Filenews 7 May 2022 - byMarilena Panagi
"The first thing that patients tell you is that they feel that they are no longer themselves", while others, whose career is affected, find it even more difficult to understand the situation. "How can you comfort, convince a singer that all the analyses, X-rays and measurements for her lungs are good, since she knows better than you the physiology of breathing and that she cannot breathe and sing as before?"
Cypriot doctors are now struggling daily with the effects that the coronavirus leaves on the body of their patients. They describe in "F" their own experience of patients presenting with long-covid syndrome and stress the need for cooperation between all competent bodies in order to prepare and start implementing, within the framework of the General Health System protocols and guidelines that will better facilitate professionals and will cover more the needs of citizens.
"In medicine, it is understood that some patients will not respond as much to the same disease as others. The natural course of a disease is usually not typical as described in medical writings. So, with the coronavirus, in the last two years we have seen in the clinic asymptomatic patients, with mild, moderate or severe disease and unfortunately some of us have never seen them again. What is not medically understood is why some patients do not completely overcome it. No matter how they went through the first/acute phase, they are left with symptoms for weeks or even months. You are faced with people, that is, describing a little fever at first and cough, which they overcame long ago, but since then describe muscle weakness, atony, drowsiness and difficulty concentrating.
Symptomatology that is so intense several times, that it forces the patient to limit all his activities except the mandatory working hours. They stop the gym, or afternoon walks, limit night outs and sleep every night early. In other words, they describe a very normal program for an 80-year-old... only most of them are 30, 40, 50 years old..." The description of the internist/diabetologist Personal Doctor of the GHS Panagiotis Demosthenous, reflects the situation in which thousands of people are currently facing in Cyprus. Most patients, he adds, "understand, fortunately, the medical instructions. Instructions on how to treat the symptoms, what vitamins/ medicines to take and especially what not to take. They understand the new limitations but also who they need to trust (dietitians, physiotherapists, etc.) to recover faster. This of course is true for most who have an ordinary, normal, morning job."
For those whose professions differ, the data is also different: "Long-covid syndrome is incomprehensible and highly irritating for professionals. Professionals affected by their careers and by extension their lives after covid. How can you comfort, convince a singer that all the analyses, X-rays and measurements for her lungs are good, since she knows better than you the physiology of breathing and that she herself cannot breathe/sing as before? A professional volleyball player could not accept, understand, that while he overcame so many muscle injuries in the past, long-covid almost kept him out of action in March and April, the most important months for the league and the cup."
"A very difficult and complicated case I have is a sympathetic 60-year-old lady who gradually developed: bronchitis from covid, acute pericarditis from covid, acute gastritis and esophagitis, allergies and pharmaceutical side effects and then long-covid. The weakness and physical stress along with the rest of the symptomatology has kept her at home. We are already in the fourth month now and we are still wondering and reflecting with colleagues who are watching it, what is the most correct and safe treatment?"
The median age of long-covid patients is 40-45 years
Andreas Tofaridis: "The difficulty is that we doctors still operate in uncharted waters. We need to be constantly vigilant, to give time to our patients, to listen to what they are experiencing."
"What I keep, and it strikes me every time, is when the patients upon entering the clinic say that they are not themselves, ''I don't recognize myself'', that's what they say," says pathologist Andreas Tofaridis, coordinator of the long-covid clinics of the State Health Services Organization.
"People from the whole spectrum of the population come to the clinic. The median age of long-covid patients is 40 to 45 years, but we see patients from all age groups. The difficulty in the case of long-covid patients is that we doctors are still operating in uncharted waters. We need to be constantly vigilant, keep up to date, give our patients time, listen to what they are experiencing themselves and then guide them."
From the long-covid clinic, patients, "those who need help from doctors of other specialties are referred to these specialties. Most referrals concern the specialties of pulmonology, cardiology and neurology", explains Mr. Tofaridis, adding that the most common symptoms reported by patients are "chronic fatigue, breathing difficulties, feeling short of breath, impaired respiratory functions in general, memory disorders, concentration, sleep, taste and smell disorders, hair loss, menstrual irregularities, etc. It is a patchwork of symptoms and for now we doctors are recording and trying to help our patients. Time will tell which symptoms will eventually prevail, but also whether the symptoms of long-covid will also vary depending on the strain of coronavirus from which the patient became ill."
From the long-covid clinic of the CSO, "there have passed through, since October 2021, more than 250 patients with at least one visit each. As the CSO, we have prepared a protocol that we follow. However, what we find is that the State, in an orderly manner, must come and recognize this long-covid situation. Everyone's cooperation is required because long-covid has its peculiarities. It is not something that we can describe in two or three paragraphs or which can address a single medical specialty. It's a peculiar situation."
ELPIDA FOTIDOU: "Everything is recorded, now we are watching it"
"We cannot say that the group of long-covid patients ''belongs'' to a medical specialty as we say about most diseases. Here we see something different",
"The key to the treatment and proper guidance of long-covid patients is the personal doctors of the GHS", says pulmonologist Elpida Foitidou. "Personal doctors need to be empowered, they need to be informed, they need to have in their hands the tools they need, whatever is available at the moment because in fact everything is now being recorded and now we are monitoring it."
Long-covid syndrome "doesn't just occur in people who have been severely ill with coronavirus. We see people who, while they had mild symptoms during the disease, then have a persistent cough, fatigue, easy fatigue, palpitations, difficulties in their daily lives", says the doctor and adds: "in essence it depends on each person. We as doctors do various functional tests. In some cases the results are normal, in others we observe minor changes, which we do not know if they will remain or disappear along the way."
"There is no specific treatment. Depending on the symptoms, medication is also administered. At the same time, some patients who are referred to a pulmonologist may then need to see a cardiologist or neurologist or doctor of another specialty. We cannot say that the group of long-covid patients "belongs" to a medical specialty as we say about most diseases. Here we see something different."
Lately, "an effort is also being made in Cyprus to guide patients. All the relevant bodies must work together. Doctors and especially personal doctors should have in their hands the tools they need to be able to properly serve their patients. This is a new situation, patients need to be separated as well, whether they are indeed suffering from long-covid or not. A lot needs to be done and of course this is a new situation internationally, it is not just about Cyprus".
