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Letter to the Editor
Long-term consequences of SARS-COV2 infection: Long-Covid patterns and possible public health implications
Consecuencias a largo plazo de la infeccion por SARS-COV2: patrones de covid persistente y posibles implicaciones en salud pública
Cristina Ausín-García
Corresponding author
, Eva Cervilla-Muñoz, Jesús Millán-Nuñez-Cortés
Internal Medicine Service, General Universitary Hospital Gregorio Marañón, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The overwhelming SARS-COV2 pandemic has led the hospitals around the world to a huge overexertion of work attending patients at the acute phase of the infection due to its high morbidity and mortality&#46; Large number of people have been discharged from hospital in need of a close follow-up due to the post-acute and long-term consequences&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The long term clinical sequelae of SARS-COV2 outbreak are starting to be described&#46; Some of them had been previously reported in the survivors of Severe Acute Respiratory Syndrome &#40;SARS&#41; and Middle East Respiratory Syndrome &#40;MERS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In a recent meta-analysis from these previous outbreaks&#44; lung function abnormalities&#44; psychological impairment and reduced exercise capacity were common and could persist beyond 6 months after the infection&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We aimed to develop a follow-up unit to assess and respond to the needs of those with ongoing symptoms from a whole patient perspective&#46; The term &#8220;Long Covid&#8221; has emerged to refer to those people who remain unwell four weeks beyond the initial onset of the acute infection&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">During the medium and long-term follow up we have identified three main &#8220;Long Covid&#8221; patterns&#46; We have evaluated a check list of symptoms including dyspnea&#44; exercise capacity&#44; fatigue&#44; cough&#44; fever&#44; chest pain&#44; increased heart rate with exertion&#44; smell and taste persistent disorders&#44; headache&#44; arthralgia and myalgia as well as psychological and neurocognitive impairment&#46; At the same time&#44; laboratory analysis&#44; radiological studies and lung function tests have been performed&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">From the patterns we have observed&#44; lung abnormalities in both radiological studies and pulmonary function tests seem to be more frequent in those who had experienced a severe clinical course during the acute phase of the infection&#44; including acute respiratory distress syndrome &#40;ARDS&#41;&#44; need for UCI admission&#44; non-invasive or invasive mechanical ventilation&#44; treatment with corticosteroids or immunomodulatory drugs among others&#46; Pulmonary function tests impairments include low-grade restriction in the spirometry test and mild decrease of diffusing capacity of the lungs for carbon monoxide &#40;DLCO&#41;&#46; At the same time these patients usually have either pulmonary fibrosis changes or ground glass opacities and areas of organizing pneumonia &#40;OP&#41;&#46; If there is evidence of OP clinical improvement could be possible after prolonged treatment with corticosteroids&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The two other patterns identified might occur independently from the severity of the acute infection being present even in those who had an outpatient management with mild symptoms&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">There is a group of patients who remains with a significant dyspnea and heart rate increase on exertion&#46; Sometimes they also complain about oppressive and intermittent chest pain&#44; not associated with elevation in biochemical markers of myocardial damage&#46; The pulmonary function tests and radiological studies do not show abnormalities&#46; This is the subgroup of people who seems to benefit the most from prompt intensive respiratory rehabilitation programs and progressive aerobic physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Concomitant comorbidities such as obesity and active smoking need to be approached in order to favor a better and faster clinical improvement&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally&#44; a wide variety of symptoms might be present alone or together with the previous respiratory patterns&#46; Predominant ongoing symptoms are severe fatigue&#44; low-grade fever&#44; headache&#44; dizziness&#44; arthralgia and myalgia&#44; memory loss and cognitive blunting &#40;&#8220;brain fog&#8221;&#41;&#46; These symptoms persist even in young people with no previous associated underlying comorbidities&#46; It is of notice that nutritional&#44; hormonal&#44; inflammatory and autoimmunity parameters are usually within normal ranges in these cases&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">As we have observed&#44; &#8220;Long-Covid&#8221; seems to be a multisystemic syndrome with yet unknown physiopathological mechanisms&#46; It has been suggested a possible miscommunication in the inflammatory response pathways and other immune disorders&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> persistent viremia or viral particles in different tissues due to a poor antibody response&#44; reinfection or relapse&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> At the same time physical deconditioning and mental factors in the setting of posttraumatic stress&#44; pandemic situations and familiar losses may also play a significant role that interferes with the recovery&#46; Post-infectious fatigue has also been described in previous epidemics and in the setting of viral and bacterial infections and in some cases&#44; it might persist many years after the infection onset&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Given the wide variety of medium and long-term manifestations observed in evolution&#44; periodic assessment and monitoring of multi-organ function is necessary to understand the consequences and mechanisms of this syndrome&#46; It would be also interesting to identify clinical&#44; laboratory parameters&#44; immunological and genetic factors that could be predictors of Long-Covid development&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Long-Covid might have several implications not only for the affected population itself but also for public health systems&#46; From our point of view&#44; it is important to accomplish a comprehensive approach of these patients avoiding multiple consultations to different departments and aiming to create specific Post-Covid follow-up units&#46;</p></span>"
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Article information
ISSN: 00257753
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos