If there is a difficult discussion in scientific circles, it is about the long covid, but it is becoming impossible not to face it in scientific circles. Meanwhile, the population, that is, people like you and me, is a little lost.
For anyone who caught Sars-CoV-2 — and, in the omicron era, unfortunately, we’re talking about about half of us — any little thing different is already cause for schism. Could the cause, deep down, be Covid-19? And what should anyone watch out for in the first few months, not to mention the first year, if they tested positive one day?
According to the CDC (Centers 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 the coronavirus infection. And the proportion rises to one in four individuals when they are in their sixties or even older.
If this is so, just look at the size of the trouble we have ahead of us: until yesterday, the 8th, Brazil had accumulated 31.3 million cases of covid-19 and the world, 534 million. Think that between a quarter and a fifth of all these people could have long covid.
In principle, under that label, almost anything new that appeared 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 in keeping your breath.
But, at the end of last year, the WHO (World Health Organization) decided to organize this shack a little 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 together with the diagnosis of covid-19 and that have not disappeared even after 12 weeks, that is, three months after the radius of the infection, as if they had arrived to stay .
But symptoms that appear only after you have already gotten rid of Sars-CoV 2 are also valid, provided that apparently there is no possibility that they have any other cause and that they also exceed 12 weeks, with the date of infection being the ” zero” of that count.
If they disappear before that deadline, we are no longer talking about long covid, but the expected and boring recovery from an equally boring disease.
Only that? No! Second point: these symptoms have to persist for at least eight weeks, or two months. Where I want to go: that person who spent a month and a half with his head bursting with pain, even if this discomfort has exceeded 12 weeks, is not framed in the long covid, according to WHO guidance. And all because she hasn’t had a headache for two whole months. Passed on? It wasn’t a long covid, it was more of a boring recovery and period.
In short, the complaint must last for two months without much truce and be present after three months of the diagnosis of covid-19.
Last detail: the WHO considers respiratory problems as part of the definition of long covid, cardiological problems such as the famous myocarditis, which is infinitely more common after infection by Sars-CoV-2, and neurological problems, as long as they are those that get in the way of people’s daily lives in a very significant way, such as fatigue and issues related to memory
According to the doctor Max Igor Lopes, coordinator of the Infectious Diseases Outpatient Clinic at the Hospital das Clínicas da Faculdade de Medicina da USP (University of São Paulo) and consultant to the Brazilian Society of Infectious Diseases, no one is minimizing the suffering of those who have symptoms that do not fit into these situations, ranging from skin problems to body aches.
“The WHO’s idea, at this moment, is to focus on what is most important, directing a profile for care in both public and private health”, he comments. “Respiratory changes tend to be more severe, for example.”
Therefore, in the first year after infection with Sars-CoV-2, the first three months of observation are crucial – even for you to come out saying that you had or have long-term covid.
However, as the infectologist himself recognizes, some problems escape this more up-to-date WHO criterion and they deserve a zealous look for a longer period.
Attention to blood pressure, blood glucose and liver health
“One difficulty is that: you must always try to prove that there is a causal relationship between what the person has and covid-19”, says Dr Max Igor Lopes. “With an omni, it will be difficult, because everything that appears in the next two, three months in 50% of Brazilians will think that it may have happened because of her. It will be difficult to differentiate.”
Ahead of the team that investigates long-term covid at the Hospital das Clínicas da USP, he says that many studies in this field focus on a particular health problem that appeared with covid-19 and make a comparison with what happened before.
“But to avoid confusion, we always compare people who, during the infection, went through similar situations. For example, we look at the before and after of those who needed ICU and separately analyzed those who stayed in a common hospital bed.”
This is how they confirmed here what is noticeable in the world now: the frequency of diagnoses of diabetes, hypertension and liver changes is higher in the post-infection period, although this is not considered a long covid.
“We cannot say that the coronavirus is the cause. But, somehow, it or the reactions triggered by it in the body seem to amplify an individual’s tendency to develop these three problems”, says the doctor. “It is even possible that a person would have become hypertensive or have diabetes anyway, but Covid-19 would have accelerated the process.”
For him, at this point in the championship, looking for a culprit, whether the virus or inflammation, leads nowhere. “Let’s be practical: the clear message is that, knowing that high blood pressure, diabetes and liver problems are more likely to appear, 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”.
Vaccine helps not to have?
Recently, a study published in Nature Medicine and signed by researchers from Veterans Research and Education Foundationin the United States, observed nearly 34,000 vaccinated people who contracted Sars-CoV-2 last year, 2021.
They were examined six months after infection and, according to scientists, the complete vaccination schedule only reduces the risk of long-term covid by 15%.
One of the criticisms of the work is to compare the prevalence of symptoms related to long covid, without, however, checking if the person already felt something similar before getting the coronavirus, or comparing people who had the same time of vaccination, knowing that the booster doses , after a period, are necessary.
“The curious point of this and other studies was to note that among patients who, for whatever reason, upon being discharged, were prescribed a prescription to take anti-inflammatory drugs at home – in this case, corticosteroids -, cases of long-term covid were less frequent”, he says. Dr Max Igor Lopes.
This indicates that the persistence of inflammation caused by Sars-CoV-2 is really an important factor for the development of long-term covid and suggests a possible prevention strategy that, of course, should not be applied left and right, but in those cases. patients who had more severe conditions. “Long covid is much more common in them” assures the infectologist.
That’s why, in fact, most research reports that when the long covid appears in vaccinated people, the symptoms are less intense. “And the duration of the long covid tends to be shorter too”, informs the doctor.
In the daily routine of the hospital, lately he has found far fewer cases of this, of intense persistent symptoms or that get in the way of people’s routine in the advancement of vaccination. And it’s our hope to hold another type of wave, the long covid, with this trawler that the omicron is doing out there.