Dr. David Putrino joined us for our Navigating the New Normal: COVID and Autoimmunity Summit. He presented on Acute COVID-19 Clinical Care Recovery.
Dr. Putrino gave some insight to how Mt. Sinai is treating long COVID during this webinar. He discussed what his team is seeing, some common symptoms of long COVID and what the future of care looks like for long COVID.
He defined long COVID and/or Post-Acute Sequelae of COVID (PASC) as "any persistent (> 4 weeks from initial infection) symptom or set of symptoms that is related to acute COVID-19 infection."
Most Common Symptom Triggers of Acute COVID-19
- Physical or cognitive exertion
- Weather changes
- Consuming large meals
- Premenstrual period
- Alcohol consumption
Dr. Putrino urged clinicians to know your history. Clinicians need to be aware that there is a long history of providers gaslighting their patients. He said clinicians need to understand that physicians have told patients to just exercise and stay positive. This makes patients weary of even discussing their symptoms with a provider. Lastly, clinicians need to acknowledge that these behaviors worsen the symptoms of patients.
Current Care Pathway for Patients with PACS at Mt. Sinai
Dr. Putrino presented how Mt. Sinai is treating patients with long COVID and/or PACS. First, a physician at Mt. Sinai does an initial evaluation on the patient. Many of the PACS symptoms seen such as cognitive issues, fatigue, exercise intolerance, chest pain, shortness of breath, etc. are all consistent with severe cardiac pathology. Because of this, cardiac clearance occurs immediately after the initial evaluation. This is done to ensure that the heart is safe and it is a PACS issue instead of a heart issue.
Once the patient has been cleared of cardiac issues, Mt. Sinai begins to work on behavioral strategies to get symptom attacks under control. During this stage, Mt. Sinai refers out to Mymee to help the patient learn their triggers. This is done using a Mymee health coach and symptom tracking in the Mymee app.
Then, Mt. Sinai refers the patient to start doing breath work. This improves CO-2 retention and CO-2 tolerance which seems to ease a majority of patients symptoms. After this, patients are then referred out to other specialties as needed such as nutrition, cognitive rehabilitation, neuropsychology. Once those referrals are in place, patients are sent to physical therapy for Autonomic Conditioning Therapy.