Two major regional hospital systems in the mid-Hudson area, WMCHealth and Nuvance Health, have recently launched extensive post-Covid recovery programs, with over a thousand local patients between them. WMC started its formal program a year ago, Nuvance its program this past springtime.
The programs are not dissimilar. They encourage post-Covid patients to explain their symptoms and learn with professional guidance how to deal with them.
Does a thousand patients seem like a lot? In the context of the Covid pandemic, it’s really not that many.
In all, more than one Ulster County resident in every ten has contracted Covid, and of those who got it about one infected person in 60 has died from it. As of this week, there had been 285 Covid fatalities in the past year and a half in Ulster County. These are sobering statistics.
Recent figures put the grand total of Covid-19 cases in Ulster and Dutchess counties at 53,461. The number of people in the programs at the two hospital systems is about two per cent of that total – and that two per cent comes from a wider geographic area. On October 21, with the number of people newly infected diminishing, there were still 86 new Covid cases in a day in the two counties.
The October 22 state health department dashboard put the positivity rate for Covid tests in Ulster County at 1.93 percent – the first time it’s been that low in a couple of months. It’s a good sign. Many experts don’t expect a seasonal surge this winter.
In all, about one Ulster County resident in every ten has contracted Covid in the past year and a half, and of those who have about one infected person in 60 cases has died from it. These are sobering statistics.
Leading the learning
Covid-19 hasn’t been around long enough for many conclusive peer-reviewed studies of it to be completed. The learning curve has been painfully slow. We know that so far the vaccines against the disease have been almost miraculously effective, with side effects only limited to a small number of people. Though a few persons who were vaccinated have contracted Covid (the so-called “breakthrough infections”), most of the incidence has been among the unvaccinated. The two local hospital recovery programs didn’t have readily available statistics on the past vaccination status of their patients.
Dr. Gary Rogg is one of the clinical leads of WMCHealth’s post-Covid recovery program, working at the Westchester Medical Center in Valhalla. Dr. Rogg said the symptoms of the WMC program’s patients were similar to those reported at programs nationally. Extreme tiredness, brain fog, and shortness of breath, he said, are the top three symptoms reported both nationally and locally by long-Covid patients. In their work in the post-Covid recovery programs, physicians must be prepared to encounter the bewildering variety of the complete list of reported symptoms.
Dr. J. Keith Festa, associate director of medical affairs at Mid-Hudson Regional Hospital in Poughkeepsie, runs the program for the northern territory of the WMC system. The two parts have the same organizational structure and follow the same protocols, he said.
Dr, Sharagim Kemp heads the New York post-Covid program for Nuvance Health. The Nuvance system has substantial assets in both Connecticut and New York State, and it has two separate post-Covid recovery programs. But as with WMC, the two operations mirror each other, Kemp’s office is at Northern Dutchess Hospital in Rhinebeck.
The two programs do intake differently. WMC begins with a physical examination by a primary-care doctor. Nuvance starts with a telephone interview. Is telemedicine effective in that intake role? Dr. Kemp says that it works well if done attentively. It’s surprising how much information a doctor can gather in a 40-minute or hour-long virtual visit with a prospective post-Covid patient, she said.
The road to recovery
We don’t know nearly as much as we’d like to about what’s called “long Covid,” persistent symptoms that can continue long after the Covid-19 infection has receded.
What are some long-term effects of Covid-19? The Nuvance list consists of a unlucky thirteen prominent ones: muscle weakness and fatigue, memory loss or “brain fog,” difficulty breathing or chest pain, balance issues and trouble walking, weakness or numbness in arms and legs, body aches or joint pain, headaches, stroke, mood changes, abnormal heart rhythms, loss of taste and smell, rashes, and hair loss
Estimates are that between 20 percent and 25 percent of all people who have recovered from Covid complain of a bewilderingly wide variety of ailments they attribute to the disease.
“The road to recovery for some Covid-19 patients may be longer than [for] others, with a wide range of symptoms that can last for weeks to months,” warns the Nuvance recovery program website. “The long-term effects of Covid-19 can be debilitating and prevent people from getting back to their normal routine.”
“A person [in the recovery program] can wake up one morning convinced that they are finally completely well,” said Dr. Festa, “and then complain the next day that their symptoms are worse than ever.”
The post-Covid syndrome
Successful recovery benefits from teamwork among medical professionals. “By creating a cohesive team of specialists across Nuvance Health, we can seamlessly help patients navigate the care they need, and ultimately, improve function and hasten recovery,” the Nuvance website quotes Dr. Christopher Lehrach, president of Nuvance Health Medical Practices, as saying.
WMC takes a similar tack. “The tristate area has been one of the hardest hit in the nation during the Covid-19 pandemic,” says its program’s website. “Today, an increasing number of people who became ill from the coronavirus continue to deal with issues surrounding their physical, mental and emotional health and quality of life. Sometimes referred to as post-Covid syndrome, this is a very real health issue. And it is treatable.”
Diagnosis before treatment. Both hospitals’ programs start with a primary-care provider reviewing the patient’s history and figuring out what specialists need to be involved. Both emphasize the customized nature of their treatment plans for dealing with the varied symptoms of this unusually elusive disease. Both assign patients the services of a clinical navigator as a guide in the development of a treatment plan.
The state has been developing a treatment plan. Its is for more intensive post-Covid research.
Governor Kathy Hochul gave a speech on October 19 assuring New Yorkers that the state would be very active in applying for its share of the billion dollars in federal funding the National Institutes of Health has been allocated for post-Covid research. “We will lead on this initiative. That is what we’re going to be announcing in the next couple of weeks, our plan for addressing this because clearly, it is still with us,” she said. “And there are many New Yorkers still struggling with this, trying to get back to work and take care of their families and get on with life, while dealing with very scary unknown side effects from having contracted Covid many months ago.”
There was considerable interest in the state Department of Health webinar this past Monday, October 25 to raise awareness among healthcare providers of post-Covid symptoms and their treatment. Some 600 providers had already signed up for it at the time of Hochul’s speech. She has promised “to convene an expert panel to determine what steps New York State can take.”