AdventHealth is investing in developing new ways to care for those affected by long COVID-19.
At AdventHealth Orlando, the health care organization opened a comprehensive Post-COVID Clinic (PCC) designed for patients with a confirmed diagnosis of COVID-19 and coronavirus symptoms lasting 12 weeks or more.
On Florida’s west coast, AdventHealth Tampa opened a long COVID clinic focusing on pulmonary issues.
Led by AdventHealth Medical Group internal medicine physician Dwayne Gordon, M.D., the PCC at AdventHealth Orlando is the first-of-its-kind within the hospital system and is composed of a multidisciplinary team, including primary care, behavioral health and physical therapy. The clinic can also refer long COVID patients to cardiologists, pulmonologists and clinicians specializing in substance abuse.
“This is a new frontier for medicine; we don’t have as much information about long COVID, therefore there’s very little guidance to provide direction,” Gordon said. “This is a fresh approach to caring for patients and learning the best way to take care of the unique needs of long COVID patients.”
Because long COVID can be difficult to diagnose, AdventHealth’s PCC established a thorough screening processes for candidates, including an initial one-and-a-half-hour evaluation with Gordon and the PCC multi-disciplinary clinical team. For each candidate, the process evaluates:
- Medical history with co-morbidities
- COVID history and experience, including date of positive test, symptoms (both previous and existing) and vaccination history
- Complete physical therapy screening
- GAD-7 screening for anxiety
- PHQ9 screening for depression
During the initial consultation, clinicians from primary care, behavioral health and physical therapy disciplines collaborate to determine whether a COVID-19 infection truly caused a new condition or exacerbated a pre-existing condition.
After evaluation, patients may be prescribed an initial 60-day plan, including referrals to subspecialities for additional treatments, with a follow-up scheduled to re-evaluate progress.
“Since opening our doors on March 30, we are finding our initial patients are struggling with multiple issues, including insomnia, which affects other functions, including brain fog, anxiety and depression,” Gordon said. He added that he suspects a direct correlation and is interested to review the long-term results after treatment.
Using the SLUMS Exam, a screening tool for dementia, several of AdventHealth’s initial PCC patients, whose ages range from 30 to 60 years old, have scored in the severe dementia range.
"These are people who don't have dementia, traditionally," Gordon said.
This echoes a recent study published in The Lancet. Researchers not affiliated with AdventHealth found COVID patients were 80% more likely to develop neurocognitive problems like brain fog and confusion, 41% more likely to be diagnosed with sleep disorders and 39% more likely to develop depression.
In addition, the AdventHealth team is finding generalized weakness and deconditioning with long COVID patients, making the physical therapy support essential to returning patients to their baseline so they can resume work and daily activities, such as cooking, cleaning and bathing.
“We developed a creative way to provide the physical therapy component of the clinic to all populations,” Gordon said. “Some patients receive traditional therapy in the office setting with a therapist and others use an app at home to access a specialized exercise program with photos, videos and written instructions to assist in their recovery.”
To help the global medical community learn more about how this virus interacts with the body even after immunological clearance, the PCC partnered with the AdventHealth Transitional Research Institute to gather insights to support future research studies.
One AdventHealth Transitional Research Institute study already underway examines how long COVID affects those with diabetes. Using advanced MRI imaging, researchers will observe changes to organs, such as the heart, lungs, liver, kidney, pancreas and spleen following a confirmed diagnosis of COVID-19 in people with and without diabetes to determine how COVID-19 and any related inflammation may impact organ function in diabetics and the overall damage the body.
“Throughout the pandemic, we’ve learned that COVID-19 can increase a person’s risk of diabetes, even months after infection, but we don’t really understand why,” Richard E. Pratley, M.D., medical director of the AdventHealth Diabetes Institute and senior scientist in diabetes research at the AdventHealth Translational Research Institute said.
According to research published in The Lancet Diabetes & Endocrinology, patients who have recovered from COVID-19 have a greater risk of developing diabetes up to a year later, even after a mild SARS-CoV-2 infection, compared with those who never had the disease.
“There’s been a reported increase in new diagnoses of diabetes following a COVID-19 hospital admission, and this is true at our AdventHealth facilities in Central Florida too,” Pratley said. “But we don’t yet know if this is truly new diabetes cases or previously undiagnosed cases that were exacerbated by the virus or if a patient’s elevated blood sugars are due to some other unexpected cause, such as COVID treatments.”
“During the past two years, we as a clinical community have learned a lot, improved and developed best practices in caring for those with COVID, but we recognize there is still much to learn,” Gordon said. “Ultimately, the PCC has broad implications for improving care across a wide spectrum of disciplines and everything we learn will play a critical role in establishing best practices for long term care.”
The PCC currently has limited capacity, but a phased expansion is planned in the upcoming months.
If you are a physician and have patients that may be a candidate for the PCC, email [email protected] the patient’s name and contact information, as well as your name and contact information, and the PCC will follow-up to determine if the patient is qualified.