David Putrino, director of rehabilitation innovations for the Mount Sinai Health System in New York City, was about to present on the Aspen Ideas: Health show Thursday morning when the news broke: About 7.5% of the American population have long to fight COVID or ongoing COVID-19.
“That was actually during my lecture — that data was released,” Putrino said in an interview Thursday afternoon.
Putrino’s work has made him an expert on the disease caused by the novel coronavirus that shook the world in March 2020. He is a physiotherapist by profession with a PhD in neuroscience. His research is focused on identifying solutions that, from a technological point of view, allow better access to healthcare. So when the pandemic struck, Putrino was in a unique position to align his work with COVID.
“I’m always doing pragmatic clinical trials on new technologies and trying to bring those technologies into practice – not just ‘We did a clinical trial and we published it and it was great’, but actually working with inventors of the technology and are working with the hospital system to find ways to ensure patients have access to the technology,” he said. “Which I think is a step that’s often overlooked in many conventional research experiences.”
With this emphasis on user nurturing — and thus interacting with actual patients — Putrino and his colleagues found they had already built an infrastructure that could be well suited for investigating COVID-19 in real time.
“We basically sat in New York and watched it all unfold, and my team ran a large number of remote patient monitoring programs,” Putrino recalls. “So we quickly took one of the apps we actually developed ourselves to monitor a condition and made it more relevant for monitoring COVID. And we just did a blast on social media and said it all listen if you have COVID symptoms and you are in New York text this number. We’ll show you how to download the app and track you every day so a doctor is watching you.”
Putrino’s first patient came on board on March 15, and he and his team were soon monitoring thousands of patients. By April, however, they noticed a growing trend: Some people weren’t leaving the app — they continued to experience symptoms far beyond what the researchers expected.
“There was one group that didn’t recover,” Putrino said. “They reported new symptoms. They said, ‘Look, I have palpitations and fatigue and cognitive impairment… all these different things.'”
At that point, about 15% of patients using the Putrino app suffered from what has since been known as Long COVID. The US Centers for Disease Control and Prevention reports that about 20% of Americans who tested positive for COVID-19 became “long-distance drivers.”
“That’s an amazing number,” Putrino said.
In Pitkin County, the number of COVID-19 patients struggling with long-term symptoms was even higher — public health officials estimated that about half of the patients who tested positive between March and August 2020, based on survey results were reported at least one symptom that lasted six months.
Putrino said there had been no official research into a link between long COVID and higher altitude, although he said the effects of altitude on body systems are well known and that otherwise unnoticed or mild long COVID symptoms could be agitated by higher elevation.
Putrino’s research has shown that there are a significant number of people still struggling with long-term COVID who may not even be consciously aware.
“What struck us is that when we screened these patients, we lost about half of our patients who self-identified … and said, ‘I had COVID; I’ve made a full recovery,'” Putrino said.
For those patients who had self-determined that they had overcome COVID-19, his team asked that they undergo screening for research purposes.
“And they would fail the screen,” Putrino continued. “They would not pass the screen, unlike our other control group, who were people who had never had COVID. We would give them the screening test and they would pass it with flying colors.”
“I think we may have more people with long COVID symptoms than we think,” he said.
And there is still work to be done, not only in properly identifying and diagnosing patients still suffering from COVID, but also in treating them. The latter is still a long way off, said Putrino. Looking at it through a data-driven lens, and familiar with the processes and the National Institutes of Health’s propensity for incremental research, he estimates that medical treatment for long COVID could take 17 years or more.
“That’s the current bench-to-bedside research,” he said of the time frame.
Nevertheless, he remains optimistic. The pandemic has created a global sense of urgency and a willingness by companies to share research and resources in the name of expediency.
“There are many organizations that are stepping up and understanding that the NIH is not moving at a pace designed for a quick cure,” he said. “It’s just a fact. I hope that we are still three to five years away from the breakthrough.”
However, until that happens – and does it in a meaningful way, where all patients of all demographics have meaningful access to care – Putrino is the bearer of the bad news: we are still in a pandemic.
He didn’t actually plan to come to Aspen for the Ideas Festival at all, but he sees the other part of his work as one rooted in advocacy, and he felt he had to speak on behalf of those whose health is too compromised to survive to speak personally about their experiences.
“I’m not saying that with any degree of judgment for others — we all need to modulate and modify our own risk,” Putrino said. “But … I happen to know that a person with long COVID was invited to speak and she declined because she didn’t feel like she could take the risk.”
Putrino, still donning a mask indoors, eased his trepidation and accepted his invitation to Aspen.
“That, to me, means being an ally of a chronically disabled community,” he said.