Every patient has something to teach
hospitalized had a head start in recovering from COVID because they had physical and occupational therapy in the hospital and may have spent time in a short-term rehabilitation center before going home, Possick said. Those who had milder cases “have been at home, in some cases trying to return to work, trying to continue to take care of kids, and not addressing this aspect of their own recovery directly,” she said. “They’re frankly exhausted and very short of breath.”
They also have higher expectations, thinking they can go back to living at the pace they did before COVID, Possick said. “And one of the messages that we’re trying to bring to patients is that what they’re experiencing is normal and, at least based on our experience, that they need to be patient with their own healing. But that just because you didn’t require hospitalization doesn’t mean that you don’t require time to recover.”
Possick said fatigue and shortness of breath are “subtle and insidious” symptoms that patients, especially young people who may have never seen a doctor for anything serious, don’t expect to deal with. While the age of patients ranges from young adults to the elderly, Possick said many older patients have not yet been seen at the clinic.
“Frankly, some of the … oldest and most frail patients have not made it to us yet because they’re still at nursing facilities and have not been well enough to come or allowed because there’s very restrictive policies right now on going to physician visits,” she said.
For some patients, anxiety about the pandemic is masked by physical symptoms. “So you’ll have people say things like, ‘I used to like going out with my family and friends,’” Lutchmansingh said. “‘Now when I go out, I feel my heart race, or I feel more short of breath when I get to the grocery,’ but they’re not doing anything differently than before.”
Sleep may be disrupted by waking up short of breath, or because of heart palpitations or nightmares, Possick said. It may be difficult to tell whether the symptoms are from COVID or from being isolated during the pandemic.
“It’s difficult to parse it out from the isolation because people aren’t able to connect with their normal support systems that get them through difficult things and illnesses,” Possick said. “They’re isolated from family, isolated from friends, community organizations, like church. And so it’s hard when they report that they’re feeling more anxious, more alone, even depressed, whether that is a manifestation of the circumstance or the illness, probably both.”
The doctors said they hope people will call the Winchester Clinic as soon as they have symptoms, when they can be treated with inhalers or perhaps steroids. If they come to the clinic in a year, they may have irreversible lung damage, with little that can be done.
Not all complications will appear right away, particularly blood clots that can cause serious problems, both in the long and short terms, Possick said. “A lot of what we’re doing is directing early evaluation down different pathways to try and detect problems when they’re intervenable,” she said. “But at the same time, trying to guide people down a path of pulmonary rehabilitation so that they are, from a physical standpoint, recovering optimally and managing their symptoms well.”
Part of the task is to keep people active so symptoms don’t get worse. “You don’t want to be breathless and you get breathless when you walk, so you don’t walk,” Possick said. “It’s logical, but it’s self-defeating because then it requires even less activity to produce the same symptoms. And that’s a cycle we’re trying to break.”
But as their lung function improves, patients feel relief that they are getting better, she said. “It alleviates a lot of the specter of worry about, ‘are my lungs damaged now for the rest of my life?’ Because we hope that for the majority of cases, that answer is no, and that they return to normal.”
The pandemic has given Winchester the opportunity for patients to receive care for a diverse set of diseases. “The spirit of collaboration in a time of crisis has been crucial to this,” Possick said. “Both that our colleagues have been generous and accessible during a time where everybody is stretched thin, that people really do care about doing all they can for these survivors, that patients have been incredibly generous in bringing us inside their experience and being really candid about what they’ve gone through. … It really is learning in real time.
“We hope that the world won’t need a post-COVID clinic forever, of course, but anything we learn here will be applicable in other situations.”
The clinic is located at 789 Howard Ave. For more information, call 203-7854198.