(Courtesy: Parkland Health and Hospital System)

Coronavirus

Parkland’s Long-Haul COVID-19 Clinic Is Navigating Uncharted Waters

Ongoing symptoms such as brain fog are difficult to treat, and there is a lot clinicians don't know about them.

New COVID-19 cases and deaths in Dallas have remained steadily low in Dallas for weeks now, but Parkland Hospital has opened a new clinic for long-haul COVID-19 victims whose symptoms are lingering. The clinic originally opened as a place for those who currently had the virus to receive treatment like chemotherapy or blood transfusions, but now a second clinic is focused on treating long-lasting symptoms of coronavirus. 

The second clinic opened in December as a joint effort between physical medicine and rehab doctors, behavioral health, and primary care. Monal Shah is a senior vice president at Parkland Health and Hospital System, a chief physician advisor, and the medical director of the COVID-19 follow-up clinic at Parkland. He says patients have followed national trends of needing multi-disciplinary care following their bout with COVID-19. 

Studies have found that between a quarter or a third of those who are diagnosed with COVID-19 ended up with long-haul symptoms, which include muscle aches, joint aches, ongoing brain fog, shortness of breath, lingering cough, and sore throats. Some are diagnosed with behavioral health concerns such as the exacerbation of underlying depression. Shah has seen similar symptoms in the clinic. He says these symptoms abate after six months for most people.

That said, there is still much that we don’t know. We are not six months past peak for cases in December and January, so time will tell if that average holds for this larger group. Also, Shah says there is much we don’t know about why certain people have lingering symptoms and others don’t. “We may find that it does end up lasting longer than current literature seems to say, but six months is probably a fairly good mark for most people,” Shah says.

Right now, the clinic is starting small and focusing on patients who were hospitalized for more than 30 days with COVID-19 symptoms. These patients, who were often in the ICU or on a ventilator, will be able to receive multi-disciplinary care from a variety of providers to address their needs. But that will leave a lot of people out of the mix. If around 300,000 people have contracted COVID-19 in Dallas County, Shah says that about 75,000 people are probably experiencing some lingering effects. 

Another hurdle to treating those with long-term effects of COVID-19 is that there isn’t a clear path to reduce long-term symptoms. The vaccines have done an excellent job of bringing down new cases, and monoclonal antibodies are being put to good use to treat those experiencing the worst of symptoms or preventing severe symptoms. Still, for things like continued brain fog, the path is not as clear. 

“These are very difficult things to treat, and there is a lot that isn’t known about them,” Shah says. “We’re going back to the basics for treating a lot of these things meaning exercise, sleep, eating well, avoiding tobacco, and alcohol, these types of things. It’s readapting to a healthy lifestyle.”

As we inch closer to six months past the peak in cases, Shah thinks there may be less need for the clinic to treat these lingering symptoms. However, with plenty of people still hospitalized and Dallas County still counting hundreds of new cases each day, the COVID-19 long-haulers aren’t going away any time soon. Parkland still has dozens of people hospitalized with active COVID-19 cases or recovering from an active case. 

“If we’re looking at six months out, we anticipate at least going through the summer,” Shah says. “We’re not at a point where we’ll be able to stop immediately. But our hope is as the number of cases goes down to the very few remaining cases that we hopefully will have, then we may be able to think about scaling back our clinic capabilities.”

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