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The sequelae of COVID-19 is still lack of effective treatments.
The sequelae of the COVID-19 is recognized as a new disease, but there is still a lack of effective treatments. 10%-20% of people with COVID-19 infections have persistent symptoms.
Tens of millions of patients with COVID-19 pneumonia will continue to suffer from some symptoms after they have recovered and been discharged from the hospital. The “Clinical Case Definition” handbook (hereinafter referred to as the “Handbook”) published by the World Health Organization (WHO) has identified the “post-coronary state” as a new disease.
According to the latest interpretation of the Centers for Disease Control and Prevention (CDC), the “post-coronary condition” may also be referred to as “long-term COVID-19”, “long-term COVID-19”, “acute post-coronary condition”, “COVID-19 sequelae” or “chronic COVID-19”.
“After the standardized definition, clinicians and researchers can identify it in different clinical environments and provide appropriate treatment, care and rehabilitation.” WHO explained.
As early as September 2020, at the request of member states, WHO subordinate departments created a code for the “post-COVID-19 status” in the “International Classification of Diseases”, hoping to help countries classify and manage diseases.
Picture from WHO
What are the “post-COVID-19 status”?
The “Handbook” shows that the WHO’s clinical definition is the 10th version that has been published so far. Prior to this, academic journals or institutions such as Nature, The Lancet, and the American CDC have all published their definitions, but they are all different from each other.
According to the WHO, this is because of the definition of “post-COVID-19 state”. The biggest difficulty is that there are too many symptoms related to it, which affect almost every organ and regulatory system of the body.
Paul Garner, professor of infectious diseases at Liverpool School of Tropical Medicine, UK, was infected with the COVID-19 in the summer of 2020. “I felt tired for the first two months after the infection, and every other day I found myself having more problems, including stomach upset, tinnitus, wheezing, and dizziness. Whenever I thought I was getting better, my symptoms would come back. Later. After 4 months, the condition gradually stabilized, but only the number of attacks decreased.”
“British Medical Journal” once organized an online discussion that “extreme fatigue” is the most common long-term symptom. Others include muscle and body pain, heaviness or pressure in the chest, rash, heart palpitations, fever, headache, diarrhea and tingling. EClinical Medicine, a subsidiary of The Lancet, released data from 56 countries in July, stating that there are 203 long-term symptoms and 10 organ systems of the human body will be affected.
To facilitate clinical application, WHO conducted two rounds of Delphi surveys. In each round, five groups of stakeholders are included, including patients, researchers, external experts, WHO staff, and others. In the end, the “manual” proposed that 12 conditions and variables should be included in the definition:
- History of new coronavirus infection;
- New coronavirus infection diagnosed in the laboratory;
- The shortest time from the onset of symptoms (or asymptomatic but positive test) is 3 months;
- The shortest duration of symptoms is 2 months;
- Symptoms and/or injuries include: cognitive dysfunction, fatigue, shortness of breath, others;
- The number of symptoms is unlimited;
- Symptom clustering: two or more related symptoms appear at the same time;
- Symptoms may change over time: fluctuating, new, persistent, recurring;
- Sequelae due to complications of the COVID-19: stroke, heart attack, etc.;
- Symptoms cannot be explained by other diagnoses;
- The definition is applicable to different groups of people;
- Have an impact on daily functions.
Based on this, the “Manual” puts forward that “post-coronavirus status” refers to the presence of at least one symptom that cannot be explained by other diagnoses 3 months after the diagnosis or suspected infection of the COVID-19 virus, and the symptoms last for at least 2 months. Common symptoms include fatigue, shortness of breath, cognitive dysfunction, depression, etc.
These symptoms may appear and persist during the acute infection period, or they may appear during the recovery period. Over time, symptoms may fluctuate or recur, but they often affect daily functions.
“The definition may change as new evidence emerges and clinical understanding deepens,” said WHO.
Photo caption: In May 2021, the Stanford Health Care Center opened the “Acute COVID-19 Syndrome Clinic” to treat survivors with long-term symptoms. /Stanford medicine
How high is the incidence?
On August 28, the “Lancet” published an editorial, calling the “long-term COVID-19” “a first-level challenge facing modern medicine.” One reason is that while the base of infection continues to increase, the number of such patients will be considerable.
In the “handbook”, WHO assessed that 10%-20% of patients with COVID-19 disease will have persistent symptoms for several months after infection. As of 8:00 on October 11th, Beijing time, a total of 236,963,427 cases of COVID-19 pneumonia infection have been reported worldwide. This means that more than 20 million infected people worldwide have suffered or are suffering from long-term symptoms.
In May 2020, Mount Sinai Hospital in the United States established the “COVID-19 Pneumonia Care Center” to receive patients with “long-term symptoms”. As of July of that year, the care center had admitted about 1,000 long-term infected people, with symptoms lasting on average from 50 to 70 days.
According to data compiled by the UK National Bureau of Statistics, as of August 1, about 970,000 people (1.5% of the total population) in the UK have self-reported long-term symptoms. This is more common among 35-69-year-olds, women, people living in poverty, health or nursing workers, and people with other underlying diseases or people with disabilities.
Research from Harvard University in the United States also shows that long-term symptoms are more likely to appear in people under 65. In other words, young and middle-aged people who bear more social and family responsibilities are the main victims of “long-term symptoms.”
But up to now, the cause of this problem in the medical community is still unclear. Some studies believe that the main culprit for all this is the autonomic dysfunction caused by infection, which affects up to 15% of people infected with COVID-19 pneumonia. Some studies claim that this is caused by chronic fatigue. And, it may be an infection that caused the immune system to become overwhelmed or out of control. There are also some studies that believe that some of the long-term symptoms are caused by anxiety.
How to manage long-term COVID-19?
After the “Handbook” was released, Ziyad Al-Aly, director of the Center for Clinical Epidemiology at Washington University in St. Louis, USA, publicly expressed disappointment. “(The manual) is very weak in detail. Its definition is far from the daily suffering of millions of patients with chronic Covid-19 symptoms.
We already know that long-term Covid-19 affects the kidneys and may cause new diabetes. But the’Manual’ does not Reflecting these contents, it does not show the complexity of the disease. I don’t understand how it serves patients. The WHO should do better.”
The “new-onset diabetes” not mentioned in the “Handbook” has been confirmed by a Harvard University study: Compared with people who have never been infected with the COVID-19, people infected with the disease are more likely to be newly diagnosed with diabetes and neurological diseases.
In September, the “British Medical Journal” held an online seminar to discuss the diagnosis, management and prognosis of the “Post-Coronavirus State”. Experts at the meeting said that the medical community has seen that long-term symptoms affect people’s daily functions and work ability, but there is still no effective treatment or rehabilitation guidance for these patients.
Nislin Alwan, an associate professor in the Department of Public Health at the University of Southampton in the United Kingdom, pointed out: “This is a continuous cycle of disappointment. You feel like you have recovered, and then your symptoms have returned.”
37-year-old Chelsea Arionar told the Wall Street Journal that he would experience rapid heartbeat, chest pain and numbness in his limbs every day. “I have made many appointments for medical treatment, but I have encountered resistance from the doctors. They said that the COVID-19 pneumonia should not be a disease with such a long cycle.”
Nislin Alwan also said that countries should include “long-term COVID-19 symptoms” in their statistics. “We have missed a huge opportunity. We could have quantified and measured the long-term COVID-19 like a positive test result and death.”
Photo caption: 37-year-old Chelsea Alionar wears a heartbeat monitoring device. After recovering from the COVID-19 pneumonia, she developed persistent dry cough, heart palpitations, chest pain and other symptoms. /Wall Street Journal
Can the long-term COVID-19 recover?
Ziyad Al-Aly also believes that the “manual” does not clarify a core issue: what is the long-term prognosis.
In response to this problem, The Lancet released the largest sample size study in August this year. A one-year follow-up of 1276 patients with COVID-19 pneumonia who were cured and discharged from a hospital in Wuhan, some countries showed that nearly half (49%) still have at least one long-term symptom after one year of illness, which is among the severely ill patients Especially prominent.
Fatigue or muscle weakness are the most common symptoms. The symptom occurred at 52% at 6 months and 20% at 12 months. Patients with sleep difficulties accounted for 27% at 6 months and 17% at 12 months. At 6 months, 128 discharged patients had lung CT examinations, and all of them had at least one imaging abnormality; at 12 months, this proportion had dropped to 84.7%. The proportion of people with hair loss and olfactory disorders will also decline to varying degrees over time. However, there was no significant change in the proportion of heart palpitations and joint pain.
It is worth noting that the proportion of dyspnea characterized by a mMRC score of 1 or higher increased from 26% at 6 hours to 30% at 12 months.
Studies have shown that regardless of the patient’s condition at the time of hospitalization, the long-term symptoms after discharge will decrease over time. However, one year after the acute infection, the health status of COVID-19 patients is still lower than that of the non-coronavirus control group whose age, gender, and comorbidities are matched.
Some small studies have found that some people with long-term symptoms have improved after being vaccinated with the COVID-19 vaccine. The CDC in the United States believes that more research evidence is needed to determine the specific effect of vaccination on long-term COVID-19 symptoms.
. A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. WHO
.Explainer: What researchers say about the long-term effects of COVID-19. Reuters
.Long Covid now has a formal definition. Here’s what you need to know. CNBC
.WHO publishes clinical case definition for long COVID. Healio
.WHO officially defines’long COVID’ as Post COVID-19 Condition. ABC 13 News
The sequelae of COVID-19 is still lack of effective treatments
(source:internet, reference only)