麻豆传媒

Early in the pandemic, many hospitals, especially in the hard-hit Northeast, created dedicated and ongoing care for COVID-19 patients with lingering symptoms.

Now, as vaccination rates increase and new infections decline, some facilities are looking to wind down their post-COVID care centers. When they're no longer needed, that would signal success. And it's important for hospitals to get back to their usual business.

At the same time, other facilities are turning their attention to different areas of longer-term care, such as dedicated spaces to monitor the after-effects of infection in children.

Regardless, hospitals continue to monitor current needs.

SUNY Downstate Health Sciences University was at the forefront of setting up a clinic for post-COVID care at its University Hospital of Brooklyn, New York, whose vast majority of patients are people of color and those who are underserved. In March of last year, the hospital was designated a COVID-only facility by New York Gov. Andrew Cuomo (D).

"Initially, when COVID hit in New York, it was a brand-new disease," said Mafuzur Rahman, MD, vice chair of medicine at SUNY Downstate.

Not much was known about treatment in the short- or long-term, Rahman told 麻豆传媒. And many COVID patients Rahman and his colleagues saw didn't have established relationships with doctors. The team at SUNY Downstate felt compelled to follow the patients after they recovered from acute illness.

In May 2020, SUNY Downstate said that their University Hospital had established a dedicated outpatient clinic for the ongoing care of discharged COVID patients. Through the clinic, hundreds of patients were treated for ongoing respiratory or cardiac issues, potential side-effects of medications they received to combat COVID, cognitive effects like brain fog, and emotional trauma.

However, as time went on, Rahman said, "We also realized that the disease is going to be here for a while."

It still requires attention, but in a less acute state, he said.

So, at the end of last summer, SUNY Downstate transitioned the way it offered post-COVID care, incorporating efforts into its primary care clinic. The model, he explained, is more sustainable. Patients follow up with primary care doctors to get general care, and if they need specialty care related to prior COVID infection, they can access that through those visits as well.

"Initially, we were a COVID-only hospital," Rahman said. "But we needed to resume normal operation."

As infection rates in New York declined, more and more chronic patients started coming to the hospital, including those with uncontrolled diabetes, chest pain, or other non-COVID ailments, he said.

"We realized that we needed to be taking care of those patients," Rahman said. Getting back to more regular operation is also important for the business of running a hospital.

Ankita Sagar, MD, of Northwell Health, based in Long Island, New York, also longs for the day when post-COVID care may no longer be needed, though she still acknowledges its importance.

Sagar is the director of Northwell's COVID Ambulatory Resource Support, or CARES, program, which focuses among other things on post-discharge care for people who had the disease.

As Northwell's health system operates more than 20 hospitals and hundreds of other facilities in the New York metro area, the CARES program doesn't operate out of a central space. It has served thousands of patients since its inception last year.

The program isn't at a specific geographic location or office like many of the centers for post-COVID care at other institutions, Sagar said. "And that was very intentionally planned."

"We didn't think it was fair to have patients come from all areas of New York state to one part of Long Island," for instance, she said. "Our program is set up so that we have a core group of clinical experts in every subspecialty that are managing patients with COVID."

The program, which has also incorporated care navigators and resources to help with social determinants of health, is still very much running, Sagar said. However, recently, the needs of acute COVID patients have decreased, and the needs of patients with lingering symptoms have plateaued.

In New Jersey, Atlantic Health System launched its center for post-COVID care last fall, and is currently seeing about the same volume of patients.

That's about 10 or 15 new patients a week, said Steven Sheris, MD, senior vice president of physician enterprise for Atlantic Health System and president of Atlantic Medical Group.

There is a sense of optimism that patients will get better over time, Sheris said. But there is also a recognition that there will be COVID-related needs for the foreseeable future.

"COVID has become its own business division for us," he said. Early last year, Atlantic Health System was "laser-focused" on the initial surge of cases, he added. More recently, efforts have shifted towards getting people healthy again and back to work, and reopening businesses.

"It's not just about the hospitalized patient," Sheris said. "Now, it's about getting the community back on their feet and keeping them on their feet."

During the recovery period, other centers are still opening, some with a specific focus in mind.

On June 1, Yale New Haven Children's Hospital in Connecticut announced the launch of its Children's Post-COVID Comprehensive Care Program.

When children contract COVID, symptoms often improve and resolve after a couple of weeks, the hospital said in announcing the program. However, long COVID symptoms in children can include an inability to tolerate strenuous activity, anxiety, cognitive difficulties, and shortness of breath.

"These needs are multi-faceted," Rebecca Ciaburri, RN, performance manager of Quality, Safety, and Program Development at Yale New Haven Children's Hospital, told 麻豆传媒 in an email. "They may include testing and treatment by specialized pediatric specialists in cardiology, pulmonology, rheumatology, or infectious disease due to prolonged COVID-related symptoms. They could also include close follow-up for children that have had MIS-C [multisystem inflammatory syndrome in children] or children that require cardiac clearance to return to sports post COVID infection."

Social workers and the hospital's psychiatry team are also integrated in treatment plans, Ciaburri said.

Currently, the program -- which has more than 50 pediatric specialists that are part of it -- is seeing about 10 patients per week, she said.

"By following this population closely we hope to learn more about the long-term effects of COVID, how to optimize care and outcomes, and work through the best illness prevention measures as next steps, such as vaccination efforts, clinical support systems, and a variety of things to come," Ciaburri said.

Sagar said that one of the questions she's often asked by other organizations is how to start a program like the one she runs, should the need arise.

She said that one of her recommendations is to think about re-allocating resources rather than creating a separate entity. That has worked well for a large system like Northwell, she said, but could also suit a much smaller system with fewer resources.

Looking forward, Sagar said what she hopes for is that her program won't be needed a year from now. However, she added that a program like it is an example of how the industry should be approaching care more generally and for other chronic illnesses.

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