About two weeks into TerryAnn Osbourne’s bout of COVID-19, she started having trouble breathing. Long plagued by chronic asthma, she felt dizzy and had chest pain; it would later turn out that her blood oxygen level was dangerously low. “I was very scared,” said the patient care technician at LIJ Forest Hills.

But Ms. Osbourne never had to go to the hospital. Instead, she became one of a growing number of patients in Northwell’s Coronavirus-Related Outpatient Work Navigators (CROWN) program. CROWN and a related program, COVID Ambulatory Resource Support (CARES), were developed at the height of the COVID surge to provide help for people infected with the novel coronavirus so they can recover at home.

“What we saw in the COVID surge was that 80 to 90 percent of patients never went to a hospital,” said Thomas McGinn, MD, Northwell’s senior vice president and deputy physician-in-chief, who created CARES. “Northwell doctors probably managed 30,000 to 40,000 patients who were never admitted. We put these programs together to make sure those patients and their primary care physicians have the support they need.”

Together, CARES and CROWN are designed to care for just about anyone with COVID-19 who doesn’t need intensive care. The programs also provide services for COVID patients who still need help after discharge from the hospital.

That accounts for a broad range of illness severity, so the programs have a wide reach. For instance, many people with COVID-19 have only mild symptoms but may lack the social support they need to easily care for themselves at home.

Others are significantly ill for weeks, never quite needing admission but requiring substantial management and specialized knowledge. In such cases, CARES gives primary care doctors step-by-step guidance for treatment, including when to schedule a telehealth appointment, when an in-person visit is needed and when it’s time for a higher level of care, among other things. CARES coordinates Northwell programs such as Northwell Health Solutions, home care, post-acute services, primary care and various specialties.

For seriously ill patients like TerryAnn, CROWN is called into play. Developed by pulmonologist Gita Lisker, MD, the program provides a nearly hospital-level of care. “CROWN is for patients who are not emergency-room sick but who have high-risk features,” Dr. Lisker said, such as shortness of breath, persistently high fever or severe nausea.

Once a doctor reaches out to get a patient into the CROWN program, things happen fast. Typically, the patient is visited by a home care nurse for a check of vitals, and a phlebotomist for COVID-specific blood tests. In many cases, oxygen is delivered to the home; the patient may also have an IV line put in, and even get an X-ray done by a portable machine. “And that’s just on the first day,” Dr. Lisker said.

When TerryAnn’s condition worsened, Northwell allergy and immunology specialist Mitchell Boxer, MD, who had long managed her asthma, reached out to Dr. Lisker. A pulse oximeter reading showed her blood oxygen level dipping down to 90; by 9pm that night, she was getting breathing treatments with the oxygen that had been delivered. Blood tests done in her home over the next few days showed an increased risk of blood clots, so she started on an anticoagulant.

Later, she began to experience dizziness and light-headedness, and Dr. Lisker arranged for her to see a cardiologist — by then, TerryAnn was no longer contagious. Fortunately, her heart was doing fine. She plans to return to work soon.

“If not for Dr. Lisker and Dr. Boxer, I would have been in the hospital,” she said. “I would be on a vent right now.”