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The long-term recovery of COVID-19, aka COVID “long-hauler” syndrome, continues to be challenging for both clinicians and patients, with evidence of how best to treat the most common symptoms. its management is based primarily on cross-departmental reviews and documentary reports.
Until a clearer picture emerged from larger, prospective and multicenter studies, experts shared what is known and what evidence is still accessible in a February 12 press release backed by the Infectious Diseases Association America.
To be considered post-COVID-19 syndrome, symptoms should persist for at least 4 weeks after SARS-CoV-2 infection. Many patients, however, experience symptoms lasting 2 to 6 months or longer.
Fatigue appears to be more common, followed by dyspnea and other lung problems, said Allison Navis, MD, assistant professor in the Department of Neuro-Infectious Diseases at Icahn School of Medicine at Mount Sinai in New York City, during the meeting.
Neurologic symptoms, particularly “brain fog” and anxiety or tingling throughout the body, as well as mental health challenges including post-traumatic stress disorder (PTSD) have also been reported, she said.
Symptoms of post-COVID-19 syndrome may be similar to those experienced at the time of acute infection.
Symptomatic disease overcomes most cases
People with asymptomatic SARS-CoV-2 infection rarely progress to chronic post-COVID syndrome, said Kathleen Bell, MD, Distinguished Chair of Kimberly Clark in Motion Research at UT Southwestern Medical Center in Dallas.
However, “we certainly see people who were not in the hospital who were seriously ill and were being managed at home” present with post-COVID syndrome, said Bell, who is also a professor and chair. on the Department of Physical Medicine and Rehabilitation at UT Southwestern.
Navis agreed with her experience that most people with long-term side effects were either managing an infectious disease at home or in hospital. “There were probably one or two people who may have had asymptomatic disease and came up with COVID long-term syndrome,” she said.
Hospital-related hazards
For some patients, being hospitalized for COVID-19 alone can lead to long-term rehabilitation issues. For example, patients who spend a lot of time in a prone position may be more likely to experience peripheral neuropathy, Bell said. The associated arm and leg weakness can be especially important in people with diabetes.
In addition, long-term hospital stays can have serious mental health consequences. “We have people in the hospital for 3 months, and in a large percentage we are seeing mental health symptoms including PTSD, anxiety and depression,” said Bell. These side effects are not specific to COVID -19 but they are also reported in others who spend weeks or months in emergency care, she said.
Some people with mental health concerns may have been compensated long before they experienced COVID-19, but the pressure of infectious and hospital-acquired infections exacerbates the condition, Bell explained.
Local rebellion can also increase risk for mental health issues. The spike in issues in March and April 2020, for example, was “a scary time here in New York City,” Navis said.
“There were some isolated people in their homes, hearing the sounds of ambulances and trumpets, and they were worried about their own health and survival,” she said, adding that it was a source of deep concern. dementia, or PTSD for some.
Consensus and Leadership in the Works
The World Health Organization issued updated treatment guidelines for COVID-19, including people with persistent symptoms, on 26 January.
The Centers for Disease Control and Prevention is working on guidelines for the diagnosis and management of people with post-COVID syndrome, “which is very interesting,” Bell said. The recommendations are expected to emerge from an event about 3 or 4 weeks ago in which the group brought together experts to share their models of care.
The National Institutes of Health is also interested in developing protocols, Navis said.
Many specialist teams and clinics have emerged to deal with the growing population of COVID-19 ” long-haulers. ‘
Interestingly, while many institutions have scrapped their own protocols for treating this patient population, “we are starting to look similar,” Bell said.
The COVID-19 rehabilitation clinics at Bell’s and Navis centers focus on multidisciplinary collaborations, including general medical care and specialists such as pulmonologists, cardiologists, and psychiatrists, as well. on rehabilitation specialists, to deal with specific symptoms.
Remaining Questions
It is not known what proportion of people with COVID-19 progress to post-COVID syndrome. “Most people would be likely to get better over weeks to months, with around 10% to 15% having long-term problems,” Bell said. clarify the figures.
While it is generally accepted that more males than females develop COVID-19 and die, it remains to be seen whether the risk of long-term side effects differs among males and females. Navis described a relatively similar distribution of cases by gender in her experience.
How vaccines may prevent or alleviate post-COVID syndrome remains an open question. The vaccines are “so fresh, that would be a crystal ball issue,” Bell said.
Bell expected it to take about 6 months for responses to these and other unknown factors about post-COVID syndrome to emerge from larger prospective studies.
Damian McNamara is an employee a Miami-based journalist. It covers a wide range of medical specialties, including infectious diseases, gastroenterology, and diagnostic care. Follow Damian on Twitter: @MedReporter.
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