During the interview with Dr. Dror Dicker, head of the first Israeli clinic for former COVID-19 patients at Hasharon Hospital in Petach Tikva, he receives a telephone call from a woman who is still exhausted after having technically recovered from the coronavirus. She explains that her doctor doesn’t have enough experience with COVID-19 to help her navigate the aftermath of the disease. “Your clinic is like a light at the end of the tunnel,” she tells him, and books an appointment.
While the coronavirus outbreak in Israel has been halted, with only about 20 new diagnoses per day, and the COVID-19 hospital wards are closing one by one, Hasharon Hospital opened a clinic last week for former COVID-19 patients. Dr. Dicker’s clinic will treat former COVID-19 patients from across Israel, including the very patients who were hospitalized with the virus in Dr. Dicker’s coronavirus ward. Some of the staff who treated COVID-19 patients have already transitioned to supervising the same patients’ recovery process – work that, like treating active coronavirus patients, involves a steep learning curve and figuring things out on the fly.
“Our initial motivation to open the clinic was to study and understand what happens to people who’ve recovered,” Dr. Dicker says to Davar. “The process of learning about COVID-19 has been extremely important and interesting to us. Because this illness was previously unknown, in the beginning we didn’t know how to treat it. We underwent an intensive hands-on learning process, unlike much medical knowledge which is built through a slow and theoretical process. We constantly encountered dilemmas – for example, the best treatment for a patient with a specific complication – and I communicated on a daily basis with colleagues in Spain and Italy in order to brainstorm treatment methods. You hear about the exponential infection curve, but worldwide the learning curve for this disease was truly exponential. Every week brought new discoveries.”
The team’s second objective for the post-COVID-19 clinic is to enable the hospital’s COVID-19 patients to continue the treatment process they started during their hospitalization. “These patients leave the hospital still in need of respiratory and physical rehabilitation,” says Dr. Dicker. “We realized that there was no existing standard-of-care for physical therapy for COVID-19 patients, and that we would need to write the handbook. After laying in a hospital bed for two months, these patients need to relearn to walk. And those who were intubated need respiratory physical therapy – should we treat them like any other respiratory therapy patient or do they have unique needs? So the understanding that we need to keep treating these patients started from physical therapy, and then we started to realize that there were other issues to address as well.
S, a father of two in his forties and a patient at the new clinic, has officially recovered from the coronavirus but still suffers from cough and phlegm. “The same doctors, nurses and specialists that treated me during my hospital stay are still taking care of me. They perform extensive tests and checkups and make me feel like I have somewhere to turn with my ongoing issues,” he says. He describes the relationship he built with the hospital staff as extremely meaningful. “Being sick with corona is confusing and overwhelming, and within all of that, the staff’s professionalism was so reassuring.”
A holistic response to a holistic illness
According to Health Department statistics, almost 15,000 Israelis have officially recovered from the coronavirus. But Dr. Dicker explains that even after the virus leaves the body, the illness often continues. COVID-19 complications are caused by the patient’s own immune system response to the virus. The immune system attacks bodily organs as an exaggerated response to the virus, which can damage the heart, lungs, kidney and digestive system, among others. This immune response, and the effects of the damage, can continue even after the virus itself has been successfully cleared from the body.
Due to the diverse nature of COVID-19’s effects, a coronavirus patient may require a wide range of care takers: Physical therapists, lung specialists, heart specialists, ear nose and throat specialists, neurologists, epidemiologists, physical therapists, nurses, and an internal medicine specialist coordinating care. At the clinic at Hasharon, patients who were hospitalized at Hasharon continue the treatment they started with the same specialists who already know them.
Many of the patients also received care for preexisting conditions such as diabetes or high blood pressure during their coronavirus hospitalization, and continue to be monitored for those conditions as well by the team at the clinic.
“We customize the treatment to the patient’s needs. Only an internist can coordinate treatment of the entire disease and the entire patient. A lung specialist, for example, treats only the lungs. But thirty percent of our patients have diabetes, and at the clinic the internist who coordinates the patient’s case makes the connection between ongoing lung treatment and diabetes treatment. Some of the patients need referrals to nutritionists, to occupational therapists, to neurologists, and we make sure all of that happens.”
In addition, the social workers who already know the patients from their hospital stay, continue to work with them to address lingering trauma, shame, uncertainty about the future, and other emotional needs related to their illness.
The clinic accepts new patients who received COVID-19 care from other institutions as well. “People are frustrated because once they’ve been declared negative, they don’t have anywhere to turn with their ongoing issues. For example, people who experience lingering loss of smell and taste want to know if they’ll regain those senses, and I don’t have an answer. We don’t know yet. We need to study what happens to these people. And people whose lungs or heart were damaged by the disease – what happens to them afterwards? Is the damage temporary? How long does it last? Are there ways to encourage recovery? We need to track and treat these patients just as they were tracked and treated while they were hospitalized, using the scientific method to determine which approaches are effective."
"What about immunity and antibodies? Do these recovered patients have antibodies to protect them from re-infection, and if so how long do they last? We still don’t know, and we want to find out.”