At the Front Lines of Long COVID, Local Clinics Prove Vital

Deborah Schoch

October 10, 2022

Editor's note: Find the latest long COVID news and guidance in Medscape's Long COVID Resource Center.

Big-name hospital chains across the U.S. are opening dedicated centers to help patients dealing with long COVID. But so are the lower-profile clinics and hospitals run by cities, counties and states – including Harborview Medical Center in Seattle.

The Harborview clinic, operated by King County, is an example of how public health agencies are stepping up to treat people experiencing long COVID.

They serve areas ranging from Campbell County, WY, with 47,000 residents, to New York City, with its 8.4 million people. Many providers working there are searching for innovative ways to approach this lingering illness with its variety of symptoms, from brain fog to shortness of breath to depression and more.

Their efforts often fall below the radar, with still-scant serious media attention to long COVID or the public health employees working to treat ailing patients.

Why are state and local health agencies taking on these duties?

They're leading the way in part because the federal government has made only limited efforts, says Lisa McCorkell, a co-founder of the Patient-Led Research Collaborative. The international group was founded in spring 2020 by researchers who are also long COVID patients.

"It's a big reason why long COVID isn't talked about as much," McCorkell says. "It's definitely a national issue. But it trickles down to state and local health departments, and there's not enough resources."

The government clinics may be accessible to people without insurance and often are cheaper than clinics at private hospitals.

Harborview has treated more than 1,000 patients with long COVID, and another 200 patients are awaiting treatment, says Jessica Bender, MD, a co-director of the University of Washington Post-COVID Rehabilitation and Recovery Clinic in Seattle's First Hill neighborhood.

The group Survivor Corps offers lists by states of clinics. While the publicly run clinics may be less expensive or even free for some patients, methods of payment vary from clinic to clinic. Federally qualified health clinics offer treatment on a sliding scale. For instance, the Riverside University Health System in California has federally qualified centers. And other providers who are not federally qualified also offer care paid for on a sliding scale. They include Campbell County Health in Wyoming, where some residents are eligible for discounts of 25% to 100%, says spokesperson Norberto Orellana.

At Harborview, Bender says the public hospital's post-COVID clinic initially began with a staff of rehabilitation doctors but expanded in 2021 to include family and internal medicine doctors. And it offers mental health programs with rehabilitation psychologists who instruct on how to deal with doctors or loved ones who don't believe that long COVID exists.

"I have patients who really have been devastated by the lack of support from co-workers [and] family," Bender says.

In Campbell County, WY, the pandemic surge did not arrive in earnest until late 2021. Physical therapists at Campbell County's Health Rehabilitation Services organized a rehabilitation program for residents with long COVID after recognizing the need, says Shannon Sorensen, rehabilitation director at Campbell County Health.

"We had patients coming in showing chest pain, or heart palpitations. There were people trying to get back to work. They were frustrated," Sorensen says.

Myalgic encephalomyelitis and chronic fatigue syndrome activists have embraced the fight to recognize and help long COVID patients, noting the similarities between the conditions, and hope to help kickstart more organized research, treatment and benefits for long COVID sufferers and ME/CFS patients alike.

In Ft. Collins, CO, disability activist Alison Sbrana has long had myalgic encephalomyelitis. She and other members of the local chapter of ME Action have met with state officials for several years and are finally seeing the results of those efforts.

Colorado Gov. Jared Polis has created the full-time position of policy adviser for long COVID and post-viral infection planning.

"This is one way forward of how state governments are (finally) paying attention to infection-triggered chronic illnesses and starting to think ahead on them," Sbrana says.

New York City's Health + Hospitals launched what may be the most expansive long COVID treatment program in the nation in April 2021. Called AfterCare, it provides physical and mental health services as well as community support systems and financial assistance.

A persistent issue for patients is that there isn't yet a test for long COVID, like there is for COVID-19, says Amanda Johnson, MD, assistant vice president for ambulatory care and population health at New York Health + Hospitals. "It's in many ways a diagnosis of exclusion. You have to make sure their shortness of breath isn't caused by something else. The same with anemia," she says.

California's Department of Public Health has a detailed website devoted to the topic, including videos of "long haulers" describing their experiences.

Vermont is one of several states studying long COVID,says Mark Levine, MD, the state health commissioner. The state, in collaboration with the University of Vermont, has established a surveillance project to determine how many people have long COVID, as well as how severe it is, how long it lasts, and potential predispositions.

The University of Utah in Salt Lake City established a comprehensive COVID-19 clinic more than a year ago that also handles long COVID patients, says Jeannette Brown, MD, PhD, an associate professor at the school and director of the COVID-19 clinic.

Jennifer Chevinsky, MD, MPH, already had a deep understanding of long COVID when she landed in Riverside County, CA, in the summer of 2021. She came from Atlanta, where as part of her job as an epidemic intelligence service officer at the CDC, she heard stories of COVID-19 patients who were not getting better.

Now she is a deputy public health officer for Riverside County, in a region known for its deserts, sizzling summer temperatures and diverse populations. She says her department has helped launch programs such as post-COVID-19 follow-up phone calls and long COVID training programs that reach out to the many Latino residents in this county of 2.4 million people. It also includes Black and Native American residents.

"We're making sure information is circulated with community and faith-based organizations, and community health workers," she says.

McCorkell, at the Patient-Led Research Collaborative, says there is still much work to do to raise public awareness of the risks of long COVID and how to obtain care for patients. She would like to see a national public health campaign about long COVID, possibly spearheaded by the CDC in partnership with local health workers and community-based organizations, she says.

"That," she says, "could make a big difference."

Sources

Mark Levine, MD, commissioner of health, state of Vermont.

Emily Taylor, director of advocacy and community relations, Long COVID Alliance.

Lori Tremmel Freeman, MBA, chief executive officer, National Association of County and City Health Officials (NACCHO).

Jessica Bender, MD, clinical assistant professor, University of Washington.

Katherine Jones, deputy press secretary, Colorado Gov. Jared Polis.

Jennifer Chevinsky, MD< deputy health officer, Riverside County Department of Public Health.

Shannon Sorensen, director of rehabilitation, Campbell County Health Rehabilitation Services.

Kasidy Jensen, physical therapist, Campbell County Health Rehabilitation Services.

Lisa McCorkell, co-founder, Patient-Led Research Collaborative.

Alison Sbrana, Fort Collins, CO.

Brain, Behavior, and Immunity: "Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis."

Jeanette Brown, associate professor of internal medicine, University of Utah, Salt Lake City.

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