Patient-Centered Care

COVID-19 ‘Long-Hauler’ Clinics Focus on Helping Patients with Lingering Symptoms

These dedicated practices across the U.S. are providing care and learning more about this still puzzling impact of the pandemic.

Brian T. Horowitz

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Brian T. Horowitz is a writer covering enterprise IT, innovation and the intersection of technology and healthcare.

COVID-19 symptoms that linger in patients over several months have brought on one of the biggest mysteries of the pandemic. The National Institutes of Health calls it "Post-Acute Sequelae of SARS-CoV-2 infection" (PASC) or “long COVID.”

Enduring symptoms include fatigue, shortness of breath, exercise intolerance and chest pain and palpitations, says Dr. Kristin Englund, an infectious disease specialist at the Cleveland Clinic. Other symptoms include brain fog, anxiety, depression and gastrointestinal disorders.

An estimated 10 percent to 30 percent of coronavirus patients are “long haulers,” according to the NIH, and medical professionals are turning to technology to keep track of them. More than 80 clinics across the U.S. have been established to address long-hauler cases, NBC News reports.

A number of these clinics are using telehealth and other technologies, such as electronic health records and mobile apps, to care for these patients. Building up these practices helps providers deliver specialized care where needed and track a course of treatment that promotes recovery.

Data Integration Necessary for Long-Term Care

Cleveland Clinic announced the opening of its reCOVer clinic in March to treat long-COVID patients. As of late April, the health system saw more than 260 patients with lingering COVID symptoms, says Englund, who leads the clinic.

It took a large IT team to get physician schedules and patient-entered data integrated into the Epic EHR system, according to Englund.

At the clinic, patients undergo an initial physical evaluation, and the EHR incorporates patient-entered data from questionnaires, Englund says. The EHR also details the patient’s health pre-COVID, and physicians can review the data to see if someone is testing strongly for depression, anxiety or post-traumatic stress disorder, so they can get needed care right away.

Physicians then follow up with a 30-minute telehealth session over a firewalled version of Zoom that launches from within the EHR.

“It’s a virtual visit where the same provider goes over all of the testing results with the patient and then discusses next steps,” Englund says. A physician may then recommend one of 18 specialists at the clinic, such as a cardiologist or physical therapist.

Englund is hopeful her team will get a better understanding of long COVID by studying patients’ data to help improve their condition.

“While we don't currently have treatments for it, we have the ability to help patients with their symptoms and try to understand it better,” Englund says. “Not until we get even more robust data on what these patients’ look like and what things they're going through can we really make that clear of a statement, so I'm looking forward to getting this data.”

Connecting with Long-Haul Patients Through Telehealth

Last year, Dr. Aaron Bunnell, a physician at the Rehabilitation Clinic at UW Medicine Harborview Medical Center in Seattle and an assistant professor of rehabilitation medicine, co-founded a long-hauler clinic to help patients who were never hospitalized but still struggle with lingering effects on physical and cognitive function.

Harborview already employed telemedicine, but now it uses HIPAA-compliant Zoom sessions, according to Bunnell. The clinic collects data from these patients in several ways. For example, patients send data to physicians from pulse oximeters and blood pressure monitors. Bunnell’s team also sends surveys from the Epic EHR platform to patients to get data on symptoms and information on how well they can walk or breathe.

We really want to focus on patient outcomes and objective outcomes, and where additional data would be really helpful to know how to guide clinical care and management.”

Dr. Aaron Bunnell Physician, Rehabilitation Clinic at UW Medicine Harborview Medical Center

“What’s great about that is it can send a link out through the patient’s phone or email to conduct these surveys,” Bunnell says. Physicians input the survey data directly into the EHR.

“We really want to focus on patient outcomes and objective outcomes, and where additional data would be really helpful to know how to guide clinical care and management,” he says.

Because physical inactivity is associated with more severe COVID-19 outcomes, UW Medicine is gathering additional data from its ExerciseRX app. Patients with symptoms such as fatigue and shortness of breath can benefit from the increased activity, says Dr. Cindy Lin, associate director of clinical innovation at the Sports Institute at UW Medicine.

“Central to their recovery is restorative movement to gradually build their activity tolerance throughout the day, which is what ExerciseRx helps support,” Lin says.

Much More to Uncover in Long-Hauler Care

The unknowns around long-hauler cases led MetroHealth, also in Cleveland, to open its own clinic, says Director of Telehealth Operations Albert Ferreira. “Our support services provide patients a lot of comfort, to get them the additional care they need to manage and get through whatever post-COVID symptoms they are experiencing,” he adds.

Patients can download the Epic MyChart smartphone app to connect to a video visit. If a patient lacks adequate technology, providers will conduct a phone call visit, Ferreira says.

When launching its long-hauler clinic, Ferreira and the MetroHealth team encountered challenges around patient connectivity, education and training. The health system also focused on getting providers comfortable with virtual video visits.

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The video component adds some assurance to patients that their needs are being met, according to Ferreira.

“In a video visit, a care provider can better determine if patients are verbally saying they are feeling OK but their facial expressions and their body language show otherwise,” Ferreira says. Symptoms such as shortness of breath will lead patients to be sent to a hospital, he adds.

The immediacy that telehealth provides is also important for patient care. “Telehealth-delivered care services allow patients to meet with their provider sooner to be able to expedite care and decision-making,” he says.

As for a timeline for COVID long-hauler clinics, MetroHealth has not defined an end date, Ferreira adds. “We will support our post-COVID patients as long as it is needed or until we have new medical information that informs us to revisit our care services and approach,” he says.