Feature
For the Long Haul: The COVID-19 Recovery Clinic
March 18, 2022
Four months into the pandemic, Montefiore Einstein clinicians had already established the COVID-19 Recovery (CORE) Clinic in Montefiore’s Medical Arts Pavilion. “There has been an understanding for decades that survivors of critical illness need specialized care following hospitalization,” says Marjan Islam, MD, assistant professor of Medicine (Pulmonary Medicine, Critical Care) and clinic co-director. “Post-Intensive Care Syndrome affects physical, cognitive and mental health.” The clinic opened its doors in June 2020 with the assumption that the majority of its patients would be post-ICU survivors of critically ill COVID-19 pneumonia.
Today, this group does constitute a sizable number of patients who come to the CORE Clinic. “But the majority of recovering COVID-19 patients seen at the clinic now were not hospitalized and had milder symptoms at the onset,” says Dr. Islam. Known as long haulers or patients with long COVID, they suffer a range of persistent, severe, debilitating symptoms. Early in the pandemic, clinicians noted coughing or shortness of breath; feeling tired, dizzy or weak; numbness or tingling; abdominal pain; insomnia; and emotional health issues. In the months since then, they have added a range of troubling post-COVID symptoms and syndromes to that list: kidney impairment, stroke, Guillain-Barre syndrome, vagus nerve issues such as difficulty swallowing, a high heart rate, low blood pressure, and diarrhea, “and many more,” says Seth Congdon, MD, assistant professor of Medicine (General Internal Medicine) and CORE Clinic co-director.
A Neurological Disease
“We’re coming to understand that long COVID is a neurological illness,” says Dr. Congdon. “It affects the small nerve fibers that control sensation and the autonomic nervous system, which regulates blood pressure, heart rate, breathing and how our GI system moves.” This may explain the profound fatigue that is so common after COVID. The CORE Clinic specialists first rule out pulmonary and cardiac conditions, and other potential causes. “Long COVID shares many similarities with myalgic encephalomyelitis, commonly known as chronic fatigue syndrome,” says Dr. Congdon. “To meet full diagnostic criteria for this condition, patients have to have symptoms that last for longer than six months. But recognizing this as a possible diagnosis early, and helping patients understand how to manage it through pacing, is important.”
“We are far from understanding long COVID,” says Dr. Islam. “The basic science and pathophysiology are still poorly understood, so any pharmacotherapy for treatment is, I believe, years away.” To fill in gaps in understanding, Montefiore Einstein researchers are conducting many studies, from pathophysiology to epidemiology to therapeutics development. Dr. Islam has a research grant to study survivors of critical illness from COVID using thoracic ultrasound funded through the CHEST Foundation of the American College of Chest Physicians. His CORE Clinic is also participating in a multi-center trial studying the effects of a novel drug in limiting lung injury following COVID-19 pneumonia, funded by the National Institute of Allergy and Infectious Diseases.
To Contact the Clinic
The CORE Clinic has helped hundreds of patients with long-haul COVID and has capacity for more at two Bronx locations: the Medical Arts Pavilion, 3400 Bainbridge Avenue, and the Hutchinson Metro Center, 1250 Waters Place. To contact the CORE Clinic, call 844-556-6683, extension #36. Patients needing post-ICU care may contact the Critical and Acute Recovery Engagement (CAIRE) Clinic, which Dr. Islam also directs, at the same phone number or at icurecovery@montefiore.org.