It is now evident that COVID-19 is not simply a disease of the pulmonary system, but a disease that can have a lasting impact on the organ systems.
A review article published in Nature Medicine offers a first glimpse into the long-term multi-organ effects associated with COVID-19 infection. The authors, led by Dr. Elaine Y Wan, a cardiologist at Columbia University’s Irving Medical Center, propose a framework for caring for long-haul COVID-19 drivers by setting up COVID-19 clinics with multidisciplinary medical teams reaching out to each long-term illness of patients with COVID-19. The article was published online on March 22nd.
“It is critical for health systems and hospitals to recognize the need to set up dedicated COVID-19 clinics where specialists from different disciplines can offer integrated care,” she and her colleagues wrote.
Wan et al. Provide a comprehensive overview of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific consequences. Fatigue, shortness of breath, brain fog, loss of smell or taste, anxiety, depression, and post-traumatic stress disorder (PTSD) are some of the most common symptoms experienced by long-distance drivers. Published data suggest that at least a third of patients hospitalized for COVID-19 experienced any of these long-term side effects.
“This scale of the pandemic in terms of the number of people infected with SARS-CoV-2 and a significant percentage of those with long-distance symptoms in preliminary reports has never been seen in our lives. Long-lasting consequences are expected for all areas of medicine, including pulmonology, cardiology, neurology, endocrinology, nephrology, psychiatry and others, ”said Dr. Kartik Sehgal, an oncologist at the Dana-Farber Cancer Institute in Boston. Dr. Sehgal was the article’s co-correspondent with Dr. Wan.
Long distance drivers can have heterogeneous presentations. Frequent presentations include fast heart rates, dizziness, difficulty concentrating and / or memory, and difficulty sleeping and mood. “It is important for internists as well as for subspecialists to keep the previous infection with SARS-CoV-2 as one of the differential diagnoses up to date. It has now become an integral part of the story, ”said Dr. Sehgal.
“The roadmap for optimal management of post-acute COVID-19 is interdisciplinary care in COVID-19 convalescence clinics.” It is crucial to step up efforts to identify those at greatest risk for long-term COVID to ensure structured care in these clinics with efficient access to subspecialists as needed, “he said.
ENDOCRINE DISORDERS UNDER LONG TERM
Endocrine manifestations in long distance riders appear to be due to direct viral injury, immunological and inflammatory damage, and iatrogenic complications. Endocrine sequelae may include new or worsening control of existing diabetes mellitus, the authors suggest.
Other concerns are subacute thyroiditis and bone demineralization. They recommend that patients with newly diagnosed diabetes – in the absence of traditional risk factors for type 2 diabetes – undergo additional diagnostic tests. Appropriate testing should also be given to patients with suspected hypothalamic-pituitary-adrenal (HPA) axis suppression or hyperthyroidism.
“Abnormalities in glucose metabolism such as euglycemic ketosis and diabetic ketoacidosis, as well as new diagnoses of diabetes mellitus during or after acute COVID-19, must be investigated by an endocrinologist, preferably as part of a multidisciplinary COVID-19 convalescent clinic.” Dr. Sehgal said.
“Those without traditional risk factors for type II diabetes mellitus need to be screened for type I diabetes-associated autoantibodies. Hormonal abnormalities, such as those affecting the thyroid and adrenal glands, need to be accounted for if there are unusual symptoms and no obvious explanation after the standard assessment, ”he said.
At the start of the pandemic, the initial focus was on maximizing the prevention and control of modifiable risk factors for diabetes and cardiovascular disease, said Dr. David Drucker, an endocrinologist at Mount Sinai Hospital in Toronto. But now, after the COVID-19 infection, patients are starting to experience new symptoms.
“The extent to which COVID-19 will present new individual challenges for individuals and the endocrine community remains uncertain and requires careful follow-up and investigation,” he said.
There is no evidence of SARS-CoV-2 in pancreatic islet cells in those who develop COVID-19. Alvin C Powers, MD, director of the diabetes, endocrinology and metabolism division at Vanderbilt University Medical Center in Nashville, said COVID-19 could worsen or cause undiagnosed diabetes.
“Does COVID cause diabetes? It’s controversial, “said Dr. Powers. “There will be a lot more research into people who have had COVID. The bottom line is that we need to monitor these people. “
This article originally appeared on Endocrinology Advisor