post-acute covid syndrome: origins and lessons talk putrino final.pdfurgent care/er patient admitted...
TRANSCRIPT
![Page 1: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/1.jpg)
Post-acute COVID Syndrome: Origins and lessons learned so far
David Putrino, PT, PhD
![Page 2: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/2.jpg)
March 2020: Mount Sinai in crisis
![Page 3: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/3.jpg)
![Page 4: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/4.jpg)
The unhappy COVID choice
Too sick for homeNot sick enough for
hospital
![Page 5: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/5.jpg)
Increasing Healthcare System Efficiency
Healthcare system capacity without RPM strategies
Healthcare system capacity with RPM strategies
Number of Daily Cases
Time
![Page 6: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/6.jpg)
Precision Recovery: The early rollout technology
![Page 7: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/7.jpg)
Acute COVID care pathway
Patient experiences COVID-19 symptoms
Patient consults Urgent Care/ER
Patient admittedPatient discharged
and referred to Precision Recovery
Patient begins Precision Recovery
Monitoring
Patient not admitted
Patient referred to Precision Recovery
Patient begins Precision Recovery
monitoring
Patient texts Precision Recovery
hotline
Patient begins Precision Recovery
monitoring
![Page 8: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/8.jpg)
The Precision Recovery Protocol
Daily physiologic monitoring and brief survey of symptoms.
Weekly video visit and data review.
Monthly video visit, data review, curricular self-management education.
3 minutes
10 minutes
30 minutes
![Page 9: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/9.jpg)
Precision Recovery: Insights from 60,000+ days of monitoring data
Patients that sought out the Precision Recovery program
self-reported the same symptomology regardless of
PCR-test status.
Tabacof et al, 2020a
![Page 10: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/10.jpg)
Fast forward to May 2020…
![Page 11: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/11.jpg)
Not everyone recovers “within two weeks”
Patient discharged from conventional care
Patient feels fully recovered
No further intervention required
~70% of cases
Patient is experiencing symptoms consistent
with post-ICU syndrome (PICS)
Enrollment into Precision Recovery:
PICS>5% of cases
Patient shows evidence of significant
pulmonary/cardiac damage
Enrollment into Precision Recovery: Pulmonary/Cardiac
rehabilitation
10-15% of cases
Patient is experiencing Post-acute COVID Syndrome (PACS)
Enrollment into Precision Recovery:
PACS10-15% of cases
![Page 12: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/12.jpg)
“Post-acute COVID Syndrome” –Demographics (from 1200 observed cases)
Gender• Female: 82%
• Male: 17%
• Non-binary: 1%
Median age: 42
COVID testing status• Positive: 16%
• Negative: 51%
• Unknown: 33%
Antibody testing status• Positive: 11%
• Negative: 32%
• Unknown: 56%
![Page 13: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/13.jpg)
Swelling
Numbness
Palpitations
Tachycardia
Thermoregulation
Syncope
Chest Pain
Fatigue
Dyspnea
Cognitive Difficulties
ConcentrationDifficulties
Anxiety
Anosmia
GI symptoms
Dizziness
Exercise Intolerance
![Page 14: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/14.jpg)
Tabacof et al, 2020b
![Page 15: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/15.jpg)
Creation of an entirely novel approach to managing a
debilitating post-viral syndrome.
Tosto et al (in prep)
![Page 16: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/16.jpg)
Multidisciplinary care is *crucial*
Medical
Nutrition
Physical Therapy
Breath work
Neuropsych
Tabacof et al. (under review)
![Page 17: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/17.jpg)
Please reach out for further information:[email protected]
![Page 18: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/18.jpg)
Acknowledgements: Clinical Team
Not Pictured: Khiara Scolari PA-C, Melissa Dickey RN, FNP, Alex Ruvinsky PT, Ariana Gluck MD, Tina Bijlani DO, Emma Keppel RN, ANP, Evelyn Dier PA-C, Meinar Chou PT, John Angeles PT, DPT, Daidre Rowe, MD
Jenna Tosto, PT Vanessa Valdes PT, MSPT Kelly Kaems PT, DPT, CBIS Loreene Correa-Esnard PT, MSPTPauline Tramantanoa PTA, CPT-
NSCA Raymond Ednie PT, DPT
Susan Feldman PT, PhD
Jenny Lieberman, PhD, OTR/L, ATP Emily Teitelbaum, OTR/L OTD Andrew Megginson PTSeva Elkanovich PT, MSPT Amanda Seidenberg MS, OTR/L,
ATPTina Sehremelis OTD, OTR/L
![Page 19: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/19.jpg)
Acknowledgements: Triage TeamFrom Left to Right (Top): Dr. Mariam Zakhary, Dr. Dayna McCarthy, Dr. Gerardo Comas-Miranda, (Bottom) Dr. Kirk Lercher, Dr. Eliana Cardozo, Dr. Vincent HuangNot Pictured: Dr. Johanna FiFi, Dr. Christopher Kellner, Dr Zijian Chen
![Page 20: Post-acute COVID Syndrome: Origins and lessons Talk Putrino Final.pdfUrgent Care/ER Patient admitted Patient discharged and referred to Precision Recovery Patient begins Precision](https://reader036.vdocument.in/reader036/viewer/2022071507/6128143b4fcd785f256c78b6/html5/thumbnails/20.jpg)
Acknowledgements: Clinical Coordinators and Research Team
Erica Breyman
Leila Nasr
Nicki Mohammadi
Connor Mensching
Hsienhua Tan
Jamal Hines
Liorah Rubinstein
Luis Ascanio Cortez
Rebecca Baron
Mar Cortes, MD
Sophia Salazar
Sophie Dewill
Susan Giorgi
Xiangna Zhang
Zachary Troiani
Lelia Jimenez
Ian Cossentino
Deeksha Chada
Daria Larine
Laura Tabacof, MD