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A study of some of the first patients hospitalized for covid-19 in the world offers worrying results: in some of them, the physical or psychological sequelae of the infection are still present for at least a year after discharge, and it is likely that some suffer from it even during more time.
One of the biggest uncertainties brought by the pandemic, so far, is how long the disease lasts and especially if this coronavirus, capable of invading many types of tissues, including muscles, nervous system and brain, leaves prolonged damage to patients, especially those who suffered a more serious illness with hospitalization and artificial respiration.
This Friday, the medical journal The Lancet publishes a study of more than 1,200 patients hospitalized by covid-19 in Wuhan, the Chinese city where the virus first emerged. The sample includes some of the first diagnosed patients, who were discharged between January 7 and May 29, 2020.
The results show that most do not have seizures a year later, but half report having at least one persistent symptom. One in three continues to have trouble breathing or pulmonary complications after a year, especially those who have suffered more severely. The authors compared the health status of these survivors with that of a similar uninfected population. And their verdict is clear: the health of the former is worse.
“Our study is the largest so far on the health status of patients hospitalized for covid-19 one year after being discharged,” said Bin Cao, a physician at the National Pulmonology Center of China and co-author of the paper, in an press release. “These findings seem to indicate that some patients will take more than a year to recover, something that health services in the post-pandemic world need to take into account.”
The Chinese work is important because it confirms what many other studies around the world have already suggested, carried out with smaller groups of patients and with shorter monitoring periods. The most common symptoms are tiredness and muscle pain, although there are also psychological impacts such as confusion and others such as shortness of breath. As seen in studies in the UK, Spain and other countries, women are much more likely to suffer long-lasting sequelae, perhaps because they have a more reactive immune system. The results of this study, in any case, do not concern the general population, since it treats hospitalized patients, and precisely at the beginning of the disease, when there was less information about their treatment.
In the Chinese study, women were twice as likely as men to report anxiety or depression, and nearly three times more likely to suffer physical lung damage a year later.
These sequelae, sometimes called long or persistent covid, pose a huge challenge to researchers because most studies rely on self-reported symptoms. Also because of this, it is difficult to know to what extent its damage is physical or psychological, and it is almost impossible to eliminate the effect of subjectivity. The Chinese work, in addition to questionnaires, analyzed the patients’ lung capacity to see if they still had reductions. The researchers found that the number of patients suffering from these problems six months after they were discharged did not decrease a year later; this effect was seen in all groups of patients, regardless of their severity. They also performed exploratory lung examinations. Although the number of patients with injuries has decreased, the incidence was still high a year later, says the work, carried out with patients at the Jin Yin-tan Hospital in Wuhan, the first city to be the epicenter of the pandemic.
Compared with people of the same age group and with other pre-existing health problems but who did not suffer covid-19, patients who contracted the disease had more pain and mobility problems. Anxiety and depression were also more prevalent among them. A worrying fact is that the reported incidence of these psychiatric sequelae increased one year later compared to six months later. “We don’t know why this happens,” admits Xiaoying Gu, a researcher at the Institute of Medical Sciences and co-author of the study, in a press release. “It could be due to the viral infection itself, or the immune system’s reaction to it. Seclusion, loneliness and even unemployment caused by the disease can also influence. We need long-term studies to understand the physical and psychiatric consequences of covid-19”, he says.
Nearly two years after the start of the pandemic, Spain is preparing the beginning of a national study on persistent covid in hospitals across the country, Health Minister Carolina Darias and Health Institute director Carlos announced on Thursday. III, Cristóbal Belda.
Some independent groups have already studied this topic, such as that of Dr. Alexandre Pérez, from the internal medicine service at Hospital Álvaro Cunqueiro, in Vigo (northwestern Spain). Their work, which has not yet been published in a specialized journal, shows that six months after the infection, almost half of patients reported having some symptoms. The most frequent ones were chest problems, shortness of breath and fatigue. In this case, the work analyzed not only hospitalized patients, but also those with milder infections who recovered at home.
“This is a very difficult disease to study because there is no precise definition, and each country or each group uses slightly different criteria”, explains Pérez. In some cases, it is relatively easy to understand that the sequelae are connected with the effects of the SARS-CoV-2 virus —for example, persistent lung lesions — but in others, such as depression, it is difficult to know if it is a direct effect. infection or a subjective outcome of a general situation of stress and/or patient concern.
Persistent problems were already known in other cases of viral infections, such as HIV, the mononucleosis virus and hepatitis. The problem now, however, is the enormous scale of the problem due to the large number of people infected around the world, Pérez adds. It is a huge challenge to understand which symptoms are related to the infection, which are due to chronic inflammation caused by the virus, and which others are due to previous illnesses, as these types of long-lasting complications are more frequent in older patients, who often have suffer with other pathologies. “Today we do not have any treatment available for patients who experience respiratory complications after covid-19. In another study that we are going to publish, we saw that, in many cases, these problems are psychological, since the lungs are perfect. However, there are other patients who, despite noticing less air loss, still have visible physical damage”, he points out.
“It takes a lot more research to understand what is happening with these patients,” observes Pilar Rodríguez Ledo, vice president of the Spanish Society of General and Family Doctors (SEMG). “It is crucial to know which factors trigger these persistent symptoms, both depending on the virus variant and the physical and genetic characteristics of each person. Only then will we be able to have biomarkers that allow us some anticipation to prevent lasting damage from occurring.”
“The Chinese study is very complete because it uses questionnaires, physical exams, fatigue tests and laboratory tests”, emphasizes Josep Maria Miro, an infectious disease specialist at Hospital Clínico de Barcelona and member of the Covid-19’s Multidisciplinary Collaborative Group for Scientific Monitoring, promoted by Barcelona Institute of Global Health. “But we don’t know to what extent the data from China would scale what happens in Spain. It is necessary, for example, to take into account that the average age of patients was 57 years, while in Spain the profile of hospitalized patients has people a little older”, he explains.
The Chinese work focuses mainly on hospitalized patients with mild or moderate cases and has relatively few patients with very severe illness and admitted to ICUs. And, furthermore, it is necessary to take into account that these patients received treatments quite different from others in Spain during later waves, such as, for example, the use of steroids. “A positive fact is that 80% of patients who had work before becoming infected returned to their professional activity, but a quarter of them in lower categories, perhaps due to the sequelae that the disease left”, emphasizes Miro.
“The need to understand and fight long covid is enormous”, say the doctors responsible for the magazine The Lancet in an editorial. “Symptoms such as persistent fatigue, shortness of breath, mental fog and depression can affect millions of people and yet we know very little about this disease. It impacts people’s ability to resume normal life. Long covid is a medical challenge of the first magnitude”, they warn.
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