Infectious Disease

What consultants know to date

February 12, 2021

4 min read

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It is becoming clear that in addition to the immediate clinical effects of SARS-CoV-2, the novel coronavirus may have long-term manifestations, experts say.

These symptoms loudly Allison Navis, MD, The assistant professor in the Department of Neuroinfective Diseases and the director of the neurological clinic at the Icahn School of Medicine on Mount Sinai are known as Post-COVID-19 Syndrome, Long-COVID-19, or Long-Range COVID-19.

It is becoming clear that in addition to the immediate clinical effects of SARS-CoV-2, the novel coronavirus may have long-term manifestations, experts say. Source: Adobe Stock.

“Generally, we use this to describe the persistence of symptoms in patients with COVID-19 infection,” Navis said during a news conference for the Infectious Disease Society of America.

She said these symptoms persist “usually at least 4 weeks after a COVID-19 infection clears, but for many people these symptoms last much longer – at least 2 to 6 months.”

“We have seen a lot of people who have had symptoms for almost a year,” she added.

Navis and Kathleen Bell, MD, Kimberly Clark Distinguished Chair in Mobility Research and Professor and Chair of the Department of Physical Medicine and Rehabilitation at UT Southwestern Medical Center shared their experience with persistent COVID-19 symptoms during the briefing.

“Long Distance” COVID-19

Navis said that many patients have long-term COVID-19 symptoms similar to those they had during their infection, but some patients may experience new symptoms.

She added that post-COVID-19 syndrome has “a large constellation of symptoms” and that while there are limited studies on the exact prevalence of each symptom, fatigue appears to be the most common. It can be caused by heart or lung problems in some patients; For others, however, the cause is unclear.

After fatigue, Navis said, shortness of breath and other lung symptoms are most common. Heart problems are also common in patients with post-COVID-19 syndrome.

In addition, according to Navis, there have been reports of neurological symptoms such as cognitive changes or “brain fog”, headaches, paresthesia and dysautonomia.

Other long-term COVID-19 symptoms that patients have reported include lightheadedness or dizziness, palpitations, gastrointestinal upset, joint pain, rash, persistent anosmia, and a variety of other symptoms.

Navis found that the cause of many of these symptoms is unknown, but it is a major focus of current research.

“The question that arises is whether this is something unique to the virus itself and whether the virus is causing these symptoms or whether this could be part of a general post-viral syndrome,” she said.

Navis added that these types of symptoms have been seen after other viruses and that other postviral syndromes appear to last a year or more, but then “resolve on their own”.

“I think the question arises as to whether this is a generalized post-viral syndrome, and we have never had a global pandemic on this scale from a virus,” she said. “The number of patients who develop post-COVID-19 syndrome could only be due to the sheer number of people infected with the COVID-19 virus.”

Long-term COVID-19 versus other issues

Bell noted that when evaluating patients with post-COVID-19 syndrome, as with any patient who has experienced a serious medical event or trauma, three aspects should be considered: the patient as a whole prior to the event; the event itself; and the experience after the event.

She said that many patients with COVID-19 also had high blood pressure, diabetes, obesity and other infections that could predispose them to serious infections and problems later in life. For example, Bell said, patients with prolonged hypertension could have chronic microvascular disease in their brain that can lead to brain problems later in life.

“People may find that they have compensated for issues they had before – possibly a minor cognitive impairment they had from high blood pressure or microvascular disease,” Bell said. “So when you put trauma like this and stress on the body, it can actually make it symptomatic of you.”

The disease itself, she said, “can cause all kinds of inflammatory problems in the brain and around the heart, around the nerves, around the muscles, etc.”

In addition, treatment during the illness can affect long-term health outcomes. For example, Bell said that patients treated in the intensive care unit may have been placed in a prone position, which puts pressure on nerves that are normally not under pressure. This can cause some patients – particularly those with diabetes – to develop peripheral neuropathy.

Then, after experiencing the illness or trauma, she said that patients experience their own mental health responses and those of their families.

For example, she said that patients who were hospitalized for long periods of time showed signs of PTSD, anxiety, and depression in response to their experiences. Additionally, having family or friends nervous or afraid of patients after they recover from COVID-19 infection can add to these problems.

She added that all of these factors taken together “distort the picture of the disease itself.”

Which patients develop post-COVID-19 syndrome?

Bell said it was uncommon for patients with “completely” asymptomatic disease to develop post-COVID-19 syndrome.

“We certainly see people who have never been hospitalized but with persistent symptoms,” she said.

Navis added that she saw “maybe one or two” patients who had asymptomatic COVID-19 and later showed mild symptoms after COVID-19, but most patients with long-term symptoms had previously had symptomatic illness.

“The majority of my patients had what we would call mild COVID-19, which means they weren’t hospitalized but were potentially sick at home for several weeks and feeling pretty sick,” she said. “That seems to encompass the majority of the patients I see.”

When asked whether patients with COVID-19 who also have pre-existing illnesses are more likely to have post-COVID-19 syndrome, Bell and Navis said that more research is needed.

While conditions like diabetes, high blood pressure, lung disease and obesity point to more severe COVID-19 infection, Bell said, “We all know we have seen young people, perfectly healthy young people, who have had very difficult courses with this disease. ”

She added that large, multicenter prospective studies are needed to understand the impact of pre-existing medical conditions on risk for post-COVID-19 syndrome.

Navis agreed, adding that there are some cross-sectional studies discussing post-COVID-19 syndrome, but larger studies are needed.

“Anecdotally, a lot of my patients were pretty well again,” she said. “I have a lot of patients who have had no previous medical problems or perhaps minor problems, but we really don’t know.”

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