While the number of new COVID-19 hospitalizations continue to decline in Pennsylvania and New Jersey, the pandemic is intensifying in some southern and western states. Both there and here in the regions Penn Medicine serves, in the aftermath of our spring peak, the number of people who’ve been infected and survived COVID-19 continues to climb.
While data show the vast majority of patients with COVID-19 recover from the disease, it’s not quite as simple as declaring someone “all better.” Research studies and reports show how the disease — which often attacks the lungs — can affect organs throughout the body, causing damage to the kidneys, heart, and even brain. It’s too early to know the long-term effects of the disease, and how it will differ among patients with mild symptoms versus those with more severe symptoms. But the unpredictable and wide-ranging health effects caused by COVID-19 — compounded, in some cases, by long stays in an intensive care unit — means the road to full recovery can be long for patients who are deemed “recovered.”
“Between our inpatient and outpatient services, we’ve come to learn that COVID-19 recovery doesn’t end as soon as someone is stable and leaves the hospital,” said Benjamin Abramoff, MD, an assistant professor of Clinical Physical Medicine and Rehabilitation at the Perelman School of Medicine at the University of Pennsylvania. “A wide range of medical issues can linger and impair functions and overall quality of life in these patients. For us, it was clear that these individuals need a team approach from multiple disciplines to optimize recovery.”
Shortly after the pandemic reached Philadelphia, Abramoff and Franklin Caldera, DO, an associate professor of Clinical Physical Medicine and Rehabilitation, began seeing patients who had recovered from COVID-19 in their acute inpatient rehabilitation unit. The patients spoke about the lingering health issues they were experiencing. Some had suffered significant deficits in physical and cognitive functioning, including residual lung damage, impaired kidney function, muscle weakness and memory loss. Recognizing the demand for a more coordinated, comprehensive approach for these patients, Abramoff and Caldera collaborated with colleagues across Penn — including faculty in Pulmonary, Allergy and Critical Care — to spearhead the launch of Penn’s Post-COVID Recovery Clinic.
Through the clinic, which officially launched in mid-June, the rehab team works closely with physical, occupational, and speech therapists, as well as social workers and a wide range of other specialists to arrange services and consults, as needed.
“During their hospitalization, these patients were seen by many subspecialists across a number of different medical disciplines,” Abramoff said. “We felt these patients needed a home within health system, post-discharge, where their issues can be identified and managed effectively.”
The initial appointment is a one-hour telehealth visit during which providers screen for impairments to determine a patient’s health and rehabilitation needs. Once the team identifies the clinical needs, they provide rehab management or direct patients to appropriate follow-up medical care based on their specific symptoms. A group of pulmonologists, led by Robert M. Kotloff, MD, director of the Harron Lung Center, helps care for the post-COVID patients with ongoing respiratory and pulmonary health concerns. The team also works with cardiologists, nephrologists, neurologists, as well as neuropsychologists and behavior health specialists.
“From a pulmonary perspective, we are seeing patients with persistent shortness of breath or cough, as well as patients whose course was complicated by development of blood clots in the lungs,” Kotloff said. “Fortunately, in almost all cases, the respiratory complications are completely reversible.”
So far, the team has seen a wide variety of patients, ranging from those with relatively minor symptoms to those with extremely complex symptoms following COVID-19 infections. The team recommends all patients with medical concerns following COVID-19 be screened for some of the common issues that they are seeing among these patients, including: pulmonary dysfunction, depression and anxiety, pain, functional limitations, and cognitive and physical impairments. Ultimately, the goal is to coordinate follow-up inpatient visits at the rehab clinic — available at the Penn Institute for Rehabilitation Medicine, Cherry Hill and Radnor locations — with same day appointments for therapy.
“As we build this clinic and learn more about this novel patient population, we expect to continue to add coordinated same day services through our clinic,” Abramoff said. “Before we do, we have to learn more about what these patients are routinely needing.”