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Stories: Voices from the frontline

George Pappas, M.D.

As our knowledge of COVID-19 has grown throughout the year, one thing has been clear: it’s virtually impossible to predict who will experience long-term serious symptoms. George Pappas, M.D., is trying to do something about that. As the director of our COVID-19 Recovery Clinic—which is new to the Puget Sound region—the pulmonologist is both caring for these so-called “long haulers” and researching the mechanisms behind their extended illness.

We talked to him about what he’s seeing and how it’s contributing to our collective understanding of the disease that has so far claimed the lives of more than 220,000 people nationwide.

Can you describe what you were seeing in the early days of the pandemic and how it compared to what you’d see in someone with, say, influenza?

Initially the patients I was seeing were very sick and hospitalized. What was unusual about this was we were seeing more people with severe illness than typically expected for our seasonal flu infections.

At what point did you start to see that these patients were experiencing long-term effects?

People with severe influenza or other conditions that result in their spending time in the ICU on ventilators will very commonly have problems that can last for months, and sometimes years. Those problems can be everything from physical weakness to emotional difficulties about the stress of their illness to compromised organ function. There's actually a name for it: post-ICU syndrome.

So we were anticipating that in folks who were very sick. But what we've subsequently recognized with COVID is that there are people who weren't so sick that they needed to go to the hospital but continue to have problems months after their COVID diagnosis, like shortness of breath, fatigue, inability to exercise and nausea.

Is that why you opened the COVID-19 Recovery Clinic?

The initial idea behind the clinic was that we believed folks who had been really sick with COVID needed a place to continue to get care from specialists after they left the hospital. But then as we started to see patients who had persistent difficulties despite not being very sick initially, we realized those people needed support as well.

The other part, though, is that we wanted to gather knowledge and experience with these patients. This is an entirely new disease. We’re hoping to gather information in a way that we can help our understanding of what COVID is so that we can use that information to take better care of them moving forward.

What have you been doing for these patients? What kind of treatments are you able to offer them?

We have a very thoughtful way that we work through particular problems that they may have. For example, if they’re experiencing shortness of breath, we’ll make sure we’re assessing not just their lungs, but their heart as well. We want to make sure we're looking for all the things that might be contributing to their difficulties, based on what we've learned about this condition so far.

We are also creating a network of providers, including cardiologists, neurologists and rehab specialists, who are interested in helping these patients as they recover from COVID.

I had one patient with emphysema who developed COVID and ended up spending three to four weeks in the hospital, on lots of oxygen. He survived, and I saw him for follow-up in the COVID Recovery Clinic. Initially he was quite profoundly limited, and we were both really concerned that this may be his new baseline, that he may not recover it further.

But over the course of months—it really was months—we were able to work on his physical therapy and rehab, and now he's doing much better and off of oxygen, which I wasn't certain was going to happen.

On the research side, what are some things you’ve learned?

We've learned that there's a small, but significant number of people who weren’t very sick, yet if you look really hard with things like MRI scans, have developed heart abnormalities due to COVID. We're trying to understand the long-term implications of those types of findings.

There also appears to be a small group of patients who have persistent breathing problems and exercise difficulties after just mild illness. In other words, it's not always as simple as the sickest people have the biggest problems and take longer to recover.

What can you do with that information going forward?

We have some experience treating patients who have scarring conditions of the lungs. So now the question is, for some of these people with persistent scarring or scarring that increases after their initial illness, would they benefit from those treatments?

How can philanthropy contribute to building our knowledge of COVID-19 and helping patients in the future?

The importance of research and gathering good-quality information and sharing it with others in this setting is so incredibly important. It's how we move forward. If you look back, we can see how there have been discussions about different medications that might be effective but were eventually proven not to be.

Gathering that type of objective information that we can then use to make good decisions is so incredibly important, and philanthropy is providing resources for us to start doing that. I am so appreciative of the help that donors are providing. We're hoping, through this work, to have a better understanding of the long-term outcomes of this infection. It sounds cliché, but we’re in uncharted waters.

If you or someone you love is experiencing persistent symptoms related to a COVID-19 diagnosis, contact your primary care provider or call 206-320-6500 to make an appointment at the COVID-19 Recovery Clinic.

To learn more about how you can support our innovative COVID-19 research and care for our patients visit www.swedishfoundation.org/COVID-19 or contact us at 206-386-2738 or foundation@swedish.org