VA Ann Arbor Healthcare System.

More about the study

The study used date from the MI-COVID19 initiative, which rapidly evolved in April as a way for Michigan hospitals to pool and analyze data on their COVID-19 patients.

It grew out of existing multi-hospital quality improvement efforts funded by Blue Cross Blue Shield of Michigan, and drew on existing staff who are experienced at analyzing medical records and interviewing patients. That gave researchers a head start on studying COVID-19 patients treated in most of the hospitals that received such patients in the early-peak state of Michigan.

Details obtained from patient medical records, and in-depth interviews conducted after attempting to contact patients by phone multiple times, give a picture of what life is like for post-COVID patients.

Nearly 52% of the patients in the study are Black, and 4% are Hispanic. The average age is 62, and 83% lived at home before being hospitalized for COVID-19.

More than 14% had no chronic conditions before COVID-19 landed them in the hospital, and for many others the only condition they had was high blood pressure. The well-known risk factors of diabetes, cardiovascular disease and kidney disease were present in about a quarter of patients.

While hospital care for COVID-19 patients has improved since the early months of the pandemic, the study shows that the 63% of patients who were ever treated in an ICU had died during their hospital stay or within two months of leaving the hospital. That's more than twice the rate for patients hospitalized but not admitted to an ICU.
trader32176
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Re: Post-COVID Clinics / Long Haulers

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Suburban Woman Warns of Lingering Effects Even After Beating Coronavirus

11/12/20


https://www.nbcchicago.com/news/local/s ... s/2368826/


A suburban woman who recovered from the coronavirus said she suffered lingering effects for months and she is urging people to take masks and social distancing more seriously.

Pam Bachman of St. Charles said she spent a week in the hospital in June battling the virus. But she said a week after returning home, she noticed her hair falling out.

“Even the texture of my hair changed. It continued until from June till maybe two weeks ago,” Bachman said.

Bachman said she also suffered arm pain and an altered thyroid.

“It’s been a journey just to get stronger every day,” Bachman said. “Just to start walking again and eating and there is some, I don’t want to say memory loss, but just fog, memory fog, which is also improving now."

Dr. Phillip Cozzi of Elmhurst Memorial Hospital said some patients who beat the virus may experience lingering effects such as shortness of breath, chronic fatigue, cough, brain fog or depressive states.

“Most people can expect full recovery without any long-term sequela. The more ill patients who have more impressive syndrome are usually those who suffer from the long-term side effect, although, even people with mild symptoms can experience a lingering cough and fatigue state," Cozzi said.

Cozzi said no matter the size of the gathering, there still has to be marked vigilance with social distancing, and large groups should be avoided altogether.

Bachman said she is pleading with people to realize the virus is “not a joke.”

“Maybe for some people the symptoms aren’t so bad, but for myself that I never thought it would be that bad, it’s horrible,” Bachman said.
trader32176
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Re: Post-COVID Clinics / Long Haulers

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These Coloradans survived coronavirus during the first wave. Here’s what they want you to know now.

The Colorado Sun caught up with three COVID-19 patients who were infected early in the pandemic to see how they are doing and what their thoughts are on the disease’s resurgence

11/17/20


https://coloradosun.com/2020/11/17/colo ... rs-advice/


With the coronavirus crisis worsening by the day, The Colorado Sun reached out to three people who survived the disease in the spring to hear how their recovery is going and see what advice they have for their fellow Coloradans as the state weathers this latest surge.

Doug Summerfield, a 75-year-old Arvada man who spent a month on a ventilator, said he gets that people may be tired of coronavirus restrictions. But he said they are nothing compared to the effects of COVID-19.

“Believe me, they are not inconveniences compared to trying to recover from this, compared to trying to deal with the financial expense that hits you,” he said. “You don’t want to get it.”

Doug Summerfield, 75, of Arvada

Doug Summerfield talks about falling ill — and recovering from — COVID-19. (Jesse Paul, The Colorado Sun)

About five months after being released from a rehab center, Doug Summerfield remains pretty weak. His wrist is still in excruciating pain from nerve damage and has required surgery. He sometimes struggles to breathe.

“Not real great,” is how he said he feels. “I had hopes when I got out of rehab that in a couple months I’d be back to normal. Everybody is telling me it’s going to take a year. I’m afraid they’re right.”

Summerfield fell ill with COVID-19 in late March and spent about a month on a ventilator. Doctors thought he wouldn’t live, especially given his battles with asthma. But in May, he awoke — he calls it a “miracle” — and began what has turned into a long recovery.

Emotionally, Summerfield says he is doing OK, but he gets choked up when discussing the anxiety his friends and family contended with as he lay in a hospital bed on the edge of death.

“I didn’t go through a month sitting on the couch like my wife did counting the seconds in the night,” he said. “… My wife, my children, my friends — all of those people went through a horrible time. Some of them can’t even talk about it. That tears me up.”

He thinks people who refuse to follow social distancing and mask-wearing guidelines even now are not being “very intelligent.”

“Just the first week in the hospital was astronomically expensive,” he said. “Thank God I had decent insurance. For people who don’t have insurance — good insurance — for God’s sake you don’t want to catch this if for no other reason (than) it will financially ruin you. It will kill you.”

Lisa Merck, 51, of Crested Butte

Lisa Merck describes her coronavirus infection. (Jesse Paul, The Colorado Sun)


Lisa Merck, a 51-year-old nurse practitioner in Crested Butte, was one of the first people in Colorado known to catch the coronavirus, but she still hasn’t totally shaken the effects of the disease.

She estimates she is about 95% of her normal self. In the months following her infection, she dealt with sore throats, headaches and hair loss. In August, she felt like she had a “mini relapse of COVID” — shortness of breath, a racing heart and chest pain.

“My sense of smell hasn’t totally come back yet,” she said.

Merck started feeling ill on Feb. 18 — Colorado’s first confirmed case wasn’t until March 5 — as she and her husband were returning from a medical conference in Hawaii. Her symptoms worsened to the point that she went to the hospital on March 8 and received a pneumonia diagnosis. She was tested for COVID-19, and the results came back positive.

Since Merck is a nurse with her own clinic, she wanted to receive two negative COVID-19 test results before returning to work. That took a difficult two months as she kept getting conflicting readouts.

“I’m frustrated with the whole way — the entire way — that the coronavirus has been handled, honestly,” she said.

If all Americans would just wear masks, she thinks businesses could stay open and infection rates would drop. She understands how hard it is for people to stay apart from each other, but it’s crucial that they be careful.

“Even though you think you’re healthy, and you’re immune to it, you’re not immune to it,” she said. “We don’t know how it’s going to affect each person. Everybody is different.” Merck pointed to the fact that her husband also caught coronavirus, but his infection was mild and only lasted a few days compared to her months-long ordeal.

Merck still hasn’t resumed seeing patients in person at her clinic in Crested Butte for fear of catching the virus again.

“Honestly, I am afraid of getting reinfected,” she said. “I’m not opening my clinic doors until we see corona go down.”

Dan Michaelec, 55, of Parker

Dan Michaelec describes losing his sense of taste. (Lucy Haggard, The Colorado Sun)

Dan Michaelec believes he caught COVID-19 at the end of February during a Vail ski trip. Just over a week later, the 55-year-old Parker man checked into a hospital.

He doesn’t remember the three and a half weeks that followed. His condition had deteriorated enough that doctors put him into a medically induced coma and on a ventilator.

Michaelec stayed in five different hospitals and rehab centers as his health improved, worsened and improved again. After nine weeks of treatment he was finally well enough to return home and see his wife and kids in person.

But Michaelec’s path to recovery has not been linear. While he’s hesitant to call himself a “long-hauler” as other coronavirus survivors with lasting symptoms are known, some of the effects of the virus remain to this day, including lung scarring, high blood pressure, kidney dysfunction, spotty memory, motor and balance issues, and fatigue.

Despite setbacks, Michaelec is focused on finding markers of success: his first breath sans ventilator, his first bite of real food in weeks — a giant sub sandwich — and pushing himself to regain his strength through physical therapy sessions.

“I’m very blessed and very proud of where I’m at,” Michaelec said. “My goal is to be that if you ever saw me on the street, you would never know what I went through.”

Michaelec doesn’t want to preach, but he does want people to feel a sense of social responsibility when it comes to living in a pandemic.

“Educate yourself and make the best decisions for you, while you still continue to enjoy this beautiful thing we have called life,” he said. “But also remember that your decisions can impact others as well.”

If anything, Michaelec says, his wife is more intent on fighting the pandemic than he is; after all, she experienced the moment-to-moment stress and trauma of his hospital stay.

“What she had to go through, and what my daughters had to go through, it’s very sad, and I don’t wish that upon anybody ever,” Michaelec said. “Ever.”
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