Veterans Health Administration takes on one of the pandemic’s most vexing challenges

The best listening experience is in Chrome, Firefox or Safari. Subscribe to Federal Drive’s daily audio interviews at Apple Podcasts or PodcastOne.

For many people who contract the COVID virus, the illness comes and goes. Others develop what is known as long-term COVID. Symptoms last for weeks or months. The Department of Veterans Affairs has developed what it calls a comprehensive health approach to long-term COVID. With how VA practitioners are dealing with prolonged COVID, Federal Drive with Tom Temin spoke with Dr. Elizabeth Brill, deputy assistant secretary for health.

Tom Tom: Dr. Brill, good to have you on the job.

Elizabeth Brill: Thank you very much, good to be here today.

Tom Tom: And let’s set the scene here. What exactly is long-term COVID? I think it’s kind of self-explanatory. There’s a lot to it, isn’t there?

Elizabeth Brill: Yes it is. So there are several different definitions from different health organizations. But essentially, long-term COVID is when symptoms either persist or return long after the initial COVID infection has occurred. So four to 12 weeks after. And there are a number of different symptoms. So not everyone will experience long-term COVID the same way. Many different body systems are involved.

Tom Tom: And I think at this point in history, we don’t know how long it can really last?

Elizabeth Brill: This is correct. We don’t know that.

Tom Tom: And how prevalent is this among the veteran population the VA serves? Do we know?

Elizabeth Brill: Well, studies so far show that long-term COVID occurs in about 4-7% of patients who have had COVID. However, again, these are early numbers and we may determine this number to be higher or lower over time.

Tom Tom: And have VA statisticians been able to link it to any particular demographic? Is it more prevalent in males versus females, age group or any other prerequisites that may exist?

Elizabeth Brill: Yes, it seems to be more prevalent in women. It is also more common in people who, early in their COVID infection, had respiratory symptoms as their chief complaint, and is also more likely in people who had a worse initial course of COVID, such as people who ended up in the ICU. instead of someone who was asymptomatic. However, even asymptomatic people can develop COVID for a long time.

Tom Tom: Wow, so much reason to be scared, since we think we’re coming out of this. Tell us about the efforts at VA to develop the whole health approach you have.

Elizabeth Brill: So initially, our community of practice, which is essentially a number of physicians from all different fields, came together organically as they began to see COVID and try to understand it and share knowledge across the VA system. It became clear as our researchers were observing during COVID—and the VA was one of the first to really notice this phenomenon—that we needed to create a truly comprehensive guide that we could share with all clinicians so that they could knew the long COVID and what to do. And so we’ve put together a project team to assess, refer and treat long-term COVID. And that’s it guide to overall health which we are talking about today.

Tom Tom: And what are the disciplines that joined here?

Elizabeth Brill: Oh, so many, from respiratory to cardiology to mental health. There are about 10 organ systems. So all these specialists were involved in the development of this guide.

Tom Tom: Mental health. It’s also an interesting thing. It seems like someone’s mental state can have an effect on their ability to fight this?

Elizabeth Brill: So mental health – two components: it’s part of a long COVID-19, some anxiety and depression, and some brain fog that can happen in long COVID. Additionally, our approach to long-term treatment of COVID is a whole health approach that truly includes the veteran in their care. And so their ability to really connect and focus can be affected by whatever underlying mental health condition they have.

Tom Tom: And this is just an off-the-wall question: Are there any service-related prerequisites, such as burn pit exposure, or something like that related to long-term COVID? Or is that a bit of a stretch?

Elizabeth Brill: Not that we have seen so far.

Tom Tom: We are talking to Dr. Elizabeth Brill. She is the deputy assistant secretary for health and clinical services at the Department of Veterans Affairs. So what does the whole health treatment consist of? What are some of its elements that you are proclaiming?

Elizabeth Brill: Holistic health as a concept includes the veteran at the center; they think about what is important in terms of their goals and what they are able to participate in their health care. Then there is a community approach and an alternative medicine approach that goes along with traditional medical approaches such as traditional medications and therapies. And so whole health includes all of these together.

Tom Tom: What are some of the non-traditional effects, or things you can get or do?

Elizabeth Brill: Well, we look at biofeedback and acupuncture and breathing techniques and exercises like tai chi or yoga. These are some of the non-traditional elements of caring for a veteran with chronic COVID that, as you can see, they can have a lot of influence over themselves by choosing to choose those therapies.

Tom Temin: MeI’m sure if you’ve looked far enough somewhere, someone is describing some sort of cannabis or CBD approach here. Is this possible within the VA system?

Elizabeth Brill: Not within the VA system per se at this time.

Tom Tom: OK. So does the VA itself administer acupuncture and Tai Chi and these kinds of things? Or do you just encourage patients to go look for it themselves, perhaps from some of the care providers in the community?

Elizabeth Brill: In fact, the VA offers many, if not all, of these alternative therapies, depending on where the veteran is located.

Tom Tom: And is one of the theories of that maybe it might not do anything, but if you believe it will, it’s kind of a placebo effect, then that’s just as good as if it actually has a physical manifestation?

Elizabeth Brill: So the placebo effect is definitely well described in medicine. And so it is important. And much of this therapy is about a general sense of well-being. And so, if yoga, relaxation, mindfulness increases the sense of well-being, then we would consider it a success.

Tom Tom: And the guide now that you’ve published, is that just for internal use at the VA, or are you announcing this widely in the medical field?

Elizabeth Brill: We are trying to promote it across the country to VA and non-VA clinicians. We’ve put so much work into putting this together, we think it’s a great product. The small fact sheets for each symptom are very easy for a clinician to use, even someone who is not very familiar with long term COVID. And so the VA wants to share that across the country with all doctors.

Tom Tom: What are the most common symptoms that can be treated with this approach? Do we know the hierarchy here?

Elizabeth Brill: The most common symptoms that we generally see are respiratory and cardiological type symptoms, like heart rate, or some of them would have to be measured in a clinic – heart function and also the development of diabetes can increase after COVID. This must be measured by laboratory tests.

Tom Tom: So then there may be a dietary component to the whole health approach, especially when you mentioned diabetes.

Elizabeth Brill: Absolutely. Diet as well as exercise are both important components of overall health.

Tom Tom: But if you think you’ve had COVID for a while, then you’re a veteran, don’t live with it. There is some help you can really get right now.

Elizabeth Brill: Yes. And we have a veteran-facing guide that asks the veteran questions that they can make notes to themselves and send to the clinician and tell what their symptoms are so that they can be guided in the direction appropriate, in terms of specialty referrals.

Tom Tom: Dr. Elizabeth Brill is the deputy assistant secretary for health and clinical services at Veterans Affairs. Thank you so much for joining me.

Elizabeth Brill: Thank you very much.