Opened in May 2020, UC San Francisco’s OPTIMAL Clinic (pOst-covid-19/PosT-Icu MultidisciplinAry cLinic) is one of the first clinics in the country established to provide follow-up care for patients who have recovered from COVID-19. The clinic’s goal is to optimize patient recovery through a centralized resource designed to coordinate with primary care services.
The OPTIMAL Clinic streamlines access to specialists, including pulmonologists, geriatricians, mental health specialists, physical therapists, pharmacists and others, to care for patients who were hospitalized with COVID-19 or have persistent symptoms. These patients, some of whom refer to themselves as long haulers, present with one or more symptoms of the condition known as long COVID.
According to the Centers for Disease Control and Prevention (CDC), long COVID encompasses a wide range of new, returning or ongoing health problems individuals can experience four or more weeks after first being infected with SARS-CoV-2. Symptoms may include fatigue, dyspnea, cognitive impairment, anxiety, loss of taste and smell, paresthesia, palpitations and many others.
Positive patient outcomes at the UCSF OPTIMAL Clinic
More than 300 patients have been treated at the clinic to date. “We’re applying the best practices of evidence-based medicine to this unique population,” said UCSF pulmonologist Lekshmi Santhosh, MD, MA, founder and medical director of the OPTIMAL Clinic. “We’re seeing patients improve in terms of their symptomatic distress.” Santhosh is the lead author of a recent article in CHEST describing proven techniques for rapidly designing and implementing post-COVID-19 clinics adaptable for use by other institutions.
According to Santhosh, the most common long-COVID symptoms seen in patients at the clinic are fatigue, shortness of breath and chest pain. However, "there is no one definition of long COVID,” Santhosh said. “There is a spectrum of severity and a lot we’re still learning about what these persistent symptoms are and how to predict who will get them and who will recover quickly.”
Various organ systems can be affected by COVID-19, both acutely and in the longer term. Patients who come to the OPTIMAL Clinic may see different specialists depending on their symptoms. For example, patients experiencing cognitive impairment have benefited from participating in neurocognitive therapy at the clinic.
“Not all that ‘long hauls’ is long COVID,” Santhosh cautioned. She advises patients not to assume new symptoms are related to long COVID and to be evaluated for other possible causes.
COVID-19 research at UCSF
The OPTIMAL Clinic collaborates with UCSF researchers on studies such as:
COMET (COVID-19 Multi-Phenotyping for Effective Therapies)
For the COMET study, biological samples of blood, respiratory secretions and viral shedding in nasal secretions from patients with COVID-19 are collected and analyzed. The goal is to identify immunophenotypic features for the development of effective therapeutic interventions.
LIINC (Long-term Impact of Infection With Novel Coronavirus (COVID-19))
LIINC is a study of volunteers who were previously infected with SARS-CoV-2 and have recovered from acute infection. The study is designed to provide a specimen bank of blood and saliva samples along with carefully characterized clinical data. LIINC specimens will be used to examine multiple questions involving the virologic, immunologic and host factors involved in COVID-19, with a focus on understanding variability in the long-term immune response among individuals.
Patient case study: an elderly woman recovering from long COVID
An 83-year-old Spanish-speaking woman with type 2 diabetes mellitus, hypertension, and hearing loss was hospitalized for COVID-19 pneumonia. Her hospitalization was complicated by prolonged intubation in the ICU, delirium, stroke and dysphagia. The patient was discharged to subacute rehabilitation at a local skilled nursing facility and later discharged home breathing room air. However, she remained dyspneic, anxious and socially isolated.
The patient lives with a daughter, who is her designated power of attorney. Their local hospital does not have a post-COVID-19 or post-ICU clinic, so the daughter asked her mother’s primary care physician about how and where to seek specialized care for her mother’s complex recovery process.
The patient was referred to the UCSF OPTIMAL Clinic. There, she received pulmonary function tests to assess her dyspnea, referral to pulmonary rehabilitation, instructions on breathing exercises, and a detailed mental health evaluation for her anxiety. In addition, the clinic’s pharmacist deprescribed nonessential medications. Ultimately, the patient told the team, “I feel like I understand my recovery process better and feel hope again.”
Adapting to an evolving condition
The OPTIMAL Clinic team meets regularly to review patient outcomes, the latest COVID-19 studies and clinic operations. Using an iterative approach, the team adapts care plans for patients based on accumulating information. "Because this is a new condition, all of us are working together to find knowledge, share it and make sure everyone’s on the same page," Santhosh said.
UCSF Medical Center is ranked as the best hospital in Northern California for pulmonology by U.S. News & World Report’s 2021-2022 Best Hospitals survey.
To learn more
UCSF Pulmonary Practice at Parnassus
Phone: (415) 353-2961 | Fax: (415) 353-2568
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