4 weeks
Lessons learned from the UI Health Care Post-COVID-19 Clinic
Nearly 1 in 5 adults have long-COVID
Some studies estimate that between 10-20% of adults who become infected with COVID-19 will experience long-term symptoms, yet a recent survey of physicians found 87% feel there is a lack of clinical guidelines on how to treat long-COVID in patients.
This comes as no surprise to providers at the UI Health Care Post-COVID-19 Clinic. Since opening in June 2020, the clinic has treated nearly 800 patients and demand for services remains high. Nearly 85% of new patients at the clinic are self-referrals, and many of them arrive desperate for answers.
The good news is that not all long-COVID symptoms require specialized care. There are many symptoms of long-COVID that can be managed by a primary care provider.
In this paper, we share lessons learned at the Post-COVID-19 Clinic that can be applied elsewhere.
What is long-COVID?
Evidence shows that patients with severe acute SARS-CoV-2 infection take longer to recover compared to patients who become severely ill with other respiratory viruses.
Although standardized case definitions are still being developed, the Centers for Disease Control and Prevention (CDC) states that “post-COVID conditions can be considered a lack of return to a usual state of health following acute COVID-19 illness.
The CDC uses “‘post-COVID conditions’ as an umbrella term for the wide range of health consequences that are present four or more weeks after infection with SARS-CoV-2.”
The constellation of symptoms is considered a syndrome defined as post-acute sequelae SARS-CoV-2 infection (PASC) or “long-COVID.”
Who is at risk for long-COVID?
Many of the patients with long-COVID had preexisting health conditions, such as asthma, heart conditions, psychiatric disorders, etc., before getting COVID-19. After becoming infected, their condition became exacerbated.
While it is true that patients who experience more severe COVID-19 infections or hospitalizations are more likely to develop long-COVID symptoms, patients with mild COVID-19 infections can also present with long-COVID symptoms.
What can primary care providers do?
Rule out other diagnoses
Long-COVID is a diagnosis of exclusion, so it is important to conduct a thorough physical exam, medical history, and order the appropriate tests. Be careful not to label it long-COVID before another diagnosis has been ruled out.
Check for lung disease
When it comes to common post-COVID lung diseases, symptoms in the clinic do not correlate with disease severity. Small airway disease with air trapping is common in ambulatory patients with shortness of breath and normal pulmonary function tests (PFTs). Small airway disease can be detected by CT chest scan of the lungs with expiratory protocols (this is slightly different protocol from standard CT, involving exhalation prior to the scan). These CT scans can be done at larger medical centers, like University of Iowa Health Care.
Reassure patients
If a patient thinks they are taking too long to recover from a COVID-19 infection, take them seriously. They are often looking for reassurance that their concerns are legitimate. Normalizing the patient’s experience and letting them know they are not alone is critical.
Schedule extra time
Patients who are experiencing long-term COVID symptoms often require longer appointment times because they have multiple symptoms that need to be addressed. Consider scheduling enough time or planning to have the patient return for multiple appointments to allow for a thorough assessment.
Screen for psychological symptoms
In addition to physical symptoms, many long-COVID patients also present with psychological concerns, such as anxiety, depression, “brain fog,” and post-traumatic stress disorder. Behavioral health screening questionnaires and referrals are highly recommended. Ongoing support, cognitive behavioral therapy, and treatment for sleep, mood, and anxiety are key to a patient’s full recovery from long-COVID.
Consider rehab services
Many patients who have visited the Post-COVID-19 Clinic have seen significant improvement in symptoms when referred for specialized rehabilitation therapies:
- Occupational therapy
- Vestibular therapy
- Pulmonary rehab
Schedule long and frequent follow-ups
Patients with long-COVID often have multiple symptoms that need to be addressed. Frequent follow-ups will give the patient peace of mind and allow you to monitor your patient's progress.
Encourage patience
Symptoms of long-COVID typically improve with time, usually between 6-72 months, but progress can be very slow and there may be backslides when patients become ill or overexert themselves.v
When should you refer a patient to a specialist or the Post-COVID-19 Clinic?
If a referring provider has a specific diagnosis/area of concern, they may refer directly to a specialist. However, sometimes a specific diagnosis can be elusive. Test results may be normal while the patient is still experiencing symptoms. If there is no clear diagnosis and the patient isn't recovering, they may benefit from a referral to the Post-COVID-19 Clinic.
Post-COVID-19 Clinic referral criteria
- 18 y/o and older
- Proven diagnosis of SARS-CoV-2 infection (nasal swab or nucleocapsid antibodies
- Presence of any long COVID-19 symptoms
What does the Post-COVID-19 Clinic do?
During a patient's first visit at the Post-COVID-19 Clinic, providers conduct a thorough physical examination and health history assessment. The first appointment is comprehensive and generally lasts several hours.
The following tests may be ordered based on patient symptoms:
- Pulmonary function tests (spirometry, lung volumes, DLCO, exhaled nitric oxide)
- Chest computed tomography imaging without contrast (inspiratory and expiratory scans)
- Blood work that includes:
- Complete blood count (CBC)
- Basic metabolic panel
- Liver function test
In addition to conducting a thorough physical exam and testing, we provide guidance on health, diet, and exercise. We also reassure the patient they are okay and that their symptoms will likely improve with time.
If signs of illness are discovered, a treatment plan is created, or the patient is referred to a specialist who can provide the best care for the patient.
Patients with small airway disease are sometimes treated by prescribing ICS or ICS/LABA inhalers. The typcail course of treatment is 6-18 months.
All patients are invited to participate in a research registry so we can continue to learn more about the long-term effects of COVID-19 and effective treatment. Consent is obtained to use patients' clinical data, blood samples, and cell samples for research.
Contact Post-COVID-19 Clinic
Medicine Specialty Clinics
31205 Pomerantz Family Pavilion (PFP) Level 3, Elevator L
200 Hawkins Drive, Iowa City, IA
31205 Pomerantz Family Pavilion (PFP) Level 3, Elevator L
200 Hawkins Drive, Iowa City, IA