28-12-2020 by Mirai
More and more patients are suffering from persistent symptoms, months after falling ill with Covid-19. Extreme fatigue, shortness of breath, memory loss. Expert explanations.
The persistence of symptoms for months after infection and their diversity are now recognized by the World Health Organization. This is a first step, but affected patients ask for better care.
Who are the "Covid long" patients?
According to a study by Kings College London, of 4 million self-reports, 10% of people with the virus continue to experience symptoms more than a month after infection, between 1.5 and 2% after three months. Other studies estimate that there are more. This could become "a more significant public health problem than deaths from Covid-19," warns Professor Tim Spector, an epidemiologist at Kings College.
Who are the patients most at risk of developing a long-term form of Covid-19?
Patients who have suffered from a severe form of the disease, but who have also experienced moderate symptoms. "Those who come to consult for Covid in the long term are active, young, without particular risk factors. Women from 40 to 60 years old, men from 30 to 50 years old," explains Dr. Nicolas Barizien, head of the functional rehabilitation service from Foch Hospital, which is piloting the Rehab Covid program, which was launched in June 2020.
Most have not been tested because testing was not available in the early months of the pandemic. Their serology, weeks later, was often negative, "either because the antibodies have disappeared in the meantime, or because they have not produced any," explains Olivier Robineau, infectious disease specialist at HC de Tourcoing.
"This lack of an initial diagnosis is difficult for them because, in the eyes of the doctors who see, the link between the observed symptoms and Covid is difficult to establish."
What are the symptoms of Long Covid?
The clinical picture produced by several Anglo-Saxon studies reveals an impressive diversity of symptoms. "We are used to post-viral symptoms: influenza, pneumonia, mononucleosis can cause respiratory sequelae, myocarditis, paralysis, but rarely with such a variety of manifestations", explains Nicolas Barizien.
What surprises doctors: extreme tiredness. "And the fluctuation of symptoms. One day patients feel good, the next day, exhausted" adds Olivier Robineau. They have to walk, work, but the body does not follow them. They are tired, they have trouble concentrating. "They are recovering. Of course, it is very long. But month after month, most are improving," says Dr. Robineau.
One question remains unanswered: since when is this convalescence unusually long?
"Doctors are groping, we can treat certain symptoms one by one, explains Olivier Robineau. But, to treat the causes, we must implement a multidisciplinary approach." The Cocolate study, which he coordinates, is monitoring 1,000 long-term Covid patients for a year to define a course of care.
Blood tests, chest scan, cardiac MRI, brain MRI. After a series of examinations, Rehab Covid patients are cared for by rehabilitating physicians, otolaryngologists, clinical psychologists
Looking back, Nicolas Barizien separates them into three categories:
"Those who lost 5 to 10% of their weight in a few days during the acute period, loss of muscle mass that weakens the heart. With the return to physical activity, supervised by a physiotherapist, these patients recover well."
A second category is marked by the stress of hospitalization, the fear of dying or the difficult context of their isolation. "Some people suffer from anxiety and even post-traumatic stress syndrome that must be controlled."
Finally, a third category suffers from the dysregulation of the autonomic nervous system, which allows you to breathe, digest, without thinking. "This results in hyperventilation or shallow breathing, and rehabilitation involves respiratory physiotherapy. Or heart rate dysregulation. At rest, it goes up from 60 to 110 beats / minute for no reason. And conversely, it stays at 60-90 for an effort. Consequence: the patients are exhausted. The heart must be reconditioned by cardiac effort, with a physiotherapist. It is long, but we see real progress. "
Long-term Covid: are there long-term sequelae?
We must distinguish symptoms and sequelae, in the sense of anatomical injury. According to Nicolas Barizien, in 90% of the cases, "the patients have been cured, we no longer see scars on their organs." For example, "some patients suffer from memory, concentration and sleep problems. Magnetic brain scans show no brain damage, it is more reassuring. "
Only 10% of patients who have undergone Rehab Covid have a sequel. "We know that the lung can be damaged after a respiratory viral attack such as a very serious flu or pneumonia," explains Olivier Robineau. Will these sequelae be more frequent with this coronavirus? No one can answer. " Especially in cardiac sequelae.
Studies are being done to understand why some people have a serious illness and others do not. "We can hope that advances in the treatment of the acute phase, such as the use of steroids, will reduce the impact of the disease."
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