Prior to January 2020, COVID-19 was quickly taking over everywhere except in the United States. However, we were swiftly initiated into the pandemic club. It has now been just over a year since the first case was confirmed. Because the pieces fell rapidly, picking them up has been a balancing act.
As healthcare providers, we have needed to figure out answers to several questions simultaneously. How do we slow the spread? What are the best treatment options? What constitutes normal and when does that happen? However, the most challenging of them all has been managing the COVID-19 long haulers. There are many unknowns and the scariest is the arbitrary course of this sequelae.
As Occupational Medicine providers, we are well-versed in return-to-work programs, but I must say that this pandemic has charted unfamiliar territory. This pandemic has shifted the way we return patients to work. I am sure providers who assign impairment ratings and perform disability exams will be called upon to address the Long Haulers as well. Like most large healthcare centers, we have many employees who contracted COVID-19 and we are faced with how to safely return them to work. We have no way to predict who will have better outcomes.
What we as healthcare providers do know is that this task requires a multi-disciplinary team. Consortiums and conglomerates are popping up in various healthcare systems throughout the United States. These Long-Hauler Think Tanks are increasing in number, as healthcare facilities solidify these teams by naming them, which I believe is a great treatment modality. Long Hauler multi-disciplinary teams provide a sense of security for patients, in that their trusted healthcare provider has all the resources under one umbrella to address their needs.
I have been charged with developing return-to-work programs for the COVID-19 Long Haulers at my home institution. All of my Long Haulers have touched me, but there is one I would like to highlight. I will refer to her as “Daisy” to preserve anonymity. She is a female nurse in her early 40s who contracted COVID-19 approximately 9 months ago.
She described her terrible fight to stay away from the Emergency Department as she battled COVID pneumonia at home on inhalers and high-dose steroids over a 3-week period. She explains the fear that at times overtook her husband as he urged her to seek a higher level of care while she was determined to remain at home because if she lost the battle, she wanted to die with her loved ones near. She continued to convalesce at home, battling the fatigue and eventually muscle aches as well as bone pain that was also debilitating.
By December, she was faced with another difficult reality and this time it involved her financial wellbeing. She was operating in the negative on her household budget while receiving a portion of her normal pay. Daisy reached out to her human resources department and requested to return to a modified position. Her request was fulfilled, and she returned, but this was not the end of COVID-19’s taunts and reminders.
Her blood pressure and heart rate took her on a roller coaster ride that would only respond to beta blockers. New findings on an echo called for a not-so-chance meeting with Cardiology. The muscle and bone pain led her physician down a path of connective tissue workup, which did not yield a definitive diagnosis. In the meantime, she makes light of her brain fog when she becomes lost while driving with her kids by convincing them that she is testing their knowledge. At times she is unsteady on her feet and even becomes tearful as she reflects on the path COVID-19 has carved thus far.
In the end, she describes her new role as a nurse that has taken her away from direct patient care. She observes the EKG monitors, which has enabled her to add a new skill to her armamentarium. Daisy is now continuing her care with Occupational Medicine, Cardiology, Physical Therapy, and Neurology. This is the beginning of my journey with Daisy, but I am hopeful that this tough Long Hauler will continue to win!
