“We have had monthly sessions and have treated a handful of long haul patients,” said Dr. Heather Abraham, one of the founders of the program and a Wayne State assistant professor of internal medicine and pediatrics. She also practices at Detroit Medical Center and Children’s Hospital of Michigan.
Michigan Medicine also is expected to soon open a post COVID-19 multidisciplinary clinic for treatment of COVID-19 long haulers, spokesperson Kelly Malcom said.
Other hospitals across the country have begun to open clinics for patients who continue to suffer lingering health problems after having COVID-19. For example, Northwestern Memorial Hospital in Chicago will soon open a Comprehensive COVID-19 Center for patients dealing with long-term effects.
Two of the most common effects are ongoing shortness of breath and brain fog, Dr. Charles Davidson, vice chair for clinical affairs at Northwestern’s Department of Medicine, said in an interview with Crain’s Chicago Business.
“We’re just at the beginning of this journey,” Davidson said. “We developed a research arm of the center to better understand what this disease is, how best to treat it and diagnose it, and also to help educate the medical community about all the different long-term manifestations for this illness.”
The Henry Ford clinic aims to minimize post intensive care syndrome and maximize patients’ recovery from serious illness. The clinic will offer the following services:
Comprehensive evaluation of cognitive, behavioral and emotional problems. Treatment for anxiety, depression and PTSD. Cognitive rehabilitation to provide patients and caregivers with strategies for managing changes in functioning.Evaluation for caregivers to provide them tools so they can aid the patient and advance their treatment.
The $500,000 grant, which was awarded in November, will provide a budget for Henry Ford to staff the clinic with several full-time equivalent staff, including a neuropsychologist, neuropsychiatric fellows and interns, social workers and support staff.
“Based on the clinical interview, there might be referrals to other disciplines and treatment for cognitive or behavioral issues,” Merker said. “We will do (30 minute) individual and (one hour) group therapy and help connect patients with (community and financial) resources.”
Merker said the program projects conducting a minimum of 10 patient evaluations each week and providing therapy for 25-50 people per week.
“With COVID-19, there is still a lot to learn and we will be doing research with our clinic,” Merker said. “We are not exactly sure why patients have these lingering neuropsychiatric symptoms and how COVID spreads to the brain. There are many ways that it’s been postulated through infection through the peripheral nervous system. It’s an immune response that passes through the blood to the brain.”
Besides the brain, early anecdotal reports from front-line providers indicate COVID-19 affects the heart, kidneys and lungs, Merker said. “All of those can have an indirect impact on the brain functioning,” he said.
When COVID-19 started to hit, Merker said providers didn’t fully understand how to manage patients in the ICU, especially because the coronavirus is highly contagious.
“Patients were totally isolated in their rooms, not allowed to have any visitors, or very limited contact with nursing and doctor staff,” Merker said. “We’ve postulated that would put an additional psychological burden on patients due to this severe isolation, which sets them apart from your traditional ICU patients, where you can have visitors and significant in multiple interactions with your health care providers on a daily basis.”
But with a COVID-19 diagnosis, the lack of personal protective equipment and family support, Merker said COVID-19 patients face even greater challenges after hospital discharge.
“The patients with COVID-19, what people call the long-haulers, might never have been in an ICU. If they didn’t, they would go through our regular clinic for neuropsychology,” Merker said.
Merker said Henry Ford will seek additional reimbursement for post-ICU syndrome patients. He said current billing codes cover neuropsychological conditions, but not the additional costs for social workers.
“With COVID, there is the issue of inequality because it affects people differently (depending on their) ethnicity. We wanted to make sure that patients who may not have had optimal insurance or had no insurance still get this high quality care,” said Merker, adding that the grant will allow research to get an understanding of the disease and the long-term outcomes or recovery.