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LONG COVID- Long Road for Patients and Health Systems

Dr Swapnil Pawar August 29, 2021 167


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    LONG COVID- Long Road for Patients and Health Systems
    Dr Swapnil Pawar

The risk of COVID-19 has been largely communicated only in terms of deaths and hospital capacity, with less emphasis on long term sequelae.

Around one in three people with symptomatic COVID-19 still, experience debilitating symptoms 12 weeks after onset.

Definition– No standardised definition.

Some of the case series defined it as persistent symptoms and/or delayed or long-term complications of SARS-CoV-2 infection beyond 4 weeks from the onset of symptoms.

Based on recent literature, it is further divided into two categories:

(1) subacute or ongoing symptomatic COVID-19, which includes symptoms and abnormalities present from 4–12 weeks beyond acute COVID-19; and (2) chronic or post-COVID-19 syndrome, which includes symptoms and abnormalities persisting or present beyond 12 weeks of the onset of acute COVID-19 and not attributable to alternative diagnoses.

Characteristics –

  1. experienced by all age groups
  2. Both critically ill and non-critically ill patients with COVID-19 affected.
  3. wide-ranging, multisystemic, and predominantly fluctuating or relapsing.

Symptoms –

Pulmonary

Dyspnea decreased exercise capacity and hypoxia are commonly persistent symptoms and signs

Reduced diffusion capacity, restrictive pulmonary physiology, and ground-glass opacities and fibrotic changes on imaging

Hematologic

Thromboembolic events have been noted to be <5% in post-acute COVID-19 in retrospective studies

The duration of the hyperinflammatory state induced by infection with SARS-CoV-2 is unknown

Cardiovascular

Persistent symptoms may include palpitations, dyspnea and chest pain

Long-term sequelae may include increased cardiometabolic demand, myocardial fibrosis or scarring (detectable via cardiac MRI), arrhythmias, tachycardia and autonomic dysfunction

Neuropsychiatric

fatigue, myalgia, headache, dysautonomia and cognitive impairment (brain fog)

Anxiety, depression, sleep disturbances and PTSD

The pathophysiology of neuropsychiatric complications is mechanistically diverse and entails immune dysregulation, inflammation, microvascular thrombosis, iatrogenic effects of medications and psychosocial impacts of infection

Renal

Resolution of AKI during acute COVID-19 occurs, however reduced eGFR has been reported at 6 months follow-up

Endocrine

new or worsening control of existing diabetes mellitus, subacute thyroiditis and bone demineralization

Gastrointestinal 

Prolonged viral fecal shedding can occur in COVID-19 even after negative nasopharyngeal swab testing

COVID-19 has the potential to alter the gut microbiome,

Dermatologic

Hair loss is the predominant symptom

Time Line

Figure 1 from Nature Medicine | VOL 27 | April 2021 | 601–615

Evidence – 

from Nature Medicine | VOL 27 | April 2021 | 601–615

Limitations – 

Different follow-up periods were used in different studies.

Different nomenclature and different definitions are used.

Summary – 

No standardised definition at the moment.

Need further research and a system-based approach in tackling this problem

Our Recommendations –  

We need International collaborative efforts to –

1) Recognise and define this problem 2) Standardised reporting system to capture the incidence 3) Structured multi-disciplinary rehabilitation. programme for COVID survivors 4) Further research to develop effective strategies for prevention.

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