Long after the initial wave of COVID-19 cases in New York City had subsided, many patients were still experiencing damaging aftereffects. To help these still-vulnerable individuals, Mount Sinai Health System created the country’s first Center for Post-COVID Care, which provides personalized, multispecialty care to recovering patients while gathering vital clinical data on a disease whose full effects are still not well understood.
“We saw the need even while our caseloads were high for a center that could provide comprehensive, expert care for a wide range of patients who continued to be impacted by this complex disease,” says Zijian Chen, MD, Assistant Professor of Medicine (Endocrinology, Diabetes, and Bone Disease) at the Icahn School of Medicine at Mount Sinai, and Medical Director of the Center for Post-COVID Care. “It was also important to us that all New Yorkers, regardless of their disease state or socioeconomic status, received that broad level of care from our team of medical specialists.”
The post-COVID initiative embraced not just multidisciplinary care, but a systematic evaluation of the long-term impact of COVID-19—much of which proved to be a surprise to scientists. “When we started doing CT scans of the chest on recovering patients, we noticed lingering changes that suggested something more than regular pneumonia or lung injury,” says Aditi Mathur, MD, Assistant Professor of Medicine (Pulmonary, Critical Care, and Sleep Medicine). “There was clear evidence that some of these patients were progressing from inflammation to lung fibrosis, and it was really eye-opening for us to see the degree of impairment two or three months out from the patient’s initial infection. Our goal now is to understand the mechanism by which this virus leads to such significant symptoms, even in our youngest, healthiest patients.”
That is why Maria Padilla, MD, Professor of Medicine (Pulmonary, Critical Care, and Sleep Medicine) and Director of the Advanced Lung/Interstitial Lung Disease Program at Mount Sinai, is directing efforts to investigate potential therapies to arrest or prevent the progression to fibrosis. In addition, she was troubled by what she observed in patients who were thought to be out of danger. One of those areas is vascular impairment. “We’ve been surprised to see that a number of patients we thought were cured continue to show lack of blood supply to inflamed areas of the lung long after their CT scans begin to improve,” she explains. “This is a condition that hasn’t been appreciated in past pandemics.”
Physicians who continue to treat COVID-19 patients believe that up to 25 percent suffer from lingering health problems. These include increased risk of thromboembolic disease, cardiovascular complications, hepatic and renal impairment, and systemic inflammatory response syndrome. Moreover, patients who fought for their lives in hospital intensive care units may, months later, manifest mental health issues such as post-traumatic stress disorder, anxiety, and depression.
The Center for Post-COVID Care is marshalling an array of advanced clinical tools and research expertise at Mount Sinai to evaluate the long-term systemic impact of COVID-19 on patients. This arsenal includes high-resolution CT imaging—a vast diagnostic improvement over the simple chest X-rays taken of patients presenting with upper airway symptoms and advanced respiratory distress in the early months of the viral outbreak. Once it opened, the Center also began offering pulmonary function tests to monitor the lung performance and continue to monitor oxygen needs and other vital signs of recovering COVID-19 patients from their homes through Mount Sinai’s expanding telemedicine capability.
The linchpin of the Center’s investigative work, however, is its COVID-19 Registry, which collects baseline information of participating patients in varied areas such as comorbidities, socio-demographics, behaviors, mental health, and medications. Researchers further obtain baseline measures of pulmonary symptoms and physical indicators such as biometrics, spirometry, EKG, bloodwork, and antibody titers for SARS-CoV-2, the virus that causes COVID-19.
“We have a comprehensive post-COVID center,” emphasizes Dr. Padilla. “We provide clinical care to the patients while investigating lung disease, and the lasting effects of this virus on many other organs and systems of the body. We’re also reaching out to patients through support groups that offer the social and psychological help physicians aren’t always able to provide in an office setting.”
Through the enormous amount of information and science coalescing at Mount Sinai’s Center for Post-COVID Care, clinicians hope to find better ways to manage and treat patients both now and in the event of future pandemics. “In just a few months, we’ve gone from knowing very little about this disease to having a much better understanding of its acute phase,” notes Dr. Mathur. “This is encouraging, and the reason why anyone who has symptoms from COVID-19 a month or more out from their infection shouldn’t wait for them to just disappear. They need to seek medical care.”
Zijian Chen, MD
Medical Director of the Mount Sinai Center for Post-COVID Care, and Associate Professor of Medicine (Endocrinology, Diabetes and Bone Disease)
Si-Min Kim, MD
Assistant Professor of Medicine (Endocrinology, Diabetes and Bone Disease)
Takako Araki, MD
Assistant Professor of Medicine, University of Minnesota