A Clinic Blueprint for Post-Coronavirus Disease 2019 RECOVERY

Abstract

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic poses extraordinary challenges. The tremendous number of coronavirus disease 2019 (COVID-19) cases in the United States has resulted in a large population of survivors with prolonged post-infectious symptoms. The creation of multidisciplinary post-COVID-19 clinics to address both persistent symptoms and potential long-term complications requires an understanding of the acute disease and the emerging data regarding COVID-19 outcomes. Experience with severe acute respiratory syndrome and Middle East respiratory syndrome, post-acute respiratory distress syndrome complications, and post-intensive care syndrome also informs anticipated sequelae and clinical program design. Post-COVID-19 clinical programs should be prepared to care for individuals previously hospitalized with COVID-19 (including those who required critical care support), non-hospitalized individuals with persistent respiratory symptoms following COVID-19 infection, and individuals with pre-existing lung disease complicated by COVID-19. Effective multidisciplinary collaboration models leverage lessons learned during the early phases of the pandemic to overcome the unique logistical challenges posed by pandemic circumstances. Collaboration between clinicians and researchers across disciplines will provide insight into survivorship that may shape the treatment of both acute disease and chronic complications. In this review, we discuss the aims, general principles, elements of design, and challenges of a successful multidisciplinary model to address the needs of COVID-19 survivors.

COVID-19 Among US Dialysis Patients: Risk Factors and Outcomes From a National Dialysis Provider

“…In early studies, COVID-19 survivors have presented a spectrum of persistent pulmonary dysfunction, and they are expected to have a high prevalence of post-intensive care syndrome, which encompasses reduced physical, cognitive, and mental health after critical illness. 27 Therefore maintenance dialysis patients who survive COVID-19 may benefit from interdisciplinary post-hospitalization care. Lastly, this study and others demonstrate that mortality exceeds 20% among maintenance dialysis patients.…”

Nefer, Sinuhe and clinical research assessing post COVID-19 condition

“…Many unknowns remain on what proportion of COVID-19 survivors will require multidisciplinary post-COVID-19 clinics to address both persistent symptoms and potential long-term respiratory and other complications ( i.e. : acute kidney injury, myocarditis, psychiatric outcomes, …) [ 21 ]. And on what standard treatments and management strategies should be applied [ 22 ], most likely to be periodically revisited whenever new, significant evidence be available.…”

“…: acute kidney injury, myocarditis, psychiatric outcomes, …). 21 And on what standard treatments and management strategies should be applied, 22 most likely to be periodically revisited whenever new, significant evidence be available. It will be another toll of this pandemic, to add up to the global risks we face in these most uncertain times.…”

Outcomes of Recovered COVID-19 Patients: 6 Months of Sequential Observations at a Designated Tertiary Center

“…Remdesivir and dexamethasone has been proved effective in hospitalized patients with COVID-19 in recent clinical trials [7,8]. As the number of recovered patients accumulate, there is a growing need to understand evolving aspects of clinical, radiological, and functional outcomes [10][11][12] Post-illness outcome studies pertaining to other Coronavirus infections, Severe Acute Respiratory Syndrome (SARS) and Middle East respiratory syndrome (MERS), have demonstrated some patients to experience long-term respiratory impairment in the recovery phase [13][14][15]. Recent studies showed some patients with COVID-19 pneumonia to manifest persistent symptoms and residual abnormalities on chest CT scans at 3-4 months after discharge [16][17][18].…”