Filenews 20 December 2020
The riddle of the long-term effects after a coronavirus disease seems to be called upon to solve for a long time the medical community, which now also faces new conditions such as "prolonged" covid-19 disease (Long covid-19).
As stated in the RES-IPA by the physician-curator B' NSI and head of the COVID department at the hospital "Alexandra" Eleni Korobokis, the term "prolonged" COVID-19 disease refers to the persistence of symptoms or the appearance of new symptoms after acute infection with SARS-CoV-2. "Extended symptoms, have great diversity, may occur even after mild disease, (and not only after hospitalization in ICU) and appear to concern all systems of the body. For this reason, the clinical approach of patients ill with COVID-19 requires a holistic treatment".
And the ideal way for this holistic treatment as Mrs Korobokis points out is to create post-covid dispensaries, such as those that are gradually being built and have started to operate in all organized health systems, offering comprehensive care to those affected by the new crown. "With the aim not only of relieving the "prolonged disease, but of restoring psychosomatic health and well-being". Covid's head of "Alexandra" stresses that patients with persisting symptoms need regular monitoring by an interdisciplinary team of health professionals. Laboratory testing and therapeutic approach should be individualized, depending on the symptomatology and clinical findings in each patient.
What specialties are needed to restore
"E.g. according to the British Thoracic Society, patients with severe respiratory symptoms need re-examination with an X-ray or axial chest after 12 weeks, while those with severe symptoms should be referred to a pulmonologist and special respiratory rehabilitation centres.". Given the multi-systemic nature of the disease, says Ms Koroboki, different medical specialties (infectious diseases, pathologists, pulmonologists, cardiologists, psychiatrists, neurologists, physiologists, rheumatologists, hematologists, endocrinologists, ENT, dermatologists and others) but also other health professionals with a key role in rehabilitation (psychologists, physiotherapists, neuropsychologists, occupational therapists, speech therapists, dietitians, etc.) should interact in an interdisciplinary way for this holistic treatment.
Up to 80% suffer from persisting symptoms after leaving hospital
According to the pathologist, around 10% of patients with a positive test against SARS-CoV -2 continue to feel that they have not fully recovered even 3 weeks or even for months after acute disease, as shown by a population study in the UK, in which patients were asked to record their prolonged symptoms in an app on their mobile phone. "A recent study from the United States showed that 35% of patients report persistent symptoms beyond three weeks. In studies carried out in hospitalized patients the rate of persistent symptoms after leaving the hospital appears to be higher and ranges between 50%-80%".
Post-traumatic stress slows recovery
But why is recovery delayed in some patients, while others are coming back more quickly? Ms Koroboki replies that among the possible causes of delay in recovery have been reported prolonged imia (presence of the virus in the blood) due to the body's inability to produce antibodies, recurrence of the disease or re-infection, inflammatory response or immune response of the body, as well as psychological factors such as post-traumatic stress. Long-term complications from respiratory, musculoskeletal and neuropsychiatrical symptoms have been described after and after disease by other coronaviruses (SARS and MERS) and there may be a ratio in terms of underlying mechanisms.
With chronic fatigue, one in two of the
The most common symptoms after COVID-19 infection may come from different systems of the body. "Chronic fatigue is the most common reported symptom in about 50% significantly affecting the quality of life and mental health of people affected by the new coronavirus. Post-traumatic stress disorder and depression, anxiety disorders and sleep disorders are often reported at about 30%. From the respiratory system shortness of breath and cough are reported at about 40%, while disturbances in imaging tests (evidence of fibrosis in the lung) can be found even three months after the acute phase of the disease.
Approximately 20% of patients report symptoms from the cardiovascular system such as chest pain, palpitations, tachycardia, orthostatic hypotension, while a small percentage may late experience more serious complications such as myocarditis and thrombosis. Memory and concentration disorders are common in about 30% of patients, while headaches and vertigo are reported. Immunity and aesthesia, often symptoms in the acute phase of the disease, can persist at 10% for an extended period of more than three weeks.
Possible detonation or exacerbation of autoimmune
"Persistent brains and arthralgias are found in 30% of cases. Alopecia, nail disorders, the appearance of rashes, osteoporosis, the appearance or difficulty of regulating diabetes mellitus and a lack of vitamin D that can lead to osteoporosis, also refer to the rarest long-term complications. From laboratory testing beyond the findings in the imaging control of the respiratory system, a persistent increase in inflammation indicators, an increased likelihood of thrombosis as well as possible triggering or exacerbation of autoimmune diseases may be observed".
