A small but growing number of COVID patients are trapped in limbo.
They’ve been released from the hospital, they’ve tested negative, they’ve gone back to work – but they still can’t breathe. The smallest tasks exhaust them, their heads and joints ache, and there’s no medical diagnosis that seems to explain it. Welcome to the hell that is chronic COVID.
As of January 24, 2021, there have been 25 million U.S. COVID cases and over 417,000 deaths. Yet, for those who recover, an increasing body of literature indicates that they may not be entirely in the clear.
As early as April, doctors in Italy noticed that COVID patients who had recovered indicated the persistence of at least one symptom, most notably fatigue or joint and chest pain. By setting up a post-acute outpatient service, they were able to follow up with patients 60 days post negative test results and confirm lingering illness.
In the U.S.
Evidence indicates that many survivors will experience a chronic COVID-related condition. However, little has been done in the U.S. to follow up with these individuals.
In the European Respiratory Journal, researchers proposed a numeric scale to measure the severity of post-acute COVID. This scale is dependent on reliable follow up from physicians, a type of continual care often missing in the United States.
U.S. contact tracing and case follow-up have been implemented irregularly on a state-by-state basis. To mitigate the risk of a chronic COVID crisis, tracing should be standardized to include follow-up with survivors to confirm that they have a regular physician and set them up with an appointment if they cannot make one themselves. This service is particularly needed among the most vulnerable, including patients with existing comorbidities or low socioeconomic status.
If the gap in providers of regular, ongoing care is not quickly addressed, the U.S. runs the risk of a secondary COVID crisis due to uncontrolled and unmanaged chronic cases.
Lack of continuous follow-up and primary care is caused by a variety of reasons, including limited access, physician shortage, and health care “churn,” wherein patients are forced to switch between types of insurance coverage rapidly (i.e., employer-sponsored insurance and Medicare).
COVID-related instability in the job market has only increased the primacy of this issue. For many people, maintaining a consistent relationship with one doctor is difficult, if not impossible. Additionally, records of their condition are likely to be incomplete, creating a greater margin for error. In contrast, patients who receive continuous care have better outcomes and overall quality of care.
However, despite the known importance of continuity of care, 25% of Americans do not have a primary care physician.
Patients with chronic conditions “stand to benefit the most from care continuity.” Yet over and over again, U.S. COVID patients feel lost and abandoned in the face of an overburdened, ill-managed healthcare system.
Nearly 10% of COVID patients return to the hospital after being discharged from an emergency room. These are patients seeking care from their last known physician, oftentimes an ER doctor – either because they do not have a primary care provider or are unaware that there are simple measures that can be taken to treat post-acute COVID.
A Better System
Clinicians across Europe are beginning to make recommendations for follow-up for COVID survivors. Early data indicates that basic measures such as pulse oximetry measurement, medical recommendations for breathing work, and a guided return to exercise could have huge impacts for chronic patients.
If there were a better system in place for care continuity, individuals experiencing post-acute symptoms could stop taking up valuable space in overcrowded emergency rooms, and they could have better health outcomes. However, if patients are only seen in emergency rooms and do not have a regular doctor, these best practices cannot be implemented.
Health care providers, policymakers, and nonprofits need to come together to call for and support organized follow-up for COVID patients at risk for the post-acute disorder. Otherwise, the United States may be facing a secondary health crisis in the form of millions of cases of untreated chronic COVID.