Preparing For Long-term Health Effects Of COVID-19

IRA FLATOW: This is Science Friday. I’m Ira Flatow. Since the beginning of the pandemic hospitals have been treating and triaging an influx of COVID-19 patients, with hundreds of thousands of seriously ill patients being hospitalized– some for up to months at a time. But now some of those patients are returning home.

And hospitals are opening post-COVID clinics to help with their transition. What have health-care professionals learned about the symptoms and long-lasting health effects? What might the road to recovery look like for individual patients? That’s what we’re going to be talking about with my guests, who are here to fill us in.

Dr. Mahfuzur Rahman is Vice-Chair of Medicine and leader of the post-discharge COVID-19 clinic at SUNY Downstate in Brooklyn, New York. And Dr. Margaret Wheeler is a physician at the Richard Fine’s People’s Clinic at San Francisco General Hospital, Professor of Medicine at UC San Francisco. Welcome to Science Friday, to both of you.

MARGARET WHEELER: Thank you.

MAHFUZUR RAHMAN: Thank you for having me.

IRA FLATOW: Dr. Rahman, a month into the pandemic, SUNY Downstate became a COVID-only hospital. Is your hospital in a hotspot area?

MAHFUZUR RAHMAN: Yes. Even our zip code has, in New York state, one of the highest mortality rates– one of the highest incidence of COVID-19. So we would be, by many definitions, one of the major hotspots for this pandemic in the last few months.

IRA FLATOW: And Dr. Wheeler, you work in an outpatient setting. What is the treatment and care that you give to COVID patients coming in?

MARGARET WHEELER: In our outpatient clinic, during the height of our surge and still even yet, we were the non-COVID hotspot place. So anybody who was thought to have COVID symptoms went elsewhere.

But of course, we saw many people coming in with COVID who had unsuspected COVID. And then we have a large primary-care panel that we follow. And so all of those folks– anybody who got COVID, we were calling them, helping them isolate, and then caring for them– hospitalizing them and then caring for them afterwards.

But my clinic is at San Francisco General Hospital. We’re the safety-net hospital for San Francisco. And although San Francisco has not been hit at all like in New York– I think largely having to do with our public health close down very, very early– we do care for the population in San Francisco who have been the hardest hit.

So for us, of course it’s the poor. But it’s the Latinos that have been hit the hardest– are the highest rates of hospitalization. And those are the patients that we care for in my clinic and at San Francisco General Hospital.

IRA FLATOW: So what happens after your patients are released? Who takes care of them?

MARGARET WHEELER: We care for people as they come out of the hospital. Some of them come out requiring oxygen still– many people with continued symptoms. As you probably know, COVID-19 causes a very inflammatory state. So many organs can be affected.

And so people come out needing to be on blood thinners, because they’ve had blood clots go to their lungs, or they’ve had strokes. People come out having worsened heart failure, worsened kidney failure. COVID-19 can cause such devastating effects to many organs.

And of course, people who have gotten COVID-19 and gotten sick enough to be hospitalized, many of them had diabetes and heart failure and lung disease beforehand. And now things have only worsened.

And then finally, I would say, even those who are not hospitalized, many people have long-lasting effects. And I think that’s one of the interesting things about this disease is that it’s such a huge spectrum.

And some of the long-lasting effects– people talk about huge fatigue, the aches, the weird, lancinating pain, the sore throats– just a myriad of symptoms that continue to plague people– sometimes we’ve been seeing months afterward. So I don’t know how long some of those symptoms are going to last.

IRA FLATOW: Dr. Rahman, do you see those same sort of long-term effects on the patients?

MAHFUZUR RAHMAN: Oh yes, absolutely. As Dr. Wheeler said, this disease is kind of teaching us new things every day. I was reading today, we have a handle on the potential complications from the virus– the side effects that our patients should be watching out for. Then a few days later, a few weeks later, we realize that this virus can cause other things. As Dr. Wheeler also said, every organ in the body– brain, the lungs, the heart, the kidneys, the gastrointestinal tract, the skin, the nerves– nothing is spared, it seems at this point.

And the impact isn’t necessarily just the virus that’s doing it. It’s also the body’s own immune system, which is actually a good thing. And we need to have our immune system ramp-up once the body detects an infection. But in this particular situation, I think we are seeing that the immune system itself, when it’s not controlled– sometimes people call it cytokine storm– that itself causes devastating conditions and situations and illnesses in our patients.

And we are seeing our patients who we thought were better, who are getting well. Then, subsequently, we are finding out that, you know what, the disease hasn’t completely gone away. Some people have come back in weeks, months later.

And we’re finding out that the lungs are not normal yet. They still require that oxygen supplementation. Some of them might have gotten worse. So those are all the medical things that we are seeing.

But mental health is another thing that we have been really worried about our patients on the get-go. And we are finding out that, especially in our area in Brooklyn, New York, in a socio-economically underserved area, is a lot of our patients may have issues pre-COVID that probably was subtle enough that they were functioning.

But once you are in hospital for weeks, months in an isolated setting, you are not normal anymore. The devoid of human contact– not being able to see the loved ones. The doctors, the nurses, we all have our masks, our gowns on. Now that we let them go and they go back to the society where other people in the society– family members, friends– are not interacting with the same patients even the same way they did in the past.

So these patients came to the hospital. They got treated. And you go home and life is usual. That’s not happening.

So some of those people who probably have sub-clinical clinical depression, or PTSD, now those things are manifesting. And we have social workers, trained mental-health workers. Maybe initially our main concern was treating the lungs– those kidneys that failed– providing dialysis for them. Yes, we did that. But a big portion of the peoples’ mental health were kind of not our priority. But we are finding out that those things are long-lasting.

MARGARET WHEELER: People are suffering gravely, and it’s not just physical illness. But the patients that I have seen are also very worried about contributing to infection in their communities and their families. They may be even self-isolating, even as they’re suffering from isolation.

And in our community the majority of people, as I said before who are getting this illness and are getting gravely ill, are Latinos and Latino men. And it’s not just the isolation, but the loss of some of their role as provider for their families.

I had one patient that I saw who had been in the hospital for months. He had suffered many, many different complications– blood clots and that kind of stuff– and had had to have a tracheostomy– which is a little tube that’s put in your trachea, in your throat to help you breathe.

And he said three things. The first thing he said was he thanked us for caring for him. The second thing he said was that what had gotten him through was his faith, and the love of his son. And the third thing he asked was, when can I go back to work?

Seeing him there and knowing that he was not going to go back to work for months, that was a huge blow to him. And so I think you being able to carry-out the roles that give meaning to your life is huge, and continues– and will only worsen the issues of food insecurity and financial stress and those kinds of things that we’re seeing in the communities that we care for.

IRA FLATOW: Dr. Rahman, why did you establish the clinic? What can you do at the clinic that, let’s say, a regular hospital cannot do?

MAHFUZUR RAHMAN: One of the reasons we wanted to open the clinic is during this height of the pandemic in New York, many of the doctors clinics in the community were closed. Doctors were not seeing their patients. They were trying to reach patients over phone and do telemedicine visits and so forth.

We understood that many of the doctors had not seen a truly sick COVID patient and cared for them. Those doctors also may not have the facilities. Every type of providers that you can think, we have in our hospital. And since we took care of those patients, we knew what the patients went through, what the complications were– the treatment plan. In our community it’s a place where many of our patients don’t have private doctors. They don’t have regular primary-care provider– PCPs– that they go to routinely.

Now, they were infected with a virus that a lot of people are afraid of catching. So a lot of the doctors clinics were closed. Now where would they go? And we treated our patients. So we wanted to make sure that our patients had an outlet.

We need to be able to give them information that’s helpful, that’s supportive, and at the same time provide counseling to the family members as well. If the family has a question, they can call us and say, my father just came home. How should we interact with him? Should we use the same bathroom? Should we wear PPEs?

We need to learn from our patients, so that we can educate others. We can do better for the next patient that comes along. When they ask, what happens next, what do we tell them? We can tell them, based on our experience, based on information from other patients– tell them, this is what we’re seeing. This is what we’re learning. And we will have more information later, and so forth.

So having that clinic kind of provided us with the outlet of helping our patients [INAUDIBLE] at the same time, helping us understand the disease itself, so that we can take future actions.

IRA FLATOW: Dr. Wheeler, it sounds to me like the patients who get discharged after months, they’re going to have medical bills. They’re going to have counseling needs. They’re going to have social-service needs. It all boils down to the way I look at the large envelope of this is money.

MARGARET WHEELER: These are big questions.

IRA FLATOW: I ask the question because, OK, we have COVID- 19 now. But we have suddenly woken-up to the idea, hey, there are a lot of bad things going on in diseases around the world. This is not going to be the last disease or possible disease that comes and hit us. Should we set something up that’s a little more permanent in place?

MARGARET WHEELER: Absolutely. And we need to expand the public-health abilities in this country, which has long been underfunded. And really, actually, throughout medical history, it’s not so much the individual care that has caused the greatest gains, but public-health measures like clean water– things that we have– isolating and contact tracing and that kind of thing.

So we do need to beef those up. It is going to cost money. We’ll just need to have the political will to pay for some of those things, which will in the long run, I think, really put us on more stable economic and medical ground.

IRA FLATOW: I’m Ira Flatow. And this is Science Friday, from WNYC Studios. I have just one more question, because lots of people have asked this. Lots of people who were suspected of having COVID-19 were told to stay home. And they became known as these long-haulers. They have lingering symptoms, but they may not have received a positive test– like Charlie, who is 30 years old and from San Francisco, and left us this comment on our VoxPop app.

[AUDIO PLAYBACK]

– My name is Charlie– 30 years old, from San Francisco. I’ve been dealing with post-COVID symptoms for four months. I’ve been dealing with shortness of breath, heart-rate issues, chest pain, muscle twitching, et cetera. I’ve had all these tests done. My doctors don’t know what’s wrong. I don’t know what’s wrong. This has been so debilitating. And I still have no clear outlook.

[END PLAYBACK]

IRA FLATOW: And they are sort of in limbo. I mean, how do you provide care for them, Dr. Rahman?

MAHFUZUR RAHMAN: That is actually a significant problem. In my area, for example, initially patients who were not in need of being hospitalized– meaning they are doing well enough that they could go back home– we didn’t test them, because we didn’t have enough test kits.

They’re worried. What’s going to happen to me? Nobody tells me what’s wrong with me. And I’m going to doctors, and I’m not getting the care.

So first, reassuring them and saying, you know what, we believe you. You are COVID-like. You have a COVID-like illness. And let’s start there, and then look at the symptoms– maybe collectively, if it’s possible, or individually– and try to provide a treatment plan. And the treatment plan can be with medicine. It can be with counseling. It can be with reassurance– with blood tests and so forth.

And as providers we learn more about COVID-19, we’re going to keep our patients in the loop. So that when the patients here that they’re not alone in it, they’re not abandoned, that they are with us, and we are with them. I think that provides reassurance. And I think that’s a start.

MARGARET WHEELER: The symptoms that people have are protean. We don’t always understand. Oh, is that hearing loss, is that COVID, or is that just hearing loss that you’re having– or whatever the symptom happens to be. It can be tricky.

And so I really feel for Charlie. Because patients don’t know. Oh, what terrible thing do I have? Is this COVID, or is it something else? And lots of times, we doctors don’t know either. And so we’re doing the kinds of complicated workup, because we can’t just assume, oh, this is all post-COVID.

And as we learn more, we may find out that, I don’t know, COVID causes you not to absorb some vitamin, or something else like that. And then we’ll need to be treating those things. Because we’re really in evolution of understanding this disease and its spectrum, and the kinds of things that we might be able to do to shorten these lingering after-effects and understand them better.

IRA FLATOW: So everyone who leaves the hospital after getting COVID-19, and they’re able to walk away, spends the rest of their life as sort of a test case. Because we really don’t know what the long-term effects are.

MARGARET WHEELER: We don’t know.

MAHFUZUR RAHMAN: To a degree, yes. Yeah, we don’t. And so the more more people hear that, there is more of an anxiety-provoking this situation becomes. So some people died of COVID. Some people, like Dr. Wheeler said, had nothing to do with COVID. That chest pain probably is a heart attack, because underlying diseases to begin with. Right now, everything is COVID.

So reassurance from us– letting patients know that we are in it together. We will do the very best we can. We are all learning from this. And we will be learning, I think, for quite some time.

IRA FLATOW: Well, we have run out of time. I’d like to thank both of you for a very interesting discussion. Dr. Mahfuzur Rahman, Vice-Chair of Medicine and leader of the post-discharge COVID-19 clinic. That’s at SUNY Downstate in Brooklyn, New York. Dr. Margaret Wheeler, a physician at the Richard Fine’s People’s Clinic at San Francisco General Hospital, and a professor of medicine at the University of California in San Francisco. Thank you both for taking time to be with us today.

MARGARET WHEELER: Thank you.

MAHFUZUR RAHMAN: Thank you very much.

IRA FLATOW: In our Science Friday VoxPop app, we want to continue the conversation about the long-term effects of COVID-19 and long-haulers. So we’re asking, have you been sick with the virus for months? Tell us about your experience and your questions that still remain unanswered. That’s on the Science Friday VoxPop app, wherever you get your apps.

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