Redefining Long COVID Care With Personalized Treatment

Many stories from the time around COVID-19 being declared a pandemic by the World Health Organization are of frontline health care workers constantly adjusting their treatment protocols. Studies are being published now about the pandemic’s impact on virtual care delivery, long COVID, and health outcomes disparities.

Noah Greenspan, DPT, PT, CCS, EMT-B, cardiopulmonary physical therapist and director of the Pulmonary Wellness and Rehabilitation Center in New York City, discusses how he and his staff adjusted their approach to care at that time, in light of realizing the complexity of each patient case would require individualized treatment plans.

In the first part of this interview, Greenspan discussed the detrimental effects of lung damage sustained from COVID-19, or another infection, and how this makes itself known through pulmonary and cardiovascular insufficiency.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

How did COVID-19 change your approach to treating patients?

COVID was very different, and COVID is very different. I've been doing what I do for about 33 years, rand prior to COVID, I knew what I had to do.… The reason why our program is called Pulmonary Wellness Complex is not because it's a complex; it's because we see complex patients. My team was very good at kind of figuring out what's going on, what is the limiting factor. Even at times when other people couldn't figure out what was going on, we could figure out and spend the time with the patient to really make sure that we keep the main thing, the main thing.

With COVID, I think I've never been wrong in such a short period of time as during COVID. It was a mixed bag. Every patient presented differently, and often the same patient would present differently from day to day, sometimes hour to hour, sometimes minute to minute. I have people who send me videos of their pulse oximeter, and we see their heart rate cycling from 80 to 150 back down to 70, back down to this.

If there's one thing I'll say about COVID and long COVID, it’s that every person must be treated as an individual. It's almost like there are certain phenotypes that we see, where we could put people and say, “Well, this person's sort of similar to this person.” But what's so challenging about this is that you really have to find each individual person's personal da Vinci code, and, first and foremost, make sure you don't hurt them. Because a lot of the things that we do with typical cardiopulmonary patients would set a COVID patient back, often for weeks or months. Sometimes you'd [see] somebody could do 2 minutes of walking in place, they could do 3 minutes of walking in place, but somehow if they did 3.5 minutes, it's like a shutoff valve for the car. A lot of what we did was trial and error.

You have to throw the tiniest pebble possible and let the pool ripple and come back, let the pool come back to calm before you try to go forward. Because I can't tell you how many times I heard this story where someone would say, “I was feeling so good…” and then it would be like, “And what did you do?” and they’d be like, “Well, I took a 5-mile hike,” or I did this, or I did that, and then they'd be knocked out for weeks on end.

It's really complex, and it has to be really geared to the patient like no other condition I've ever seen.