Feb 11, 2021 COVID CARE for the Long Haul

The new Post-COVID CARE Program at Saint Barnabas Medical Center offers individualized care for those recovering from COVID-19.

COVID-19 is a novel and complex virus, so we are just learning about its long-term ramifications. Many of those who have been diagnosed make a full recovery, but others, known as COVID-19 “long-haulers,” suffer from lingering side effects that can impact their heart, their lungs and/or their minds and behaviors.

Saint Barnabas Medical Center and RWJBarnabas Health Medical Group have developed the Post-COVID Comprehensive Assessment, Recovery and Evaluation (CARE) Program as a way to assist those who are still suffering weeks or months after their diagnosis. Vanessa Trespalacios, M.D., an RWJBarnabas Health Medical Group internal medicine physician and Post-COVID CARE medical director, along with her nurse navigator, Christina Davis, R.N., work with a multidisciplinary team of doctors at the program to bring unique, individualized treatment to aid patients in their recovery and help them get to the bottom of their symptoms.

Here, Dr. Trespalacios and Davis reveal more about the program, the common symptoms their patients are presenting with and what else you need to know.

When and how did the Post-COVID CARE Program come about?

VT: In August, Stephen P. Zieniewicz, FACHE, president and CEO of the Medical Center, wanted to create a treatment option for people with residual symptoms post COVID-19. He spoke with leadership in the RWJBarnabas Health Medical Group, who then reached out to me to lead the program. From there, I developed a clinical model, which is what was presented to the leadership panel.

Where are your physical offices located?

VT: Because it was a pilot program and we needed to have proof of concept, we started it out of my practice in the Barnabas Ambulatory Care Center (ACC), which some might consider a mini hospital. We don’t have overnight stays but we have subspecialists, physical therapy, radiology, a same-day surgical center, a pharmacy: This is a one-stop shop. We are in the process of identifying a space within the ACC so we can continue to expand the program.

What are the most common lingering symptoms you’re seeing in patients who come to the Post-COVID CARE Program?

VT: The number one lingering symptom is shortness of breath. Ninety percent of patients have some degree of shortness of breath, even if it’s not their main complaint. Second is cognitive, meaning memory loss, feeling like they are slower to react, having trouble finding the right words. I’ve had some patients with difficulty doing math that were proficient at it before. Patients have been calling it “brain fog.”

Are these symptoms typically the same across sex, age, etc.?

VT: These symptoms are across age and sex and even preexisting medical history. Even patients who formerly had no preexisting conditions [are still suffering] and have been unable to go back to work or resume exercise because of the degree of cognitive impairments or shortness of breath.

Are these symptoms still lingering from COVID, or did they return and come back?

VT: For most patients it’s lingering symptoms: the symptoms started with COVID and may have improved but have not completely resolved. A couple have had symptoms that have gone away and come back and they tested negative [for COVID]. But most frequently, symptoms are whatever they had with their diagnosis that continued to persist to some degree, despite now being COVID negative.

What comes next after a patient’s initial visit at the Post-COVID CARE Program?

CD: After they are screened and come in for their initial visit, depending on their exam and their complaints, we either start the diagnostic process and see what we can refer them for, or we set them up for a consultation with the appropriate subspecialist. These are doctors who have been seeing COVID patients since the beginning, both in the hospital and in their offices, and they are well-versed and familiar [with the symptoms]. We also have our Behavioral Health pathway, through which we can refer patients to talk to a counselor within two weeks. Every patient in the program goes through me, and we as a team individualize a plan of care for each patient.

How do you work in tandem with a patient’s primary care physician (PCP)?

CD: We are not replacing their PCPs. Each patient has an initial visit with our internal medicine specialists and another in three, six and 12 months. After a doctor orders bloodwork and we have our notes, I forward that info to their PCP so they’re aware of everything that’s going on with their patients.

Do you conduct telehealth visits?

VT: We feel the initial visit should be in person—there is a lot lost in telehealth without a preexisting relationship, and you can’t fully evaluate a patient that way. But many follow-ups can be virtual, depending on the patient’s particular complaint and diagnosis.

CD: A lot of our patients feel stigmatized and it’s hard for them to get appointments due to their COVID diagnosis. Whether that’s real or perceived we don’t know, but having that first appointment in person helps build that rapport.

How often are you seeing patients at the Post-COVID CARE Program?

VT: We are currently seeing patients here two days a week for 45-minute appointments. Once we get into our new space and recruit other internists to participate, then we can expand that availability.

What else do you want someone who may be experiencing lingering COVID symptoms to know?

CD: A lot of your symptoms are real. A lot of our patients say, “I’m not sure if this is real but I‘m losing my hair,” or, ”I feel like I use a lot more Post-its and I don’t know if that’s just me or people teasing me.” Some of these things feel very taboo to these patients, but don’t be reluctant to share [with us] if you feel something is wrong.

If you had COVID-19 and continue to experience lingering symptoms or if you want to learn more about this program, contact nurse navigator Christina Davis, R.N., at 888.COVID94 or via email at postcovidcare@rwjbh.org.