BC doctors meeting the challenge of long-term COVID-19 recovery and care

Since the onset of the COVID-19 pandemic, BC’s doctors have been working to understand this virus, and provide the best care possible to people affected all over the province. Three post COVID-19 recovery clinics opened in the Lower Mainland early in 2021, as part of the Provincial Health Services Authority’s (PHSA) Post COVID-19 Interdisciplinary Clinical Care Network (ICCN). The network aims to support doctors and allied health professionals with patients who are dealing with longer-term effects of COVID-19 province-wide.

The three post-COVID-19 recovery clinics are at St. Paul’s Hospital (SPH), Vancouver General Hospital (VGH), and the Jim Pattison Outpatient Care and Surgery Centre in Surrey. At the clinics, people dealing with long-term adverse effects of COVID-19 can receive specialized care, while ongoing research allows teams to learn more about the virus, so they can best support their patients.

Supporting COVID-19 patients with severe symptoms

Those who are living with longer-term effects can exhibit a wide range of symptoms, says Dr Sharry Kahlon. An internist at Surrey Memorial Hospital, and the Medical Director of the post-COVID-19 clinic in Surrey, Dr Kahlon says many of the people she sees are dealing with severe fatigue months after getting sick. “We’re seeing a lot of fatigue, what we’re terming ‘post-exertional malaise’ and brain fog as well.” Many patients are also dealing with a prolonged loss of smell and taste, which is affecting their day-to-day functioning. With these physical symptoms also comes negative mental health impacts, says Dr Kahlon. “Having the long-term symptoms and not being able to return to a prior level of functioning has really had an impact on patients’ mental well-being and health.”

Dr Zachary Schwartz, Physician Lead at VGH, said the clinic is seeing a lot of elderly people with long-term symptoms who were previously hospitalized with COVID-19, but there have been some younger people presenting to the clinics with long-term symptoms, who were never initially admitted to hospital.

Post-COVID-19 care – a true team effort

For the work of the clinics and the overall clinical care network, collaboration and standardization were vital elements to get right. Dr Peter Birks, a nephrologist serving as the administrative lead for post-COVID-19 care in Fraser Health, said: “By collaborating and working together as a group of clinics and doing things in the same way, we can see the effects that our work is having on our patients.”

“We can collect information on outcomes and continue to re-evaluate the best ways to optimize care for these patients over time. By the time some of these patients are reaching months into their symptoms, we may have even better strategies to help them as the pandemic progresses.”

Dr Jesse Greiner, Medical Director of the clinic at SPH, agreed that standardization is vital to the network’s success. “A lot of us are actually learning how to do clinic very differently, and in the context of standardized questionnaire standardized investigations.” Greiner added that sharing data between the clinics and fostering good communication has been a major priority. “We've been working really closely together over the last couple of months to try to make sure that the education and the communication is happening.” The teams have monthly rounds to bring notable cases and interesting findings to light, with the goal of boosting the capacity of all the physicians managing these kinds of cases. 

Vision, leadership, and commitment

For Dr Kahlon, the collaborative steps that the health authorities have taken on this project has been a “really nice highlight” of the work. “We can still learn about an illness in real time in a standardized way with the data collection piece, but it's only because there's been vision and leadership, which has allowed for clinicians to come together to make this operational.”

The commitment of the doctors involved is also a huge part of the project’s success so far, says Schwartz. “I think part of the reason why it works so well is because everyone here has been so dedicated to the actual cause – this has been on top of all of our usual clinical work, which was already increased in the actual COVID-19 area. I think having dedicated individuals who believe strongly in providing these resources and avenues for patients to access has been really important.”

The key for the clinicians has been lots of discussion, with Schwartz crediting Zoom for allowing clinicians to meet at home, creating a more workable schedule for them and their families. “I think everyone with kids in the network are very familiar with all the children of the group.”

Sharing knowledge leads to better patient care

Sharing the knowledge they have accrued on the job is paramount to the clinic teams, says Dr Birks: “We’re using the unique knowledge for members of our multi-disciplinary team and multiple specialists to create patient-facing and practitioner-facing resources that can help physicians across the province care for their patients.”

Looking forward, the teams hope that the ICCN can continue to help doctors across BC provide the best care to their patients, both in the clinics themselves, and in diverse medical communities spanning the province. They are keen to share their knowledge to help and support their peers. As well as clinic referral information, the resources include access to post-COVID-19 care advice from an internal medicine specialist via the Rapid Access to Specialist Consultation (RACE) app for urgent questions, and an e-consultation service, which offers responses within seven days. For patients, there is a wide array of resources that will inform and educate British Columbians who are managing similar symptoms.

As many British Columbians continue to deal with the effects of COVID-19, it can often be a difficult and disheartening experience. Through this initiative, the clinicians working in the network want people to know that there is support out there.