Dr. Aaron Bunnell, a UW Medicine physical medicine and rehabilitation physician, had expected to see a steady stream of patients needing therapy after developing COVID-19, as the pandemic marched from spring, summer and then into the fall. But what he didn’t expect was a multifold increase in patients needing clinic services, a spike which began at the end of the summer and continued into the winter.
In May, when the clinic opened, about 2 people a week were seeking out the clinic; now 25 a week are being referred to the rehab clinic at Harborview Medical Center, Bunnell estimated earlier this month.
“And even with that we’re not even capturing everybody that’s in the UW system or the community,” said Bunnell
New estimates of the number of long haulers have grown alongside the COVID-19 numbers. Of the 24 million in the U.S. who have contracted COVID-19, up to 2 million might be dealing with symptoms that have persisted for months, according to one JAMA study. In addition, initially the Post-COVID Rehabilitation and Recovery clinic at Harborview Medical Center – one of the first in the nation to open – was set up in to take patients who had needed ICU care. That model has now changed to include patients never hospitalized, but who continue to have symptoms, Bunnell said.
Bunnell added that he expected younger patients to be relatively spared, but they are seeing many with ongoing symptoms. The most common long-term symptoms which persist after a patient has tested negative for COVID-19 include decreased endurance, shortness of breath, fatigue and changes in cognition many patients are calling “brain fog.”
Yet there are also symptoms including rapid heart rate, dizziness, skin irritation, loss of smell and taste, ringing in the ears, and problems with balance and gastrointestinal issues. A new non-peer reviewed study tallied up over 200 different post covid symptoms patients may have to deal with, months after they initially contracted the disease.
“We think that multiple systems can be affected and as literature comes out, we’re seeing that autonomic, immune and cardiac issues are more common than maybe we initially thought,” he said. “And we’re also seeing the cognitive impairments are probably more common in patients that were never hospitalized.”
A majority of the patients coming to the clinic are now presenting with one or more of these symptoms, he said.
“I think we’re going to have a lot more COVID infections and even if it’s only 5 percent of the infections that have long term effects, it’s a massive public health issue,” he said.
And the symptoms may not just last “one to three months, but a year or five years or indefinite effects,” he said. “We really want to be here to serve those patients and help rebuild life in whatever way that we can for those patients.”
The clinic is taking a multidisciplinary approach, because many of the post-COVID-19 patients or long-haulers do have a variety of ailments they are still trying to battle. As the pandemic has progressed, so have the various treatments.
Bunnell noted, for example, that they might have to develop treatment plans with pulmonologists and cardiologists as well as take a more cautious approach in some patients with heart, lung or autonomic symptoms.
“For example we have one patient in their 40’s whose heart rate is getting into the high hundreds just doing basic household tasks,” he said. This patient is being evaluated by multiple specialists and careful thought has been given to have to improve their endurance and symptoms. Still, the clinic staff strive to return the patient back to a quality of life they enjoy.
“You have to look at this disease with regards to the quality of life you’re living. Can you hold down a job? Take care of your family,” he said. “I mean is life really meaningful if you’re stuck on the couch all day long?”
Bunnell estimated that over 300 people will likely come through the clinic by February.
Those patients interested in being admitted to the clinic can either get a referral from their doctor, or going to the UW Medicine Contact Center and calling 206.520.5000. Ask for an appointment with the COVID-19 clinic out of Rehab Medicine. The clinic also has a tele-medicine component.
Barbara Clements, 206.740.5043, email@example.com