What do we know today about long-COVID

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Months after passing the acute phase of the COVID-19 infection, many people report that they still have ailments such as widespread aches, exhaustion, and a general sense of weakness. These are the symptoms of the so-called “long-COVID”, a condition that according to estimates by the World Health Organization affects about a quarter of people who have had the disease, and who struggle to recover the health conditions they had before. The problem became evident last summer and is still today, a year later, a topic of great interest for doctors and health institutions in search of clearer data and elements to provide better patient care.

In fact, many elements of long-COVID are not fully known. For example, it is not known why only some patients develop this condition, although there are indicators of major risk factors among the elderly, women and those who have developed severe symptoms, such as to require hospitalization. The amount of symptoms in the acute phase of COVID-19 appears to be a factor in determining any long-COVID, although for now it is unclear whether more severe symptoms necessarily lead to developing the condition. The evidence collected so far, despite the uncertainties, is however important in assessing the importance of vaccines even in the groups considered least at risk in the case of COVID-19.

The largest study to date to investigate the characteristics of long-COVID involved around 20,000 individuals who tested positive for coronavirus in the UK between 2020 and 2021. 13 percent of them found a prevalence of symptoms of more than three. months after infection, about 8 times higher than that found in a control group, made up of people who probably did not have COVID-19. The calculated risk was slightly higher among women than men (14.7 percent versus 12.7 percent), while the prevalence was more marked in the 25-34 age group.

A study carried out in China on 1,700 patients who had been hospitalized for COVID-19 instead found a rather marked presence of symptoms six months after hospitalization: 76 percent of those concerned had declared that they had at least one. However, the study was carried out on a numerically small sample and mostly involved patients who had developed severe symptoms, especially affecting the lungs.

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Another UK analysis of 4,000 individuals found long-COVID prevalence in 13 percent of patients one month after the disease, 4.5 percent at two months and 2.3 percent at four months. . The trend seems to confirm a slow recovery for most of the interested parties, but even in this case the data collected are not sufficient to draw any conclusions.

In Italy, studies on long-COVID have so far been limited and research is still ongoing. For an analysis, a group of researchers evaluated the conditions of 143 patients, who had been hospitalized, two months after they first developed symptoms. The analysis found that only 13 percent no longer had symptoms, while 32 percent reported having up to two. Most, 55 percent, reported having three or more symptoms.

An archive photo taken at the Bergamo hospital in 2019 (Tiziano Manzoni / LaPresse)

Defining long-COVID through a diagnosis is not always easy, because the symptoms are numerous and vary greatly depending on the person concerned. The most common general manifestation is the sensation of persistent tiredness (asthenia), associated with weakness, widespread pain (both muscle and joint) and in some cases short bouts of fever.

To these symptoms are added those that can be objectively observed by doctors, through diagnostic tests of various types. They mostly result from damage to the organs of the respiratory, cardiovascular and nervous systems. Coronavirus infections can also lead in some cases to damage to the kidneys, gastrointestinal tract, skin and other tissues.

Depending on the organs affected, this damage involves persistent coughing, difficulty breathing properly, tightness in the chest, palpitations, arrhythmias, and pressure problems. Among the neurological symptoms, headache (cephalalgia) is the most recurrent, in some cases with difficulty in treating the symptoms with common analgesics.

The combination of one or more of these symptoms generally affects the quality of life of long-COVID patients, with consequences for their psychological conditions. Many of those affected report that they sleep little and badly, that they have mood changes and anxiety, especially given the concern of returning to suffer from more serious symptoms comparable to those faced during COVID-19.

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The Istituto Superiore di Sanità (ISS) found that long-COVID affects older people more frequently: “Among the elderly assessed two months after the onset of COVID-19, up to 80% report the persistence of at least a symptom, in particular asthenia, dyspnoea, joint pain and cough. This high prevalence may be linked to the reduced functional reserve in the elderly and to the high prevalence of frailty, which results in a reduced ability to recover from stressful situations ». Furthermore, in the elderly with other chronic diseases, long-COVID can contribute to a worsening of living conditions.

(Michele Lapini/Getty Images)

Other syndromes
Over the past year, doctors have sometimes reported difficulties diagnosing long-COVID among patients without a clear history of COVID-19, for example if the disease was not recognized as such. In fact, long-COVID has some aspects in common with chronic fatigue syndrome, another condition that is difficult to diagnose and which leads to a constant sense of fatigue, even after long periods of rest. However, the variety of symptoms is greater among long-COVID sufferers and this can help make the diagnosis.

Some patients with symptoms consistent with long-COVID may actually suffer from post-ICU syndrome, a condition that sometimes occurs in the recovery phase after a long period in bed, especially when on mechanical ventilation. In some cases, this syndrome can occur alongside long-COVID, making the diagnosis of the two conditions more difficult.

As in other countries, also in Italy various hospitals have for months now launched programs to follow patients who still show symptoms, even after a long time from the time they tested negative for coronavirus. Patients can usually count on the assistance of a doctor, who has now developed knowledge about COVID-19, and who is in charge of coordinating the various activities both for diagnosis and to facilitate the recovery of patients.

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The Gemelli Polyclinic in Rome, for example, has already started a day hospital service since the spring of 2020 for people recovering from COVID-19, even if previously hospitalized and treated in other hospitals. Healthcare is mostly oriented towards the elderly, with diagnosis and therapy paths.

At the Niguarda hospital in Milan, one of the largest in the city, an outpatient clinic was organized to follow up patients who had been hospitalized with COVID-19. The program foresees to follow all the interested ones starting one month after the discharge, with a first pneumological visit to ascertain the conditions of the respiratory system and its recovery. Patients of the first wave are followed with particular attention, also because at the beginning of the pandemic the knowledge about the disease was limited and consequently the therapies were not always effective.

Initiatives of this type not only make it possible to offer therapies to alleviate the symptoms of patients, but also make it possible to collect important data on the long-term effects of COVID-19 and on recovery times. The information obtained is invaluable in medical research to better understand long-COVID and develop more appropriate treatment protocols. This condition seems to affect millions of people around the world, who will need assistance for a prolonged time, further weighing on health systems affected by the pandemic.

In Italy, the so-called “Sostegni bis” decree, approved by the government at the end of May, established a “national monitoring protocol” to provide outpatient health care to those suffering from health problems attributable to a previous COVID-19. The focus is mainly on those who had been hospitalized during the illness, and could therefore have longer and more difficult recovery times than other patients. The protocol provides for patient monitoring to be carried out in order to collect data for research purposes.