What is the syndrome, LongCOVID or PostCOVID, what symptoms and complications (late or long-term) does it involve, persist or appear after SARS-COV-2 infection, what are the protocols for its treatment?
The APE-MPE was addressed to two scientists: the Stelios Loukidis, professor of pulmonology at EKPA and president of the Hellenic Pulmonary Society and the Konstantinos Stratakis researcher, research director of the laboratory of genetic and medical precision of FORTH, for all the latest data.
According to Mr. Stratakis, at the moment there are many studies around the world to define the syndrome, describe all its symptoms, and of course its treatment. In the US, the Centers for Disease Control (CDC) prefers the term “post COVID-19 conditions” and accepts a time limit of 4 weeks (28 days) after the initial infection. The symptoms that most often afflict patients are fatigue, loss of smell or taste, inability to exercise and problems with mental function. From these, it seems that fatigue and inability to exercise persist in the chronic COVID-19 syndrome, says Mr. Stratakis.
The Hellenic Pulmonary Society notes that every patient with COVID-19 should be informed of the possibility of persistent symptoms that usually subside within 12 weeks and appear depending on the severity of the disease and his previous state of health.
“When there are persistent symptoms, mainly of shortness of breath in fatigue, this needs to be evaluated – but not directly therapeutic interventions that have not been proven to be effective,” Stelios Loukidis told APE-MPE. He recommends special attention, patience and good evaluation to capture and clarify the “LongCOVID syndrome” and notes that the Hellenic Pulmonary Society increased the follow-up time to 3 months, “which is a good time to make the first evaluation”.
However, the positive thing is that “after a structured monitoring, the persistent complications of covid-19, seem to be in a very small percentage and not in the percentage we expected at the beginning”, says Mr. Loukidis.
He makes special reference to the holistic treatment of pulmonary rehabilitation of covid-19 patients admitted to the ICU. Developments are dynamic and guidelines are being updated, he emphasizes.
Few patients who after 9 to 12 months have a chronic disease
“In the beginning we rushed and talked about very common complications of longCOVID. Few patients have a chronic disease after 9 to 12 months. It was heard a lot at the beginning for interstitial lung disease, fibrosis – however after monitoring for a period of time which is usually 9 to 12 months, it seems that the persistent problems are in a small percentage of people. So in the majority of the sick, they escape. “
It takes time we must not be in a hurry
“It takes time to be able to escape when a serious illness has passed and we must not be in a hurry and apply treatments which at the moment do not have the appropriate confirmation and the appropriate documentation from studies”, stresses Mr. Loukidis.
“This thing that we see, that someone comes in 2 or 3 months and because he has a little shortness of breath in fatigue and because he has a serious covid disease, to take cortisone directly, makes no sense. His defense goes to the Tartars. Logic says patience, good evaluation. LongCOVID takes time to capture and clarify. He does not want to rush. “
In three months the first evaluation
According to Mr. Loukidis, “when there are persistent symptoms, mainly of shortness of breath in fatigue, this needs to be evaluated, but not directly therapeutic interventions that have not been proven to be effective.” He attaches great importance to the observance of the protocol, noting that it has no value to do a computed tomography after a month of a serious illness has no value. “You will see damage, there is no case”, he emphasizes. He adds that this is why the Ltd. increased the monitoring time to 3 months “which is a good time to do the first evaluation”.
Two categories of protocols
The first concerns the follow-up of covid patients admitted to the ICU or common ward. According to Mr. Loukidis, 4 weeks after their discharge from the hospital, it is suggested that they visit a doctor, preferably their family, who should see if they have persistent signs or symptoms and if they need something more. At 3 months they should definitely do an imaging, preferably a computed tomography and then do a functional examination of the lungs and possibly a cardiological assessment. If findings remain, then they should slowly begin to enter a follow-up that is usually every 6 months, until it is clarified that these findings go away, or in some – a very small percentage – remain.
In addition, for people coming out of the ICU, priority is given to the holistic treatment of lung rehabilitation and according to Mr. Loukidis, this intervention will help mobility, breathing, nutrition and psychological support of patients, “but unfortunately it is done in limited centers in Greece “.
The second category concerns those who have a mild illness, who have not been treated or have been treated but with a mild illness. After the final stage of the disease, they are evaluated by a doctor in a month, and if they have nothing the control stops. However, if findings are found, they also enter the follow-up process like the patients of the previous group.
Most people, when they get sick, have a large percentage of telephone contact with a doctor, then they should visit the doctor and live, because some things over the phone may have escaped. This is not easy to do in the acute phase, but in the second year as soon as the infection is over it is necessary. There are clinics in public hospitals that do post covid follow-up.
It is important to distinguish patients who have complications from the initial infection, or from their hospitalization in the intensive care unit, etc., from what we call chronic or after COVID-19 syndrome, Mr. Stratakis emphasizes. For example, a patient who suffered a stroke or heart attack during the initial infection clearly has various complications for many weeks after the initial infection but which are explained by the respective episodes and are not unexplained, or something new.
At the US National Institutes of Health (NIH) we studied the data of patients with COVID-19 and clearly showed the many and various complications of the initial disease, especially in patients with obesity, hypertension or diabetes, says Mr. Stratakis. In these patients, complications of the initial infection are to be expected.
What is chronic COVID-19 syndrome?
Mr. Stratakis answers the question: In the late 1980s (1988-89), several patients were infected with Coxsakie virus and others later with Epstein-Barr virus infection, both of which caused in their acute form relatively common viral infections. syndromes (runny nose, erythema, etc.) occurred long after the initial infection with a syndrome characterized by fatigue mainly, but also other symptoms ranging from arthritic pain to transient paralysis etc … The syndrome became known in the literature as chronic fatigue syndrome ( chronic fatigue syndrome-CFS) and has since been so named. Even today, the cause remains unclear – and even at the US National Institutes of Health (NIH) where I worked for over 30 years and for which I was director of Endocrinology and Genetics, a new study has recently begun to investigate … At our clinic in NIH, we saw many patients with CFS, many of whom have endocrine problems, such as partial adrenal insufficiency (cortisol deficiency). Many have been diagnosed with fibromyalgia which, when it occurs independently of CFS, is often also associated with partial adrenal insufficiency. Many patients had depression and psychosomatic disorders.
Therefore, the appearance of a syndrome characterized by fatigue, neurological symptoms, muscle or bone pain, inability to exercise, drowsiness but also inability to sleep and rest normally, after the initial viral infection has passed (4-6 weeks later) and many other symptoms ( respiratory, dermatological, etc.) is not something new in Medicine.
First of all, chronic COVID-19 syndrome is something we have seen with other viruses but also infections with parasites, germs, etc. It seems that it may be more common after coronavirus, since it is estimated that 1 in 7 patients with COVID-19 has symptoms 12 weeks after the initial infection. These symptoms are more common among patients who needed hospitalization than those who did not need to be hospitalized, and in the 15 days after the initial infection, the most common persistence is fatigue, loss of smell or taste, inability to exercise, and problems in mental function. It seems that fatigue and inability to exercise persist in chronic COVID-19 syndrome, but others are added, such as indefinite pain, erythema, etc ..
What are the causes of chronic or post-COVID-19 syndrome?
No one knows exactly what causes these symptoms that lead to post-COVID-19 syndrome, notes Mr. Stratakis. “They are likely to be an inflammation, in other words an ongoing reaction of the body to the initial infection, which is possible because, either there is a genetic or hormonal predisposition, or because there was damage to tissues or organs of the body that was not obvious at first , or it just takes time for them to show up “.
How is chronic or post-COVID-19 syndrome treated?
At the moment, the treatment concerns the individual symptoms, says Mr. Stratakis. For example, treatment of depression, treatment of any myalgias or arthralgias, etc … We hope in the future and as we better understand what causes the syndrome to have targeted treatments for the cause of the syndrome as a whole.
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