It won't be easy: Doctor wants to open long COVID clinic in Worcester

WORCESTER — There is no disputing that the number of COVID-19 infections are at a minuscule level compared to the height of the pandemic in 2020 and 2021. 

However, COVID remains. The latest weekly numbers from the state Department of Public Health reported 676 confirmed cases from March 24 to March 30 and three confirmed deaths. 

There’s also a phenomenon called long COVID and its numbers appear robust. The Centers for Disease Control and Prevention reports 17.4% of all U.S. adults 18 and older experienced long COVID between Feb. 6 and March 4. In Massachusetts, it’s 13.9% of all adults over the same one-month period. 

What is long COVID?

The definition of long COVID is precise: Those exhibiting COVID-19 symptoms for at least three months after being diagnosed with an acute case of the virus. A positive test or a doctor’s evaluation determines diagnosis.  

Symptoms are numerous including fatigue, fever, difficulty breathing and a cognitive malady known as “brain fog.” Effects can last for weeks, months or years. In some cases, symptoms appear, disappear and return. 

It’s just one piece of the long-COVID puzzle that has doctors and researchers scrambling to get a more complete understanding. There are many questions and not enough definitive answers including how to diagnose long COVID, who is most at risk and how to treat it. 

Currently, there is no treatment.

A recent study in the UK and published in Nature Immunology showed long COVID leads to inflammation that doctors can detect in the blood. The findings mean a possible breakthrough against long COVID are existing drugs that regulate the immune system. 

Long COVID clinic in Worcester?

Dr. Michael Hirsh, Worcester’s medical director and a pediatric surgeon at UMass Memorial Medical Center, wants to establish a long COVID clinic in Worcester. He knows it won’t be easy, but he’s determined to give a full-faith effort. 

“What we’ve learned from the pandemic is to be proactive,” said Hirsh. “The CDC is sending up smoke signals and we’re expecting to see many more patients declared having long COVID.” 

The percentages from the CDC on the condition derive from a 20-minute online survey conducted by the National Center for Health Statistics.

The CDC noted that the Household Pulse Survey has limitations compared to more traditional, in-person methods to establish disease benchmarks. Speed and real-time data were the goals of the online survey to hasten post-pandemic recovery. 

Hirsh is aware of the percentages and wants to model a Worcester clinic after one at Boston Medical Center. That hospital’s ReCOVer Long COVID Clinic has doctors in various specialties who collaborate on patient care. 

Boston Medical Center didn’t have a clinic doctor available to comment for this story. 

Like the Boston Medical Center clinic, Hirsh envisions “one-stop shopping” for long COVID patients who can see various specialists under one roof.

COVID ambassador

Hirsh is a so-called COVID ambassador, having finished a course at Boston Medical Center through the Massachusetts Community Engagement Alliance Against COVID-19 Disparities. The training focused on improving access to resources to fight COVID and long COVID in diverse communities of color hardest hit by the virus.   

Over the next few months, Hirsh hopes to lead an ambassador-training course in Worcester for staff at the city’s Department of Public Health. 

He also plans to organize a meeting of doctors that deal with long COVID symptoms. The goal is to gauge their interest in a potential clinic. That gathering would likely include pulmonologists, rheumatologists, cardiologists, gastroenterologists, neurologists, physical therapists and psychiatrists. 

Achieving consensus among that group to move forward on a clinic could be difficult and Hirsh is just getting started on what could be a long and bumpy path ahead.

"It’s very embryonic in its phase now,” said Hirsh. “It will take a little work and I don't know how much interest there will be for this.” 

'Definitely a roadblock'

Besides finding a location and staffing a clinic, there is the financial piece. Insurance companies tend to frown on the kind of “block billing” in such a clinic, according to Hirsh. Multiple medical services would be lumped into one charge instead of billing for each procedure that, Hirsh said, is a revenue stream for insurers. 

"It's definitely a roadblock," said Hirsh of the insurance piece.

If precedent is a guide, Hirsh has an uphill climb. In the 1990s he tried to establish a clinic in Pennsylvania for patients suffering with spina bifida. "I had so many hoops to go through. I couldn't get it together," he said.

There’s also what Hirsh called the “hassle factor.” That means even if a clinic is possible, where patients are screened and identified as having long COVID, there is always the possibility there is no cure for what ails them. 

“In the end, it could cause patients to be discouraged," said Hirsh. "There’s no one pill to give and that always makes the populous a little less complaint. Maybe there is initial enthusiasm, but they could be disappointed if there’s not much to offer.”    

Goal is there, but is the urgency?

Ultimately, Hirsh wants to swell the ranks of COVID ambassadors in Worcester and establish a clinic to ensure those who have long COVID get the help they need.

“My concern is it ends up being an underrepresented disease group," he said.

As for whether there's a sense of urgency to bring this kind of clinic to Worcester, Hirsh said, “I don’t have a pulse on that, yet.”  

Contact Henry Schwan at henry.schwan@telegram.com. Follow him on X: @henrytelegram.