For some people, recovery from COVID-19 is a long and puzzling process, with symptoms including fatigue, brain fog and coughing that linger for weeks or even months beyond initial diagnosis.

"We don't know why some people seem to bounce back quickly and others don't," said pulmonary specialist Dr. Mike Czarnecki, who recently launched a clinic at his office on Highway 153 specifically to treat and research these 'long COVID-19' cases. "These long-haulers have a prolonged period of inflammation that just doesn't turn off that's causing damage."

The finishing touches were going in at his new clinic early this year when Czarnecki realized he could make a few changes and serve people who couldn't seem to shake their COVID-19 symptoms.

"The pandemic hit right at the moment where the contractors were still available," Czarnecki said. "We made our space a self-contained space, with an individual high-vac setting so we could have a separate scrubber from the rest of the building. We knew we need better filtration, and ultraviolet capability in the ventilation system."

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Chattanooga clinic focuses on COVID-19 long-haul cases

In September, he started offering a post-COVID-19 recovery clinic one Friday a month. It filled immediately. He expanded it to two Fridays a month. Again, it filled. Now he's shifting to make every Friday a post-COVID-19 clinic day.

"We're expanding it as the need is there," Czarnecki said. "There's an underserved need, this is what I do as a pulmonologist, and I've got to lean into it, we've got to serve this population somehow."

About 10% of COVID-19 patients become long-haulers, according to a recent article in the Journal of the American Medical Association, as well as a study from a team of British scientists.

Last week, Hamilton County reported a record 260 COVID-19 cases in one day, as well as 104 hospitalizations — the most since the mid-July surge that led to the deadliest month for COVID-19 with 27 deaths in August. Of those current patients, 30 were in the intensive care unit, which is the highest number of ICU coronavirus patients reported in local hospitals since Aug. 8.

The main challenge in treating persistent cases of COVID-19 lies in the fact that this is a novel virus — one that no one has seen or treated before, Czarnecki said. The science evolves constantly, and physicians working in emergency and general medical settings can't always keep pace with the rapid development of treatments for complex cases, he said.

"Everything keeps changing almost every seven days," he said.

Czarnecki modeled his post-COVID-19 clinic after similar facilities he learned about from colleagues in New York City, he said. There's an emphasis on connecting with major medical institutions, including Duke University and the Cleveland Clinic, that run global clinical trials, and evaluating patients for inclusion in those trials, Czarnecki said.

"I'm a guy they come to and they need 30 patients that meet these criteria," he said.

Many of his patients come to him after they've been released from the hospital, and the initial symptoms of their illness have abated, but they aren't having any treatment for persistent, long-term symptoms.

"We want to make sure they're no longer infectious, take time to review their films and get them on the right meds, and get them involved in whatever clinical trial may be available," he said.

Contact Mary Fortune at Follow her on Twitter at @maryfortune.