Extending COVID-19 Care Beyond "Recovery"

Dr. Julie Biller serves as director of the Froedtert & the Medical College of Wisconsin Post-COVID Multispecialty Clinic.

Since the start of the COVID-19 pandemic, more than 612,000 Wisconsinites have been diagnosed with the disease – 95 percent of whom have recovered. However, medical experts are now finding that the “recovered” designation might be misleading. “When the pandemic first started in the US, medical professionals began to notice a pattern of lingering symptoms in a portion of patients who tested positive for COVID-19 and since became negative for the virus,” says Julie Biller, MD, professor of medicine (pulmonary) at MCW. “As more data have come in, we’ve realized that this phenomenon was common to a certain extent, with studies finding prolonged symptoms in 10-30 percent of COVID cases.”

The official term used by the medical community is “post-acute sequelae of COVID-19,” and describes patients who continue to experience a constellation of symptoms long past the time that they’ve recovered from the initial stages of COVID-19 illness. Often referred to as “Long COVID,” symptoms can include fatigue, shortness of breath, “brain fog,” sleep disorders, fevers, gastrointestinal symptoms, anxiety and depression – and can persist for months, ranging from mild to incapacitating. New symptoms also arise well after the time of infection or evolve over time.

To that end, MCW experts realized the need for a concerted effort to care for post-acute sequelae of COVID-19 that would cater to each individual’s unique symptoms. “We began serious conversations about starting a clinic dedicated to this goal last fall,” Dr. Biller says.

Joseph E. Kerschner, MD ’90, FEL ’98, The Julia A. Uihlein, MA, Dean of the MCW School of Medicine, provost and executive vice president, initially led the initiative that ultimately became the Froedtert & the Medical College of Wisconsin Post-COVID Multispecialty Clinic – which launched on January 28, 2021. Through his leadership, MCW dedicated an administration team and recruited multidisciplinary providers from across MCW. One such specialist is Dr. Biller, who serves as the clinic director.

The clinic operates in a virtual format, allowing physicians across specialties to collaborate on a patient’s treatment after being referred by a primary care provider. Patients are evaluated through triage by a specialized nurse coordinator via video consultation, which includes a panel of questions about past medical history and current symptoms. Patients are then further referred to appropriate specialists and treated according to their specific symptoms.

“The true value of this clinic is its ability to seamlessly facilitate collaboration across each department,” Dr. Biller says. “By taking a multi-specialty approach, we ensure that patients are being treated by experts who can address their particular symptoms.” As of July, the clinic is just one of two in the state dedicated to dealing with post-acute sequelae of COVID. To date, the clinic has received 569 total referrals – and continues to receive about three referrals per day.

In addition to improving clinical outcomes, the ability to collect pertinent information on COVID-19 patients allows the team to better understand the disease. Dr. Biller believes clinicians already have learned several lessons.

“We’ve found that some of our patients have inflammation of connective tissue around the heart. We also have found many commonalities between our patients and those diagnosed with chronic fatigue syndrome,” she shares. “A clinic dedicated to caring for post-COVID patients enables us to uncover more about the disease.”

The Post-COVID Multispecialty Clinic team will continue to track the data long-term and hopes to publish its findings. Although the clinic is important to the Wisconsin community, Dr. Biller hopes that it eventually will close for lack of patients. “As we continue to make strides in vaccinating our community, we hopefully will get to the other side of the pandemic, reducing the number of people who will become infected and need this specialized care,” she adds.

– Alex Krouse