New review of post-hungry COVID-19

The first year of the COVID-19 pandemic has taken the lives of millions of people around the world but it has also left hundreds with lingering symptoms or completely new symptoms weeks after recovery.

Little is known about what causes these symptoms and how long they last. But with nearly 740,000 cases of COVID reported in New York City since March last year – and 28 million in the United States – doctors are increasingly seeing these “long haul carriers” in their practices.

Over the summer, we began to understand the issues facing these people. We felt that a review of these potential issues would be important not only for health care providers but also for patients. It is important for patients to be aware that their symptoms may be the result of COVID-19 infection and that they are not alone in experiencing the visual effects of COVID-19 infection.“

Ani Nalbandian, MD, First Author and Fellow of Cardiology, Vagelos College of Physicians and Surgeons, Columbia University

Nalbandian is the study author of a new review of post-acute COVID-19.

Nalbandian, along with first author Kartik Sehgal, MD, a medical oncologist at Harvard Medical School and Dana Farber Cancer Institute, led the review effort, bringing together more than 30 experts from Columbia and other medical centers hit the original wave.

The review summarizes what the physicians saw in their own patients and what others had reported in the literature. The specialists represented a wide range of fields, including neurology, cartography, and nephrology.

Nalbandian and Elaine Y. Wan, MD, Esther Aboodi Associate Professor of Medicine in Cardiology and Cardiology at Columbia University, senior author of the review, will discuss the symptoms that should be known. patients and providers about COVID-19 long-haul carriers.

It’s not just “brain fog”

Chest pain has been reported in up to 20% of COVID-19 survivors two months after recovery from the disease, COVID-19 can reveal previously unrecognized cases of diabetes, and few percent of patients experience strokes, lung movements, and other complications from blood clots.

Wan specializes in electrophysiology, and during the pandemic she and her colleagues published more than 10 articles about COVID and cardiac arrhythmias.

“Arrhythmias can lead to stroke, heart failure, and long-term damage to the heart,” he says, “and that’s something patients won’t be aware of.”

In addition, several organs may be affected at the same time. “If you go to a cardiologist, the cardiologist may just be focusing on the heart,” Nalbandian says. “But we have to think about the whole person because COVID affects many organs, especially in those who were admitted to the hospital.”

Everyone is vulnerable

Most people with long-term symptoms may have had health issues before they contracted the virus or became seriously ill as a result of COVID-19 infection.

“But in reality, any of these cases can happen to any patient who has had COVID-19,” Wan said. “For example, we have seen young patients without prior medical illness who developed autoimmune dysfunction and rapid heart rates after COVID-19. It is not just the most vulnerable who have cases after COVID.”

“Of course there is post-COVID syndrome and it is not always linked to the severity of the infectious COVID disease itself,” says Nalbandian.

Most COVID patients never come to the hospital for treatment. “We may not be monitoring these patients with the same urgency, but they should not be forgotten,” she said.

The symptoms can appear weeks, months after recovery

“I’ve seen young patients, weeks even months after COVID-19 infection, and suddenly they’ve started heart racing, palpitations, and obesity,” Wan says.

Other patients complain weeks later about new breast discomfort or difficulty with decision-making, memory, and focus.

“When we think of COVID-19, we think of mostly respiratory illness,” Wan says. “But even after recovering from their respiratory illness, there may be other clinical symptoms. still have issues with other organ systems. “

Patients need special “COVID-19 clinics”

“COVID-19 is the first infectious disease I came across that has such an effect on a wide variety of organs,” Wan says. “It has changed my clinical practice. No matter what patient comes in, I am now wondering if they have ever had COVID-19 infection. It will change the field of what could be. “

“Based on this review, we all recognized the need for interdisciplinary care to treat patients for a long time,” says Nalbandian. “Care for patients with COVID-19 should not end at the time of discharge from hospital.”

To provide interdisciplinary care, health care systems should establish specialized “COVID-19 clinics”, similar to those now found in Italy.

Nalbandian says it is difficult to set up such clinics in the United States because physicians are still busy caring for new COVID patients as waves follow. “Clinics may be a priority provide follow-up care for those at high risk for post-acute COVID-19 and those with the highest burden of chronic symptoms. “

Patients should be vocal

Nalbandian says many patients have complained that their doctors do not recognize that their symptoms may be related to COVID, which is one reason she and her co-authors reviewed the review. way.

“Here in New York, we see patients who have been struggling for weeks and months looking for doctors who are knowledgeable,” Nalbandian says. “Physicians should be vigilant, validate patients’ concerns, and record the symptoms accurately.”

Patients should not be afraid to be vocal about their symptoms. “Contact your doctors even if you’re not sure if your symptoms lie from your COVID infection,” she says. “The situation is still moving and we’re learning more every month.”

Join patient advocacy groups and clinical trials

The work of new patient advocacy groups has helped identify persistent symptoms and was instrumental in highlighting the persistence of symptoms among those who did not require hospitalization.

“Active communication with these organizations is essential,” Nalbandian says, “along with participation in clinical trials for long-term evaluation.”

While the medical community now has a better grip on the long-term symptoms that come after COVID, “we don’t know how long and the long-term complications are,” Nalbandian adds.

“To learn more, we need to put patients to the test, and we have listed many active research studies in our review.

“Health care providers are still responsible for caring for patients with hungry COVID, but that is a common responsibility of the wider medical community.”