Mount Sinai Health System in May became one of the first providers in the nation to open a COVID-19 recovery clinic, offering care for so-called long-haulers. Dr. Kenneth Davis, president and CEO of the New York-based health system, talked with Modern Healthcare Managing Editor Matthew Weinstock about some of the key lessons learned from caring for these patients.
MH: What was the thought process when you looked to open the COVID recovery clinic last May?
Davis: It was early for the country, but it wasn’t early for New York City. Our peak had happened actually weeks earlier. At the peak of it for Mount Sinai Health System, which has eight hospitals, we had 2,200 patients with COVID in the hospitals. We had opened up a lot of beds, enhanced our ICU capacity, but we were really swimming in COVID patients.
So by the time May rolled around, we already had a number of people who were “recovered,” but they still had a lot of symptoms. We realized those symptoms were debilitating in some instances, certainly compromising their life, and that we needed to address them. We needed to address them with front-line internists and then with specialists.
We have seen 8,000 COVID patients in our hospitals, and we’ve had 20,000 COVID outpatients. So between those nearly 30,000, we have a substantial number of people who have chronic symptoms.
MH: Are there specific things you saw early in the stages of COVID that were lingering in these patients?
Davis: You’d see a lot of them complain of fatigue, a lot would still have shortness of breath. But of course, it wasn’t just a lung problem. The more we learned about it, the more we realized it was also a kidney problem. It was also a brain problem. It was a cardiac problem. So depending on the symptoms people had, there were any number of organ systems that could be affected that we needed to address.
MH: How do you staff something like this since you are spread thin during the pandemic?
Davis: We’re integrating it into our other clinics. And we have a lot of our primary-care people and our internists who wanted to be there. We’re making them do lots of things, but this hasn’t been something that has been hard to staff. There’s just a lot of people who really want to help.
MH: Is there cross-training that you need to do?
Davis: It’s mostly about making the right referrals to the specialists who are necessary because the symptoms that people have aren’t unique. If they’re congestive heart failure problems and other cardiac problems, we know what to do with them. If it’s depression, we know how to deal with that. If you’re developing end-stage renal disease, it’s just like any end-stage renal disease. We know how to deal with these bad consequences; we just don’t understand exactly what their prognosis is and why some people get them and other people don’t get them, and how long they’re going to last.
MH: If you could go back to May, what kind of changes would you make when standing up this recovery center
Davis: We need to be in contact with patients. We really would like to have said ahead of time, “This could happen to you, and when it does, here’s a phone number to call,” or, “Here’s an email,” or, “Here’s a text because we’re there for you.” That would have been the biggest thing we would like to do. Because a lot of people just don’t know what to expect. To be able to communicate what you’re experiencing is not unique … if you’re depressed, it’s not because there’s something wrong with you, it’s what happened with COVID to your brain.
MH: Was depression a large segment of what you were seeing in patients?
Davis: We’re seeing the whole spectrum. It’s not surprising when people still complain that they have some shortness of breath and fatigue. That could be lung, that could be cardiac. That doesn’t surprise any of us. And with that, you may feel depressed anyway. So whether it’s COVID in your brain that has triggered some biological mechanism or the stress of now being chronically fatigued or finding out that your kidneys don’t function the way they used to, it can be depressing.
MH: Now that vaccines are rolling out, how do you see that affecting staffing issues?
Davis: The vaccine is a light at the end of the tunnel, and clearly there isn’t enough vaccine to go around. Everybody wants it. I am inundated with calls and emails and texts from various people in various capacities asking, begging that they can get to the front of the line. But we have strict prioritization.
We got, for our eight hospitals, about 7,000 doses to start. We have about 14,000 workers right now who are on the front lines.
And then we have to make decisions about at-risk patients. There are people who already have some of the underlying conditions that would be made a whole lot worse by the chronic COVID consequences. So what do you do? How quickly should you vaccinate a 55-year-old who has 20% normal renal capacity so that they don’t need dialysis down the road, or people who are already in some level of congestive failure, but are able to function with medications, but if they got COVID, they’re disabled?
We’re going to need more flexibility around how we use those vaccines. Where do you put a person who is at tremendous risk versus a person who appropriately is working in a grocery store and is also seen as an essential worker? These are very difficult decisions that we’re having to make.
MH: It sounds like we need a lot more research, especially for patients with underlying chronic conditions.
Davis: We started a longitudinal study where we’ve already entered 500 long-haulers who we hope to study regularly and potentially for years to figure out what was their prognosis—what did work, what didn’t work—so we can learn from this.
MH: What role will primary-care doctors play in being able to help manage some of these long-haul conditions?
Davis: We ultimately have to hand off the long-haulers to their internists, their traditional doctors, and work in concert with them.
MH: And do you think these types of symptoms will last a year or two years?
Davis: We don’t know. We’ve had some who’ve gone only a month, some six months, and some still from when they contracted it in March.