Community-based primary care management of “long COVID”: A center of excellence model at NYC Health + Hospitals, 2021, List and Long

Introduction

Most patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) survive novel coronavirus disease 2019 (COVID-19). Many experience one of over 200 reported ongoing symptoms after acute infection regardless of severity.1
These symptoms constitute what both patients and health care workers termed “long COVID” early in the pandemic and also now called “Post-Acute Sequelae of SARS-CoV-2 infection” (PASC).2 While not fully understood or characterized, “long COVID” generally refers to survivors of COVID-19 who experience symptoms after 4 weeks since original onset of acute COVID-19 symptoms. 3,4 A reliable prevalence for PASC overall and stratified by disease severity has not been determined, but a conservative estimate of long COVID in a recent study suggests at least 13% of community treated COVID-19 survivors experienced long COVID symptoms 28 days or longer.5 At the other end, among COVID-19 hospitalized survivors in one study, an estimated 76% experienced at least one symptom after acute infection persisting six months after infection.6 The recovery phase for survivors remains incompletely understood, and survivors’ ongoing medical needs present immediate challenges and opportunities for primary care and population health. But given the overall number of individuals with a history of SARS-CoV-2 infection, even 13% presents a scenario that might place significant strain on healthcare systems for effectively addressing PASC.

People with PASC need a responsive health care system that provides high-value, patient-centered care in the setting of rapidly evolving, but limited clinical and research guidance for treatment. The public health and economic burden of PASC could potentially be staggering if even a small percentage of COVID-19 survivors are affected.7
Academic Medical Centers play a crucial role in providing an array of subspecialized services for survivors in communities where they exist 8, but they alone cannot provide the anticipated volume of care to all survivors. In this article, we offer an approach for providing COVID-19 survivorship care tailored to community health center (CHC) clinical settings. We discuss: 1) the emerging scope of potential post-COVID-19 complications; 2) how New York City's municipal public health system designed CHCs with an explicit focus on post-COVID-19 care; 3) and how primary care should proactively engage survivors of COVID-19.

Open access, https://www.amjmed.com/article/S0002-9343(21)00405-8/fulltext

 

It's wild that this keeps being repeated, almost verbatim, and yet no one seems to ask the obvious: wait, isn't it already like this, if not why? Because the fact that health care is "evidence-based" and "patient-centered" is basically a common trope, even though somehow it's easy to recognize that it absolutely isn't. Two mutually exclusive realities co-exist and almost no one seems to notice outside of us.

We have been pointing out these things for years and many before us did so for decades. And yet at every turn we were told to shut it, that it was already this way and would become even more so with the magical BPS thing, which is the exact opposite of this. With every attempt to be more "evidence-based" and "patient-centered", health care becomes less and less of both, adopting the very worst of alternative medicine and doing everything by physicians for physicians, never allowing patient perspective anywhere at any time.

Anyway it's seriously wild that this obvious doublethink is out there in the open yet everyone seems unable to see the issue, since all anyone ever does about it is make it worse by pushing the problem as the solution.

 

Agreed. So far in the history of ME "evidence based" has an absolute meaning of we are the evidence of their conceptual model.

"Patient centered" has meant that we are some colony of their paternalistic whim. They will whip us into real people if it kills us.