Long Covid: what to keep an eye on until one year after infection – 09/06/2022

If there’s a difficult discussion in scientific circles, it’s about the long covid, but it’s becoming impossible to stop looking it in the eye. Meanwhile, the population, that is, people like you and me, is a bit lost.

For anyone who caught Sars-CoV-2 – and in the omicron era we’re unfortunately talking about about half of us – every little thing different is already the cause of schism. Could the underlying cause be Covid-19? And what should anyone look out for in the first few months, not to mention the first year, if they tested positive one day?

According to the CDC (Center for Disease Control and Prevention), in the United States, one in five people under the age of 60 who have had Covid-19, including children and adolescents, will have late or persistent manifestations of coronavirus infection. And the proportion rises to every fourth person when they are in their sixties or even older.

If this is the case, just look at the magnitude of the problems we face: Until yesterday, the 8th, Brazil had accumulated 31.3 million cases of covid-19 and the world, 534 million. Imagine that between a quarter and a fifth of all these people could have prolonged covid.

Under that label, almost everything new that emerged after the infection was worth it, and we are therefore talking about a list of more than two dozen unpleasant symptoms, some of them really complicated, such as difficulty breathing.

But at the end of last year, the WHO (World Health Organization) decided to organize this hut a bit and defined a logic for doctors to say that someone really has a long-term covid condition. An important part of this criterion has to do with the duration of complaints.

The long covid, by definition

First point: The WHO criterion implies that you present symptoms that appeared with the diagnosis covid-19 and which have not disappeared even after 12 weeks, ie. three months after the radius of infection, as if they had arrived to stay. .

However, symptoms that only appear after you have already got rid of Sars-CoV-2 are also valid, provided that there is apparently no possibility that they have another cause and that they also exceed the 12 weeks, where the date of infection is “zero” of that number.

If they disappear before that deadline, we are no longer talking about long covid, but the expected and dull recovery from an equally dull disease.

Only that? None! Second point: these symptoms should persist for at least eight weeks or two months. Where I want to go: the person who spent a month and a half with his head bursting with pain, even though this discomfort has exceeded 12 weeks, is not framed in the long covid, according to WHO guidance. And all because he did not suffer from headaches for a full two months. Passed on? It was not a long covid, it was more a dull recovery and period.

In short, the complaint should last for two months without much ceasefire and be present after three months after the diagnosis covid-19.

Last detail: WHO considers respiratory problems, cardiological problems, such as the famous myocarditis, which is infinitely more common after infection with Sars-CoV-2, and neurological problems, as long as they are the ones that get in the way, as part of the definition of long-term covid. people’s daily lives, such as fatigue and problems related to memory, in a very significant way.

According to Dr. Max Igor Lopes, coordinator of the Outpatient Clinic for Infectious Diseases at the Hospital das Clínicas of the University of São Paulo (USP) and a consultant for the Brazilian Society for Infectious Diseases, no one minimizes the suffering of those with symptoms. , which do not fit into these situations, ranging from skin problems to body aches.

“The WHO’s idea at the moment is to focus on what is most important, to lead a profile for care in both public and private health,” he explains. “Respiratory complications tend to be more serious, for example.”

Therefore, the first three months of observation are crucial in the first year after infection with Sars-CoV-2 – even for you to come out and say that you have had or really have long-term covid.

But as the infectious disease doctor himself acknowledges, some problems escape this most up-to-date WHO criterion, and they deserve a zealous look for an even longer period of time.

Attention to blood pressure, blood sugar and liver health

“One difficulty with talking about long-term covid is that: you should always try to prove that there is a causal link between what the person has and covid-19,” says Dr. Max Igor Lopes. “With an omni it will be very difficult because everything that shows up in the next two, three months in 50% of Brazilians, someone will think it would have happened due to infection with this variant, and it will be difficult to distinguish. “

Prior to the team examining long-term covid at Hospital das Clínicas da USP, he says many studies in this field focus on a specific health problem that emerged after covid-19, and compare with what happened before.

“But to avoid confusion, we always compare people who in the acute phase of the infection have been through similar situations. For example, we look before and after at those who needed intensive care, and we analyze individually those who stayed in a shared hospital bed without mixing these groups. “

This is how they confirmed something that is noticeable around the world: The frequency of diagnoses of diabetes, hypertension and liver changes is higher in the post-infection period, although none of this is considered to be long covid.

“We can not say that coronavirus is the cause. But somehow it seems that the reaction or reactions triggered by it in the body amplifies a person’s tendency to develop these three problems,” says the doctor. “Maybe the person would become hypertensive or diabetic anyway, but Covid-19 would speed up the process.”

For him, at this point in the championship, it leads nowhere to look for mechanisms. “Let’s be practical: The clear message is that knowing that high blood pressure, diabetes and liver problems are more likely to occur, clinicians and patients need to recognize the importance of monitoring for up to two years after covid-19, with the first year the most important “. He advises studies for this purpose every six months during this period.

Vaccine does not help to have?

Recently, a study was published in Natural medicine and signed by researchers from Veterans Research and Education Fundin the United States, nearly 34,000 vaccinated people observed receiving Sars-CoV-2 last year.

They were examined six months after infection, and according to the researchers, the full vaccination plan only reduced the risk of long-term covid by 15%. A slightly disappointing result. But will it be like that?

One of the criticisms of the work is to detect the occurrence of symptoms related to long-term covid, however, without checking whether the person already felt something similar before he contracted the coronavirus – sometimes anxiety crises that already existed in the past were sometimes. only appreciated when they became ill. The research also gathered people who had been vaccinated at another time, even though their immunity is already lower on the eve of the booster season.

“But the curious point of this and other studies was to note that among patients who, for some reason, after being discharged, were prescribed a prescription to take anti-inflammatory drugs at home – in this case corticosteroids – long-term covid were less frequent “, says Dr. Max Igor Lopes.

This indicates that persistent inflammation caused by Sars-CoV-2 is really an important factor in the development of long-term covid and suggests a possible prevention strategy, which of course should not be used left and right, but in those cases patients who had more severe conditions. “Long covid is much more common in them” assures the infection doctor.

This is actually why most studies report that when the long covid appears in vaccinated people, the symptoms are milder. “And their duration also tends to be shorter,” says the doctor.

In the daily routine of the hospital, he has lately found far fewer cases of persistent and intense symptoms, of those capable of ruining people’s routine. The change I can bet on can be attributed to the progress of vaccination. It is our hope to keep another type of wave, that of the long covid, after this trawler that the micron makes around.

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