Hedy Tung, Contributing Photographer

Just because someone does not require hospitalization when they catch COVID-19 does not mean the virus cannot bring severe difficulties, even months after they first test positive. Long-term symptoms –– which are just as mysterious as they are concerning –– can creep up even on those who did not fall severely ill.

To help patients facing these difficulties –– such as labored breathing, shortness of breath and chronic fatigue –– the Yale New Haven Hospital’s pulmonology division and department of ambulatory medicine spearheaded the implementation of a post-COVID-19 recovery program at the Winchester Chest Clinic. Although primarily pulmonary-based, the program leverages the expertise of a multidisciplinary team, which includes specialized physicians, pulmonology nurses, respiratory therapists and physical therapists, to address the enduring damage of the disease. 

“It was a wonderful work of IT, construction, facilities, painters just coming together because this was the right thing to do for our patients,” Anna Andreozzi, director of ambulatory medicine at YNHH, told the News. “Ultimately that’s what it comes down to, it’s about our patients and delivering the quality care they deserve.”

According to Andreozzi, who coordinates YNHH’s many clinics, the new post-COVID-19 clinic now occupies the physical space that used to belong to the hospital’s dental department. After finding out that the dental team had relocated, she started to investigate whether the space could host additional exam rooms to tend to post-COVID patients.

She told the News that talks of starting the new clinic started in April, picked up speed in May and materialized by July, when they first opened their doors.

Jennifer Possick, medical director of the Winchester Chest Clinic, said that the generosity of patients who faced extremely trying challenging circumstances earlier in the pandemic has been incredible to witness.

“They were alone in rooms for the majority of the day,” she said. “They were suffering through an illness that nobody knew anything about, they came out to recover in a society where we were all socially isolated from one another and despite all of that so many of these patients come to the clinic and say what can I do to help you understand what we’re all going through.”

According to Naftali Kaminski, YNHH chief of Pulmonary, Critical Care and Sleep Medicine, some genes can confer a genetic predisposition for lung injury, scarring and fibrosis, which are symptoms associated with severe cases of COVID-19. 

If this genetic predisposition were like gasoline, COVID-19 would be the spark that sets its potential on fire. Without a spark, the gasoline may never incendiate, but when stoked by events like COVID-19, dramatic damage can occur.

“What I think is happening is that, usually, in our lifetimes, we don’t get exposed to the events that would uncover our genetic predispositions,” Kaminski said. “So when we have sort of a wildfire type of pandemic, the chances of an injury meeting a genetic predisposition are much higher.”

Kaminski explained that in a scenario such as a global pandemic in which millions of people are infected, even rare complications can become significantly prevalent. Phenomena that have a 0.001 percent chance of occuring, for example, can afflict one thousand people when one million are infected. 

He also added that, because many coronavirus symptoms are non-specific, the pandemic presents physicians with the challenge of having to treat patients while developing an understanding of why they may be feeling unwell. 

“Usually in medicine, we take care of patients based on our knowledge and evidence, but with COVID-19 we have to generate the evidence while we take care of patients,” Kaminski said.

Denyse Lutchmansingh, clinical lead physician of the post-COVID-19 recovery program, told the News that one of the most aggravating enigmas shrouding post-COVID effects is the development of persistent symptoms even among those who did not have a complicated course of infection. 

According to Lutchmansingh, to date, the new program has seen more patients who were not hospitalized than those who were.

“I think for a long time we were told that …  those who had mild disease would resolve very quickly if they ever got COVID, they’d move on in life and they’d feel better, and the people who you really need to be concerned with are those who were severe disease patients,” Lutchmansingh said. “But the majority of our clinic patients are actually patients who had mild disease.”

Lutchmansingh described a concept colloquially known as “happy hypoxia,” under which patients who experience a significant drop in oxygen saturation levels do not present with any symptoms. 

Although this puzzling phenomenon has been observed in some COVID-19 patients, there is currently no scientific consensus on why it happens.

“It’s difficult for the patients because normally, when you are diagnosed with something, you go to your physician, they tell you you have disease X, this is what it will do, this is how it will feel, this is how it will progress,” Lutchmansingh said. “For patients with post-COVID syndrome, it’s not clear to anybody how long it’s going to affect them.”

Possick highlighted that some post-COVID-19 patients present concerning symptoms with completely regular exams. Conversely, it is sometimes not until other patients perform muscle strength endurance tests that they start demonstrating visible symptoms. Some can present normal lung function while at rest, she said, but show changes in oxygen levels when moving. 

Because this complex presentation of symptoms can exacerbate the challenge of understanding why patients are feeling unwell, paying close attention to what people have to say becomes even more essential than usual.

“The first and most important part of what we do is we spend a lot of time listening to the patient, because the story is very rich and there’s a lot buried in their experience,” Possick said. “If we don’t allow them to tell the whole story of what they are experiencing, it’s easy to miss a lot of other things that are going on with them physically, functionally and psychoneurologically.”

Possick pointed out that the team was lucky to work in a supportive hospital, with people who recognized that COVID-19 would leave behind a large population in need of special pulmonary attention.

Kaminski also highlighted that the expeditious implementation of the program, even while the hospital contends with real financial stressors, was a significant achievement.

“Coming within a few weeks, renovating a space, staffing it and creating it … shows how forward-thinking the leadership of the hospital is,” he said.

The Winchester Chest Clinic is located on 789 Howard Avenue.

Maria Fernanda Pacheco | maria.pacheco@yale.edu