The average number of new COVID-19 cases confirmed in Texas has receded in recent months, but physicians are facing another, related onslaught: patients with lingering effects from the virus, known as post-COVID conditions or “long COVID.”
And there are limited resources and long waitlists for these patients – a problem the Texas Medical Association is advocating lawmakers help resolve.
“It’s here to stay,” said Monica Verduzco-Gutierrez, MD, a physical medicine and rehabilitation physician in San Antonio who opened two long COVID clinics in August 2020. They now have wait times of seven to nine months. “You’ve heard it’s a mass disabling event, and I believe it. I feel like the waitlist is unacceptable. We need to get as many physicians and clinicians understanding long COVID so they can treat it at the front lines.”
Long COVID represents a wide range of symptoms – including fatigue, shortness of breath, heart palpitations, brain fog, and depression – that can last for weeks or months after someone is first diagnosed with COVID-19 and may impair physical or mental function. The American Academy of Physical Medicine and Rehabilitation estimates more than 23 million Americans have been affected by long COVID, with nearly 2 million of those cases in Texas.
The terms long COVID or “post-COVID conditions” account for the wide range of health consequences that are present for four or more weeks after a COVID-19 infection, according to the Centers for Disease Control and Prevention. It can be difficult to distinguish between symptoms caused by post-COVID conditions and those that have other causes. Some patients with long COVID will not have a previous positive test to establish infection because of lack of testing availability or inaccurate results.
Although the number of active COVID-19 cases has abated since the omicron surge, many patients continue to struggle with long COVID, which affects 20% to 30% of those infected by the virus, according to early estimates.
In San Antonio, a majority-minority city, many of Dr. Gutierrez’ patients struggle to access specialty care, and some of her long COVID patients have lost their jobs because of the condition, leaving them without health insurance. She hoped her two clinics – one offered through UT Health Physicians, the clinical practice of the UT Health San Antonio Long School of Medicine, and the other through University Health – would help close this gap.
Multidisciplinary clinics are helpful for patients whose symptoms span multiple specialties, such as pulmonology, cardiology, and psychiatry. But such clinics are “time-intensive, person-intensive, and financially intensive,” Dr. Gutierrez said, adding that her non-long COVID patient case load hasn’t decreased over the course of the pandemic.
Primary care physicians are critical to this effort, she says, because they are likely more accessible to patients, especially those without insurance, and can help them manage certain long COVID symptoms, easing demand for specialists and multidisciplinary clinics.
Jimmy Widmer, MD, an internist at an integrated health system in Temple, helped open a post-COVID clinic in November 2020 to do just that. At that time, the clinic’s team recognized primary care physicians were struggling to balance acute COVID-19 patients – some of whom were decompensating quickly – with patients who were stable but struggling with symptoms of long COVID, which was relatively new and little understood to many physicians.
“This gave us an outlet and a valve to get these patients some care and understanding about what was going on,” he said of the clinic, which connects primary care physicians with specialists who consult on cases and provide recommendations for treatment.
TMA’s Council on Legislation urged state lawmakers last summer to allocate federal American Rescue Plan Act funding to both of these treatment tracks: training primary care physicians in long COVID symptom management and covering start-up costs for multidisciplinary clinics offering such treatments.
The Texas Legislature failed to heed this request. But TMA continues to advocate on this issue, most recently asking the state to study the potential impact of post-COVID conditions on the state’s health care delivery system, access to care, patient health outcomes, and health disparities, including examining strategies to train and support primary care physicians in the treatment of such conditions.
Following that request, Texas House Speaker Dade Phelan (R-Beaumont) issued interim charges to the House Select Committee on Health Care Reform on March 10, which included examining the potential impact of delayed care on the state’s health care delivery system, health care costs, and patient health outcomes.
Although the charge does not mention long COVID specifically, TMA Associate Vice President of Public Affairs Michelle Romero says it may touch on it, since the state continues to incur costs related to treating long COVID patients.
In the meantime, TMA continues to prioritize long COVID in its advocacy. “If we have physicians who see that their patients are still suffering from [this condition], we’re going to continue to advocate for funding for treatment,” Ms. Romero said.