Patients hospitalized for COVID-19 are experiencing a broad spectrum of long-term multi-organ issues involving pulmonary, cardiovascular, kidney, metabolic, mood and neurologic complications. Most recently, it’s become apparent that the risk of developing these complications is high even in patients who only experienced mild forms of COVID-19.

Now, to better serve this population, Michigan Medicine is establishing clinics to provide post-discharge care to both adults and pediatric patients experiencing these long-term post COVID symptoms and complications.

More than 1,500 adult patients have been hospitalized with severe COVID-19 at Michigan Medicine, with more than two-thirds having diabetes. Meanwhile, doctors at C.S. Mott Children’s Hospital have seen more than a dozen cases of kids and teens with persistent COVID symptoms, including respiratory issues and fatigue, months after even mild cases of COVID.

“There is an urgent need to better understand the long-term complications of COVID-19 and provide specialized care for high-risk groups of patients’,” says Michigan Medicine endocrinologist Rodica Pop-Busui, M.D., Ph.D., director of the adult clinic.

“The COVID-19 pandemic has affected all of us, and of course those infected by the virus. Data suggests that 10-20% of those previously infected and over the acute phase of the infection have lingering symptoms that could be organ-based damage or a syndrome called post-acute sequelae of COVID-19 (PASC),” says John M. Carethers, M.D., M.A.C.P., chair of the department of Internal Medicine. “Dr. Busui has led assembling an outstanding multidisciplinary team of experts that cross multiple medical disciplines to create a one-stop evaluation and treatment approach clinic for patients afflicted with PASC.”

The adult clinic, formally named the Multidisciplinary Post COVID-19 Clinic, operates under a mixed in-person – virtual care model, and is located at Domino’s Farms (4000 Ave Maria Dr. Lobby C, Suite 1300). The in-person appointments are held on Friday afternoons.

A large proportion of the patients who have been hospitalized at Michigan Medicine are new to the institution and don’t have established care, highlighting an unmet need for post-discharge care.

Eligible clinic patients must:

• Be 18 years and older with a history of lab-confirmed COVID-19.
• Be referred by a primary care provider or inpatient provider at discharge.
• Have a comorbid diabetes, prediabetes, obesity, thyroid or adrenal diagnosis with continuation of symptoms post COVID-19, including fatigue, shortness of breath, joints and muscles pain, weakness, dizziness, chest pain and memory problems.

“While our goal is to offer our clinic services to all patients hospitalized with COVID-19, we’re initially targeting patients with diabetes or obesity given their high-risk status and the significant disturbances in blood glucose attributed to COVID-19,” says Pop-Busui.

The patient’s first visit will include consultations with endocrinology, physical medicine and rehabilitation and neuropsychology. In addition, there are specific criteria for laboratory and other tests that will guide personalized referrals to selective virtual specialties based on how each patient presents in clinic, including cardiology, nephrology, neurology, pulmonary, podiatry and infectious disease will be consulted as needed. Social workers and certified diabetes educators will also be onsite as ancillary providers.

All consenting patients are also invited to participate in research, in a true integration of cutting-edge research into the clinical care where patients will undergo a comprehensive battery of tests and questionnaires, with labs and imaging provided on-site. Then, patients will be prescribed a treatment plan by the pre-designated subspecialties’, with follow-up appointments at three and six months.

“Given the large number of patients that have contracted COVID-19 in these several waves and the extent of the post-acute sequelae, the demand and community need for these services is expanding, and it falls in line with Michigan Medicine’s mission that we are at the forefront to meet that need,” says Michigan Medicine cardiologist Salim Hayek, M.D., Ph.D., co-director of the adult clinic and COVID-19 researcher.

“At Michigan Medicine, we aim to not only diagnose and better the patient, but to continually learn from patients with PASC so that we can apply that knowledge to future patients, and improve the care of those participating with us in clinical research and in their own clinical care,” says Carethers. “We will assess, provide the best care, and learn from this unfortunate affliction to minimize its occurrence going forward.”

Pediatric Post-COVID Syndrome Clinic

The pediatric Post-COVID Syndrome Clinic is located at Mott where Michigan’s top-ranked pediatric subspecialties will assist children, adolescents and teens coping with the long-term effects of COVID-19 or multisystem inflammatory syndrome in children (MIS-C).

Eligible clinic patients must:

• Be under the age of 21 with a history of lab-confirmed COVID-19.
• Be referred by a primary care provider. 
• Have a continuation of symptoms, including fatigue, shortness of breath, joint pain, chest pain, and cough that persist for more than two months (60 days) post COVID-19.
• Have no other exposures or explanations for the new or worsening symptoms.

“We’ve seen many children who have breathing issues and other lingering symptoms long after an initial infection,” says Carey Lumeng, M.D., Ph.D., a Mott pediatric pulmonologist who leads the Mott post-COVID clinic.

“Most of these initial infections were mild and didn’t require hospitalization or even outpatient care. Our goal is to better understand this phenomenon in young people and ensure that patients see the right group of specialists to address their specific symptoms.”  

Patients will benefit from care coordination with Mott’s pediatric subspecialists and patients’ primary care providers. The patient’s first visit will either be in person or virtual to assess the symptoms, the need for coordinated care, and the need for additional testing.  Experts in pediatric pulmonology, pediatric cardiology, pediatric psychology, and pediatric physical medicine and rehabilitation will review the cases and come up with an assessment and treatment plan.

Similar to the adult clinic, the pediatric clinic will offer virtual and in-person visits with the option to participate in research studies on the long-term effects of COVID-19 in children.

To learn more or make an appointment at the adult Multidisciplinary Post COVID-19 Clinic, visit michmed.org/postCOVIDclinic. To learn more about the pediatric Post-COVID Syndrome Clinic, visit mottchildren.org/postCOVIDclinic.