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Dr Swapnil Pawar August 29, 2021 189
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 –
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
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.
Dr Swapnil Pawar August 18, 2021
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Dr Swapnil Pawar June 10, 2022
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