Post-COVID-19 Program

UT Health Austin’s Post-COVID-19 Program aims to create an educational community in which healthcare professionals can come together to learn more about post-acute sequelae of COVID-19 (PASC) infection, an increasingly recognized syndrome in which patients continue to experience symptoms of COVID-19 months after initial infection. The Post-COVID-19 Program’s mission is to expand the collective capacity to care for these patients across Central Texas by developing clinical guidance and educational support for frontline healthcare professionals.

Many answers to the questions you have about the Post-COVID-19 Program and PASC can be found below.

    Post-COVID-19 Program

    At UT Health Austin, we focus on you, the whole patient, making sure that you have the support you need throughout your care. We take a multidisciplinary approach to your care, meaning you will benefit from the expertise of multiple specialists across a variety of disciplines. This multidisciplinary, coordinated care model makes it easier for patients to get the care they need without having to make multiple trips to various locations. Our goal is to help patients recover from the lasting effects of COVID-19 through rehabilitation and other therapies designed to restore their function and quality of life.

    Our experienced healthcare professionals deliver personalized, whole-person care and treat each patient as an individual with unique circumstances, values, and beliefs. During your visit, you will undergo an initial in-person or telehealth visit with a healthcare professional who will evaluate your wellness, including personal, mental health, cognitive, and rehabilitation needs. After the assessment has been completed, our providers will recommend a personalized care plan and provide referrals to other medical specialists as needed. Every phase of your assessment and all recommendations will be shared with your primary care provider as well as any designated caregivers.

    Screening methods include:

    • General health questionnaire
    • Post-COVID-19 symptom questionnaire
    • Medication consult and reconciliation
    • Montreal Cognitive Assessment (MoCA)
    • Mental health screening assessment for depression (PHQ-9), anxiety (GAD-7), and PTSD (PC-PTSD-5)
    • Social and financial impact of COVID-19 (Austin IMPACT Survey)

    We provide a broad spectrum of care for individuals who were diagnosed with COVID-19 and continue to experience various physical, cognitive, and functional difficulties several months after initial diagnosis. Our services are available to patients whether their symptoms ranged from mild to moderate or they experienced hospitalization as we are aware that many COVID-19 patients who recovered from the illness at home may also be experiencing lingering symptoms or disabilities that can be improved through rehabilitation and other therapies.

    The Post-COVID-19 Program is committed to studying and developing treatments for this new disease. Patients may have the opportunity to meet with a research coordinator to discuss their interest in participating in ongoing studies at The University of Texas at Austin. We also collaborate with our colleagues at the Dell Medical School and The University of Texas at Austin to utilize the latest research, diagnostic, and treatment techniques, allowing us to learn more about this emerging disease and develop diagnostic and therapeutic guidance as well as referral pathways to specialty providers.

    The Post-COVID-19 care team includes internal medicine specialists, neurologists, nurses, advanced practice providers, social workers, and more, who work together to help you get back to the things in your life that matter most to you.

    Yes, appointments with the Post-COVID-19 Program are available by referral only. Speak with your primary care provider to request a referral.

    If you need assistance with getting a referral, please call the Post-COVID-19 Program at 1-833-UT-CARES (1-833-882-2737) and we will be happy to help.

    UT Health Austin accepts most insurance plans in Central Texas. To view a complete list of accepted insurance plans, please visit here.

    For patients without insurance or who prefer to pay cash, we offer self-pay options. Self-pay patients are offered a prompt pay discount or payment plans.

    For questions about our payment options or to verify that we accept your particular insurance plan, please call our Access Center at 1-833-UT-CARES (1-833-882-2737).

    Please note: Insurance plans are subject to change at any time and without notice. A patient’s level of coverage depends on the specific benefits described in their plan. Patients are responsible for verifying that UT Health Austin is a participating provider and that their benefits plan allows them access to care on the day of their first scheduled visit. Please contact your insurance plan or benefits administrator to verify this information.

    To explore FAQs regarding your upcoming visit, please visit here.

    UT Health Austin’s Post-COVID-19 Program is committed to providing compassionate, whole-patient care to ensure patients are receiving the highest level of specialized care. We believe you deserve the best possible care, which is why we’ve compiled resources that may be beneficial to you.

    Explore our list of patient resources.

    The Dell Medical School at The University of Texas at Austin hosts case conferences, which are a part of a series known as the Austin PASC Collaborative. During these case conferences, community healthcare professionals present cases to and receive feedback on diagnosis, management, and the emerging science of post-acute sequelae of COVID-19 (PASC) infection from an expert panel consisting of specialists across internal medicine, neurology, pulmonology, and rheumatology as well as behavioral and mental health.

    If you are a healthcare professional interested in participating in these case conferences and joining the learning community, please complete the Austin PASC Collaborative Case Conference Registration Form.

    If you are a healthcare professional interested in submitting a case to receive feedback from our expert panel, please fill out the Austin PASC Collaborative Case Submission Form.

    To view upcoming case conferences, please visit here.

    To view case summaries from past conferences, please visit here.

    To view the most up-to-date clinical guidance, please visit here.

    Please Note: This information is intended for healthcare professionals, specifically primary care providers. These are not meant to be guidelines or supplant individual provider discretion in the management of PASC, as evidence-based consensus guidelines for the diagnosis of management of this new disease do not exist currently. The following represents the expert opinions of an interprofessional group that is appraising emerging evidence and should be interpreted as recommendations and clinical guidance rather than the standard of care.

    Post-Acute Sequelae of COVID-19 (PASC) Infection

    Post-acute sequelae of COVID-19 (PASC) infection is an increasingly recognized syndrome in which people continue to experience symptoms of COVID-19 months after initial infection. PASC is also known as “post-COVID” or “long-COVID,” and many patients with PASC often refer to themselves as “long-haulers,” although the scientific community has not fully agreed on an official name for these patients. COVID-19 “long-haulers” experience a wide variety of symptoms, including fatigue, persistent dyspnea, neurocognitive changes, depression, and anxiety.

    Symptoms of PASC vary from person to person. The most common symptom of PASC is chronic fatigue, which includes exhaustion, tiring with exertion, and brain fog (e.g., difficulties with memory, lack of concentration, headaches, confusion, and decreased mental clarity). PASC can also lead to more serious health conditions, such as heart damage, lung damage, blood clots, and blood vessel problems. Surviving the experience of PASC may also lead to posttraumatic stress disorder, depression, and anxiety.

    Symptoms of PASC may include:

    • Fatigue
    • Difficulty sleeping
    • Persistent cough
    • Shortness of breath or difficulty breathing
    • Chest pain
    • Headaches
    • Joint or muscle pain
    • Loss of smell or taste
    • Rash
    • Hair loss
    • Rapid or pounding heartbeat
    • Depression or anxiety
    • Fever or night sweats
    • Inability to control body temperature
    • Constipation
    • Diarrhea
    • Memory problems or difficulty concentrating
    • Dizziness
    • Confusion
    • Worsened symptoms after physical or mental activities

    Symptoms of PASC vary from person to person. It may take weeks, months, or even longer for symptoms to go away completely. Initial studies show that most people are improving slowly over time; however, we are in the beginning stages of understanding PASC and being able to predict recovery times.

    There is still a lot we do not know about PASC. In the absence of evidence-based guidelines for the diagnosis and management of this new disease, we are working to learn as much as we can about this emerging disease so that we can develop diagnostic and therapeutic guidance as well as referral pathways to specialty providers. Potential treatment options may include a combination of physical rehabilitation, breathing and mental exercises, and medications. Treatment options will look different for each person as treatment is based on that person’s specific symptoms.

    There are currently no FDA-approved therapies for PASC. Research is still in the preliminary stages, and as it is released, clinicians and patients must continue to examine and evaluate any published studies in a vigorous scientific manner.

    Research and approval of new medications or treatments is a slow process, requiring strict protocols to protect the safety of volunteer participants in the trials and to ensure the treatment has its intended effect over time. Researchers across the country are working hard to develop these treatments, and as they become available, people can consider participating if they are eligible

    PASC is more common in people who experienced severe symptoms of COVID-19 that required hospitalization. However, anyone can experience PASC, including younger adults and otherwise healthy people as well as people who experienced mild symptoms of COVID-19 or were asymptomatic.

    Risk factors for PASC may be associated with:

    • Older age
    • Number of symptoms
    • Higher BMI
    • Female sex
    • History of asthma

    If you are continuing to experience symptoms of COVID-19 months after initial infection, speak with your primary care provider about being referred to a multidisciplinary care team with expertise in PASC.

    If you need assistance with getting a referral to UT Health Austin’s Post-COVID-19 Program, please call 1-833-UT-CARES (1-833-882-2737) and we will be happy to help.

    People with PASC continue to experience symptoms of COVID-19 months after initial infection, and most people with COVID-19 are no longer contagious 10-20 days after their symptoms begin. While PASC is not as contagious as the initial infection, it is still recommended that all PASC patients receive a COVID-19 vaccination and take the appropriate health precautions to prevent re-infection.

    To receive a COVID-19 vaccination through UT Health Austin, please visit here.

    People who have had COVID-19 should get vaccinated once they do not have a fever and their healthcare provider believes that they have recovered from the initial infection. This timing is usually 10-20 days from the time symptoms begin for those people who were not hospitalized.

    For people who received monoclonal antibody or convalescent plasma treatment, they should wait 90 days after treatment completion to ensure that the body produces its own antibodies.

    To receive a COVID-19 vaccination through UT Health Austin, please visit here.

    There have been studies reporting that a small portion (~25%) of people with PASC may experience improvement of their symptoms after COVID-19 vaccination. There is a smaller portion (10-15%) who may experience worsening of their symptoms. However, most people will experience no changes in their symptoms aside from any temporary side effects of the vaccine (e.g., pain, redness, or swelling at the injection site; fatigue; headache; chills; muscle pain; or joint pain), which is normal as vaccines are designed to elicit a slight immune response. Therefore, it is recommended that most people receive the COVID-19 vaccine after their initial infection because it can raise their immunity by 25- to 1000-fold.

    If your PASC symptoms got worse following the first Pfizer or Moderna vaccine, it is recommended that you discuss whether to receive a second dose with your primary care provider. Receiving both doses offers maximal protection; however, natural infection in addition to a single dose of vaccine can still provide significant protection.

    PTSD is common following COVID-19, with 6% of survivors receiving their first psychiatric diagnosis within 90 days of illness and up to 30% of all ICU survivors experiencing PTSD at some point following illness.

    PTSD symptoms may include:

    • Flashbacks
    • Nightmares
    • Hypervigilance
    • Avoidance
    • Irritability
    • Anxiety
    • Depression

    Speak to your primary care provider about being screened for PTSD and/or request a referral to a mental health provider for further evaluation and therapy. Available evidence-based treatments include trauma-focused CBTp (cognitive behavioral therapy for psychosis), cognitive processing therapy, EMDR (eye movement desensitization and reprocessing), and exposure therapy.

    Upwards of 80% of people with PASC experience some degree of brain fog, including issues with memory, lack of concentration, headaches, confusion, and decreased mental clarity. Going on daily walks and engaging in brain games, such as crosswords and puzzles, can help refocus the brain as long as the activity is enjoyable.

    Current recommendations include:

    • Decreasing screen time
    • Improving sleep hygiene habits (e.g., approximately 8 hours per night, no screens in the hour prior to bed)
    • Regular exercise
    • Avoiding alcohol and coffee

    It is recommended that most patients with PASC be engaged in a supervised and graduated rehabilitation plan. This means that patients should have a healthcare professional develop a personalized exercise plan that avoids over-exertion and promotes healthy lifestyles. A physical therapist can develop this plan for most patients.

    For patients with a history of heart disease or cardiovascular risk factors, cardiac rehabilitation aims to reduce cardiovascular risk factors in patients by focusing on lowering blood pressure; improving control of cholesterol levels and diabetes; and implementing tobacco cessation counseling, behavioral counseling, and graded physical activity. This typically includes 36 sessions of monitored graduated exercise over the course of 12 weeks. While cardiac rehabilitation is not specific to PASC and physical therapy will likely be enough for most patients, many of the principles of cardiac rehabilitation overlap and may also help address heart health issues in people with PASC.

    Neural retraining is a program focused on using elements of cognitive behavioral therapy, mindfulness practices, behavior modification, and emotional therapy. While there are currently no FDA-approved treatments for PASC, many of the tenets of neural retraining may help address mental health symptoms and cognitive dysfunction commonly associated with PASC.

    There are currently no FDA-approved treatments for PASC. Current management consists of treating end-organ damage with evidence-based therapies for those specific organs (e.g., heart failure or chronic kidney disease), rehabilitation with physical therapy, and management of symptoms.

    NADH is not a part of the standard treatment regimen in PASC, although it can be purchased as a nutritional supplement in most pharmacies or vitamin stores without a prescription. There is little potential harm in moderate NADH supplementation as it is well-tolerated; however, evidence does not demonstrate any definitive benefit for chronic fatigue syndrome. Data shows that NADH may lead to small benefit in symptom improvement (e.g., reduction in anxiety) in chronic fatigue syndrome, though studies cite small sample sizes. NADH has not been studied for PASC specifically.

    There are currently no FDA-approved treatments for PASC. Current management consists of treating end-organ damage with evidence-based therapies for those specific organs (e.g., heart failure or chronic kidney disease), rehabilitation with physical therapy, and management of symptoms.

    Ivermectin is a controversial medication as it has exclusively been studied for treatment of the initial COVID-19 illness and received mixed results, although a recent review of all the evidence that was published in a prestigious journal showed no benefit. Currently, the National Institutes of Health, Infectious Disease Society of America, and other major guidelines recommend against the use of ivermectin for acute illness due to incomplete data, methodological issues of available studies, and lack of clear benefit until more trials are completed.

    Some healthcare providers have publicly recommended ivermectin for PASC, although they do not cite any evidence to support its use and it is not widely accepted by most physician groups. Although ivermectin is generally safe, we only recommend taking it as part of a clinic trial.

    Tremors and sensations of total body vibration, such as a buzzing or tingling in the limbs, as well as tinnitus, or ringing in the ears, can be attributed to various neurological causes in PASC. While post-COVID-19 symptoms can be hard to describe, it is recommended that you write down as much information as possible to prior to your evaluation.

    The following information can help with your evaluation:

    • Type of tremor, including what parts of the body are affected and what the movement is like
    • Timing and duration of symptoms, including anything that may be causing the symptoms to start
    • Variation of symptoms with sleep, time of day, or stress levels
    • Medications you are taking that may affect the symptoms

    Rapid and irregular heart rates have been widely reported in PASC. The exact cause of PASC is not fully understood, but many believe it is caused by immune system dysregulation that can cause inflammation or damage to nerves throughout the body. These small nerves control heart rate, blood pressure, and other “autonomic nervous system” functions in the body. When these nerves are not functioning properly, it is called “dysautonomia,” which has been reported in patients after experiencing COVID-19 and other viral illnesses.

    Postural orthostatic tachycardia syndrome (POTS) and inappropriate sinus tachycardia causing erratic heart rate are thought to fall under the “dysautonomia” umbrella. Treatment is available for these conditions.

    People who were hospitalized have significant rates of cardiac injury, and it is recommended that a full evaluation be conducted by their primary care provider or a cardiologist. People who recovered at home very rarely experience long-term cardiac injury (less than 1%); however, they should be evaluated as well and will likely need less testing than those patients who were hospitalized.

    Nearly 75% of people with PASC experience post-exertional malaise in which exhaustion and fatigue are greater than would be expected for the effort exerted. It is important to know your limitations and to not over-exert yourself during recovery. Work with your primary care provider and physical therapist to develop a graduated exercise plan that will help you slowly build back function.

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    Additional Resources

    People with PASC frequently experience cough, chest tightness, or shortness of breath when exercising. People who required hospitalization and oxygen for their initial COVID-19 illness may have lung scarring and decreased air exchange measured on pulmonary function tests (PFTs), which evaluate the respiratory system and how well the lungs are functioning. For people who did not require oxygen or were not admitted to a hospital, the rate of lung scarring is very low and, in most cases, their PFTs are normal.

    PASC does not cause asthma, but it can cause lung problems with symptoms similar to that of asthma. If you are experiencing breathing difficulties after COVID-19 infection, it is recommended that you speak with your primary care provider about a basic initial evaluation. Testing may include a chest x-ray, labs to rule out anemia or thyroid problems, and PFTs.