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A Long Road to Care: Nurses at Post-COVID Clinics Help Patients Recover from Lingering Health Problems
BY LINDA CHILDERS
On any given day, Maryjane Keller, RN, ANP, a critical care nurse practitioner at UTHealth’s COVID-19 Center of Excellence in Houston, Texas, sees how the coronavirus continues to take a toll on patients.
Despite being weeks or months out from their initial COVID-19 infection, some patients, referred to as “long-haulers,” continue to struggle with symptoms including respiratory issues, cardiovascular problems, extreme fatigue, anxiety, depression, and loss of taste and smell. A recent study, conducted at the University of Washington, found that between 10-30% of COVID patients become long-haulers.
Last September, UTHealth opened their post-COVID clinic to screen, assess, and treat patients with lingering coronavirus symptoms. They join a growing number of clinics across the country who are providing specialty care to patients. While much is still unknown about the best methods to treat post-COVID patients, the CDC recently released guidelines for treating post-COVID patients.
Since COVID-19 is a new disease, nurses and other health professionals are still gaining a better understanding of the long-term effects of the virus and the best way to treat lingering symptoms. In February, the National Institutes of Health (NIH) launched the first phase of a research initiative to explore why some COVID-19 patients become long-haulers.
The UTHealth clinic takes a multidisciplinary approach to caring for patients with postacute COVID-19 symptoms. After an initial assessment to ask questions about their symptoms, an individualized plan of care is developed for each patient. With a team of doctors representing specialties ranging from neurology to cardiology and pulmonary medicine, patients avoid having to seek out multiple doctors on their own and receive all of the care they need under one roof.
“The most important thing nurses can do when working with post-COVID patients is to listen, never discount their symptoms or imply they’re psychological,” Keller says. “Some of these patients have faced a stigma for contracting the coronavirus and others haven’t had their symptoms taken seriously.”
The good news, Keller says, is that once post-COVID patients begin receiving care at a specialty clinic they typically begin to see improvements in their health.
“Most of our patients are doing well and improving over time,” Keller says. “Some of the more severe cases, such as patients who suffered permanent lung damage will need lung transplants.”
In addition to the physical toll of post-COVID symptoms, Keller says many patients also experience financial hardships as the result of contracting the coronavirus.
“Approximately half of our patients aren’t able to return to work because their jobs are physically demanding,” Keller says. “The good news is we’re seeing some long-hauler patients report a significant improvement in their symptoms after receiving their second dose of the COVID vaccine.”
Navigating the Road to Recovery
As a patient navigator at Saint Barnabas Medical Center’s Post-COVID Comprehensive Assessment, Recovery and Evaluation (CARE) program in Livingston, New Jersey, Christina Davis, RN, CCRN, helps to guide long-haulers through the recovery process. After establishing they have had a documented positive COVID-19 test, Davis takes a full health history of each patient. This is followed by a call to the patient from a staff pharmacist, who goes over what medications the patient has taken, documenting what worked to improve their symptoms and what didn’t.
Davis says the most common post-COVID symptoms they treat at the clinic are shortness of breath, extreme fatigue, cognitive changes, loss of taste and smell and Tinnitus (ringing in the ears).
At the six to nine-month recovery period, Davis reports that 75% of patients report varying degrees of improvement and 6% report a complete resolution of symptoms.
“One of the most important things nurses can do when working with post-COVID patients is to really listen to patients as they describe their symptoms and the impact their condition has on their life,” Davis says. “A patient might say they have loss of taste and smell and as you talk more, you learn they’re three months pregnant and are losing weight because they physically can’t tolerate family dinners.”
In these cases, Davis says patients may benefit from sensory rehab and seeing a nutritionist to ensure they don’t continue losing weight. If they are experiencing additional symptoms, they will be referred to another member of the clinic’s multidisciplinary team such as a neurologist or behavioral health specialist.
“On average, each patient may have three to four specialty referrals,” Davis says. “Each patient receives an individualized treatment plan.”
“Ninety-one percent of the patients we see have at least two lingering symptoms 4-6 weeks after contracting COVID-19,” Davis says. “Sixty-six percent have three or more symptoms and forty-five percent have four or more symptoms.”
Prevention is Key to Curbing COVID-19
With the new Delta variant, a more contagious strain of the coronavirus, causing an uptick of cases among the unvaccinated, many nurses are working to ensure that vulnerable patient populations receive the vaccine.
Brenda Davis, RN, BSN, CIC, Senior Director of Nursing at The Catholic Care Center, a senior living facility in Wichita, Kansas, saw how the first wave of the coronavirus devastated nursing homes and minority communities. As a member of the Wichita chapter of the National Black Nurses Association, Davis and her colleagues have been traveling to historically Black churches in the city and offering COVID19 vaccination clinics on Saturdays.
“We started going into the community in March and each Saturday we vaccinate approximately 120-130 people,” Davis says. “The preachers explain to their congregation why they should get the vaccine, and they have trust in their faith leaders and the Black nurses.”
Studies have shown that Black, Latino, and Native American patients are disproportionately affected by the pandemic, are at a higher risk of contracting COVID-19, and often have worse outcomes. Currently, these minority groups are also being vaccinated at a lower rate.
Transportation issues, a lack of access, and a trust in the medical system are among the reasons many people of color are hesitant to get vaccinated. The Black and Latino churches across the country that have partnered with nurses to offer vaccine clinics have proven to be an effective model. The hope is that an increase of vaccines will result in fewer cases of COVID-19 and patients with long-hauler symptoms.
After the first wave of the pandemic, Davis says most older adults and seniors are ready to receive a vaccine.
“They want to be able to see their grandkids,” Davis says. “Surprisingly, it’s younger people who are more hesitant. We talk with them, address their questions and concerns, acknowledge their fears, and offer them facts and a different perspective.”
