Q&A: NJ center focuses on post-acute COVID-19 syndrome
One of every 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), hit hard by the first wave of the pandemic, has treated more than 15,000 patients with COVID-19. Recently, it became one of the first health systems in the country to launch 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 Seton Hall-Hackensack Meridian School of Medicine, about post-acute COVID-19 syndrome and the services that the recovery center is providing to patients.
Q: Tell us about the recovery center.
A: It is somewhat of a virtual center as it spans all of New Jersey where HMH provides care. Patients generally have a telehealth visit to determine what their chief complaints and symptoms are and what they are seeking. They then may be seen by primary care physicians in specific offices who are experienced with COVID-19 and chronic COVID. Physicians meet with me by phone weekly to discuss approaches to care and new developments in the literature.
The patient may be referred to a behavioral health specialist if primary symptoms are psychological, such as anxiety or depression. They may also be referred to a cardiologist, neurologist or pulmonologist — in addition to primary care — depending on the issue. Specific practices participating in the program have provided acute COVID care, have expertise and are participating in research in this area. Patients can also be referred to physical therapy. This referral is usually part of a treatment plan, and because these are generally outpatients, they attend outpatient physical therapy, pulmonary rehabilitation and/or cardiopulmonary programs.
Thus far, our center has seen several hundred patients.
Q: According to the Infectious Diseases Society of America, “there is currently no clearly delineated consensus definition” of post-acute COVID-19 syndrome. What are the most common symptoms that patients present with, and can you describe your approach to care?
A: The NIH convened a 2-day conference regarding this issue to define the name and the time. For our program, we call it chronic or post-acute COVID, and we identify persistent symptoms as a part of this syndrome if they are present more than 3 months. It may take weeks for individuals to recover from the acute illness. That is not what we are focused on.
Symptoms include fatigue, malaise, anxiety, confusion, cognitive change, trouble concentrating, memory problems, shortness of breath, cough, chest pain, headache and insomnia. There may be symptoms and syndromes due to the blood clotting problems associated with acute COVID, causing subsequent strokes, leg or arm clots, pulmonary embolisms, etc. Those need urgent treatment but are not part of the chronic COVID syndrome. They are a result of the acute illness.
Our approach is holistic and supportive. The treatments may be physical therapy, medications, etc., but there is no current direct treatment. These symptoms may be separate syndromes or all part of one syndrome with one underlying cause — perhaps autoimmunity — with varying manifestations, but we don’t know yet.
Q: Will you be conducting research on post-acute COVID-19 syndrome at the center? If so, can you tell us what you hope to find?
A: We are conducting research. We hope to characterize clinical syndromes, epidemiology and treatments, and we hope to link this with biologic research.
All patients are asked if they will provide consent for excess biological material (such as extra blood from a blood draw) to be saved and used for basic research purposes regarding chronic COVID-19, as well as clinical data.
Q: Is treatment of post-acute COVID-19 syndrome complicated by health insurance? Is reimbursement a problem?
A: Not really — the symptoms are real and there are diagnoses with syndrome descriptions that can be used.
Q. Post-treatment Lyme disease syndrome (PTLDS) has been associated with a loose confederation of nonspecific symptoms. Do you have concerns that post-acute COVID-19 syndrome will become the latest condition to which vague symptoms will be attributed without a concrete diagnosis?
A: I believe that there will be a tremendous amount of research in this area — as we see the NIH now initiating grant support efforts along with others worldwide. Even if the prevalence is low — say, 2% of those infected — millions of people have been infected worldwide, so we must understand this symptom complex better, and I expect that we will, given time.