Britney Broyhill, DNP, Atrium Health’s senior director of advanced practice, had professional interest in treating COVID-19 “long haulers” before the matter became more personal: Her sister-in-law contracted the virus last November and endured symptoms that impacted her through March of this year.
“She ended up in the emergency department because she was so dizzy, she couldn’t stand up,” says Broyhill. “The vertigo would hit out of the blue. Then she couldn’t drive for three months and she has three small children.”
Watching as her sister-in-law navigated an issue that healthcare systems across the country were just beginning to understand, and that often leaves patients feeling like there is nothing that can be done for them, Broyhill was motivated to work with Atrium Health leadership and help develop a program for patients with Post-Acute COVID-19 syndrome (PASC).
PASC is defined as persistent symptoms that last more than four weeks after the onset of COVID-19, or delayed, long-term complications that occur more than four weeks later after COVID-19. “In my sister-in-law’s case, it was getting vertigo several months after active infection,” says Broyhill.
Broyhill partnered with Scott Lindblom, MD, senior medical director of adult medical specialties at Atrium Health and together – and with indispensable assistance from medical professionals throughout the system – they helped Atrium Health develop an innovative program, called Post COVID Recovery Care, to treat and streamline care for patients with long haul COVID symptoms.
“We know there’s a large portion of patients out there who still have these symptoms,” Dr. Lindblom says. “The national studies are pretty clear about that. We also know there are limited things we can do for a number of symptoms. But a good medical evaluation is required to make sure there’s no underlying reasons contributing to the persistent symptoms.”
“We give patients the opportunity to understand that what they have will get better,” he says. “When they have true specialty needs, or we think there are issues that require further evaluation, we have specialists available to address it.”
A Vocation-Centered Process
The new program makes ample use of guidelines, compiled by Atrium Health infectious disease and other medical specialists, for care of patients with acute COVID-19.
“When we looked at people who had COVID-19 infection, probably 10 to 30 percent of patients have persistent symptoms at some point after eight to 12 weeks,” says Daniel Howard, MD, specialty medical director of respiratory health at Atrium Health. “The most common symptoms are malaise (fatigue), shortness of breath, and mental fatigue or brain fog.
“There are others sometimes as well,” he says. “We wanted to address those persistent symptoms and concerns the best way possible.”
Atrium Health strategically chose not to develop a single clinic under a brick-and-mortar roof. Instead, the program will rest upon specifically selected primary care offices throughout the system’s geographic footprint in the Charlotte region. Patients will have access to offices close to home, where nurse practitioners and physician assistants serve as intake specialists.
“We’ve identified different areas where we can offer longer appointment times, which we think is going to be really beneficial for these patients, and different than going through a regular primary care office,” Broyhill says. “To sit down, do a physical exam, and spend extra time to listen to the needs of the patient and talk through their long-haul symptoms. We’ll do a complete workup based on our specialist guidelines, and appropriate testing prior to sending them to a specialist.
“Hopefully, that will save time,” she says. “Once patients get to the specialist, they’ve had everything that they need for the specialist to see them and offer support and guidance.”
Dr Lindblom says that Atrium Health is perfectly-suited to offer such a program. Being such a vast organization with a broad range of medical professionals and experiences, the system can bring together specialists from every field. They review medical literature, discuss what they’re seeing in cases, and weigh in on best practices.
“We’re actually learning as we go,” Dr. Lindblom says. “And we’re probably learning faster than others because of our scope and scale.”
Reasons for Long-Haul Symptoms Vary
The new program focuses on providing appropriate care, which can be confounding when prolonged symptoms are evident. Most viral infections are over within two to four weeks, but when COVID-19 symptoms linger much longer, patients seek assurance that nothing serious is going on.
“Patients sometimes have persistent symptoms, but evaluations don’t find anything that’s measurably abnormal,” Dr. Howard says. “Other times, patients don’t necessarily have a problem with COVID-19, but there are some underlying medical problems that were either exacerbated or unmasked by that illness.”
For patients with specific, identified, and measurable problems, they can receive the necessary treatment from specialists. For patients who have ongoing symptoms without measurable or identifiable physical symptoms, there will be resources and services to help them recover and feel better faster. “That may prevent patients from taking or receiving unnecessary therapies sometimes,” Dr. Howard says. “They seem harmless and well-intended, but sometimes they have adverse effects.”
Broyhill says the system’s behavioral health team is a big component of the program. COVID-19 has created underlying anxiety – including stress about work conditions, vaccination rates, childhood education, and more. The resulting pandemic fatigue also covers concerns about long-haul COVID-19 sufferers, helping fuel mental and behavioral health issues across the country.
“I don’t want to imply a lot of these symptoms are in patients’ heads, because they’re very real and there are biological reasons,” Broyhill says. “But we have to make sure we also treat the whole patient – not just their symptoms – and support them from a behavioral health standpoint.”
Broyhill and Dr. Lindblom stress that post-COVID viral illness has commonalities with other viral illnesses that can leave lingering symptoms. But the nature of COVID-19 often leads patients, consumers, and clinicians to worry more than they do about the flu or similar viral illnesses.
However, primary care providers have plenty of experience treating patients with lingering symptoms of viral illness, and that same experience will power Atrium Health’s approach to PASC with the Post COVID Recovery Care program.
“The biggest thing is making the community aware that we have a team here to help support them thoroughly,” Dr. Lindblom says. “Secondly, we want to make everyone aware that even though COVID-19 is unique and has some unique symptoms, it’s not all that different than what a good primary care doctor or good pulmonary doctor deals with day in and day out to some degree. It’s just initiated by something different.”
“We have the capability to manage, evaluate and treat all of this, with all of our different care teams working together.”
To learn more about the program or to enroll, visit AtriumHealth.org/COVIDRecovery.
