A physiotherapist works with a covid patient at the Isabel Zendal Hospital in Madrid, on April 19, 2021. (Photo: PIERRE-PHILIPPE MARCOU via . via .)
On Thursday, July 22, Dr. Xoan Miguens treated a patient in his office whom he had not seen for eight months. Miguens, a rehabilitation doctor and vice president of the Spanish Society for Rehabilitation and Physical Medicine (SERMEF), discharged this man in November 2020, after having suffered a severe case of covid.
At the end of last year, the patient was fine, and “had returned to exercising at a significant rate”, but more than half a year after recovering, he had to go back to the consultation. “I don’t understand anything, I was phenomenal, and now I can’t move anything. What happened? Have I got infected again? ”The patient asked the doctor. The second question has an answer: no, it has not been reinfected. The first is more “complicated”, acknowledges Miguens. And it has to do with persistent covid.
According to the guide of the Ministry of Health, persistent covid or long covid is a syndrome that is characterized by the persistence of coronavirus symptoms weeks or months after the initial infection, or by the appearance of symptoms after a time without them, regardless whether the patient has suffered a mild or serious illness. “We are concerned about the persistent COVID, it is necessary to specify what it is and give it due attention from the National Health System,” said the Minister of Health, Carolina Darias this Wednesday.
At least 200 symptoms described
The latest studies describe at least 200 symptoms associated with this long covid. The most frequent have to do with asthenia or generalized fatigue without having made physical efforts, but the rosary of symptoms is very extensive, and includes neurological problems (memory disorders, lack of taste and smell), intestinal (diarrhea), muscular (pain, difficulty swallowing) and respiratory (shortness of breath). According to research published in the journal PLOS ONE, one in four infected people had not fully recovered six months after having passed the infection. The figures vary according to the publications.
“At the moment, we see people unable to do simple things such as climbing a minimum slope, walking for more than 10 minutes or doing a daily task such as washing their hair, which can be strenuous,” explains Xoan Miguens. The doctor also expresses his “concern” about the cognitive impairment of these patients. “They have frequent forgetfulness, with a very poor short-term memory, and this has its impact on day-to-day life, but it also poses difficulties for that person to go to medical appointments, complete treatments or do rehabilitation exercises, because they are forget ”, he warns.
We see people with the impossibility of doing things as simple as climbing a minimum slope, walking 10 minutes or washing their hair Xoan Miguens, rehabilitation doctor
The other problem is that the patient load is “very large”, since the system did not have this ‘flood’ of affected people, who also accumulate with each epidemic wave and present different characteristics. “Each wave has had a series of peculiarities. In this, the decline in age is striking, “says Miguens.
“Every time we see younger people”
The so-called ‘young wave’ affects, indeed, especially young people, who have less vaccination coverage. While it is true that, by age, they are less vulnerable to the mortality of the virus, they are not entirely immune to it, much less to developing persistent forms of covid.
“Every time we see younger people, who right now form the bulk of the group we are serving,” confirms Miguens. “We have people who cannot wash their heads, who cannot sing, who cannot swallow food. I have patients who are semi-professional singers in orchestras and cannot work ”, acknowledges the rehabilitation doctor.
A patient who passed COVID exercises with the help of physiotherapists at the Puerta del Hierro Hospital in Madrid, in May 2020. (Photo: PIERRE-PHILIPPE MARCOU via . via .)
An article published in the journal Nature at the end of June warned that it is “worrisome” that people between the ages of 16 and 30 who have not been hospitalized for COVID suffer “potentially severe symptoms, such as concentration and memory problems, dyspnea and fatigue. half a year after infection ”. “It could interfere with their learning progress,” say the researchers of the study, conducted in Norway with 312 people. Half of the participants between 16 and 30 years old reported having some symptoms six months after being infected.
For its part, the PLOS ONE study points out that young people and women reported symptoms of fatigue more frequently than older patients and men, respectively. Young people and women also registered more stress symptoms than the rest of the participants in the study, carried out among 431 citizens of Zurich (Switzerland).
A “correct and realistic definition” of the disease is needed
A few weeks ago, Fernando Simón, director of the Center for the Coordination of Health Alerts and Emergencies (CCAES), admitted that the persistent covid was going to be the “workhorse” of the next few months, or even years, for Health. Simón explained that there is still no “realistic and correct definition” of the disease, which makes the task of narrowing down and trying to tackle this disease quite difficult. The Ministry of Health is already working on determining this issue, but it seems that the process will be long and complex.
“The first step in the approach to persistent covid is to know what it is and how it is,” agrees Javier Padilla, Primary Care physician. In the aforementioned article in Nature, it is found that the severity and duration of the symptoms remains “unknown”. Its authors acknowledge that before this pandemic, a physical and mental decline had already been observed in people passing through the ICU, which could explain the symptoms of persistent covid in critically ill patients. “However, the persistent COVID burden in patients with mild or moderate symptoms is not well defined,” they point out.
There is a danger that persistent covid will get into a mixed bag like other types of diseases that are difficult to diagnose
Padilla emphasizes the need to “delimit the symptoms well” so that the diagnoses are more accurate, and both doctors and patients know better what they are facing. “There is a danger that the persistent covid gets into a mixed bag like other types of diseases of difficult diagnosis such as fibromyalgia, and that it ends up being attributed to moods, as happens with other diseases present mainly in women,” he warns the doctor.
A covid patient attends a physiotherapy session at the Isabel Zendal Hospital in Madrid, in April 2021. (Photo: PIERRE-PHILIPPE MARCOU via . via .)
So far it has been observed that, in general, although men experience COVID with greater severity, women have greater persistence of symptoms, and the reasons have yet to be elucidated. In the last year, Padilla has treated at least five patients with persistent covid, four women and one man, and some have been sick for more than a year. “They all had fatigue, general cramps, difficulty concentrating and joint pain. Two of them also had respiratory distress, ”he explains.
In the most severe and limiting cases, these people have to go to rehabilitation, and those are the patients that Xoan Miguens treats. The doctor explains that many have to undergo a therapy similar to that faced by people who have been bedridden for two years, and then are unable to lead a normal life. They must be taught to gain aerobic capacity and even to change the way they breathe, says the rehabilitator.
“A systemic disease that affects the whole organism”
Miguens defines covid as “a systemic disease that affects the entire organism”, and about which too many aspects are still unknown. “The first wave made it clear that the virus was going to the lung and destroying it. But then a second part came, with the following waves, and we have already seen that the virus also goes to the intestine, the muscles and the nervous system ”, he enumerates.
One of the biggest concerns of health workers is that they observe that in some people the symptoms do not go away, neither after more than a year nor after months of treatment. “You can count on the fingers of the hand the highs we have taken since the first wave,” confesses Miguens. “I do not want to alarm, but every day it seems clearer that there are going to be more or less definitive important consequences,” he acknowledges. And nobody, nobody, is immune to it.
I do not want to alarm, but every day it seems more clear that there are going to be important consequences of the covid more or less definitive
“Nobody wants to pass the covid, nobody should say: ‘Well, if I get infected, I’ll pass it and that’s it,'” Javier Padilla warns. “No matter how healthy and very young you are, you don’t know what will happen next,” he highlights. “We are not clear about the pattern of why persistent symptoms appear in some people and not in others,” insists the doctor.
Xoan Miguens also believes that it is time to remind young people, the most affected in this fifth wave, “that they do not feel immortal or invincible.” “I have cases of very severe disease in young people of 29 years from the first wave,” he recalls. And if it is difficult for everyone to take on this unknown disease, it is much more difficult for young people. “For a young or relatively young patient, who does not have an underlying disease, and encounters this loss of functional capacity, it is very difficult to explain,” admits Miguens. “Whoever believes today that the covid will not have sequels is quite far from reality,” he says.
This article originally appeared on The HuffPost and has been updated.