Is the long Covid real? If so, what is it?

NSis that true? That was my first idea, “Good guidance. Don’t put ideas in people’s heads.” Because if people think they will get sick for a long time, they are more likely to get sick for a long time. And, “Well, I’ve never seen anything,” when I saw the turmoil made in the treatise. But like Florence Nightingale – “Bacteria; never seen” – I was destined to prove wrong. The next day I saw it.

Hospital physiotherapy, he caught COVID In the first wave. He was not hospitalized and recovered to OK, but now had a long list of persistent symptoms. “… diarrhea, shortness of breath, malaise, loss of taste, fainting, asthma To make matters worse, chest pain and headaches. I scribble them on my pad and then read them back to him over the phone to make sure it’s correct. It’s my job to understand his symptoms and figure out what’s causing them.

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It turns out that this patient is not explaining the mental health problem, although he is tired and the elephants in the room are often mental health problems. He is a coper. He continued to work and returned to work, setting up a four-day week to manage his and his partner’s health care work and his family.

He isn’t impressed when I struggle to handle all mental health questions, but it has to be done.

It’s an old idea, but we also have to consider the real recovery period. It takes time to recover from a serious illness. Traditionally, it has been advised that hot days need to be doubled before returning to normal activity. Therefore, if the temperature is 7 days (usually for Covid), you will need to rest for another 14 days once the temperature has subsided. The recovery period is important. It gives time for recovery and sets people’s expectations to a more realistic level.

Loss of conditioning is another consideration. Not only did they recover from their actual illness, but they also found that every day they took a rest, they lost 1% of their muscle mass. It also causes symptoms such as malaise and needs to slowly re-accumulate.

And what about fatigue itself? This is a common presentation in general practice and certainly describes some of the long Covids. There are many possible causes, including medical care such as anemia and thyroid gland, mental health problems such as depression and anxiety, and problems in daily life such as work stress.

Is this patient still only recovering from acute covid? I have seen patients who took weeks to improve. A computer programmer diagnosed with Covid by A & E was monitored there for a day and then discharged with a pulse oximeter. She was told to keep checking oxygen levels with a pulse oximeter, but never below 92%.

However, when chest tightness and diarrhea continued three weeks later, she called the clinic for advice. I started arranging weekly follow-ups over the phone, and there was a sense of improvement every week. By the fifth week, she was walking a little more out of the house every day. By the sixth week, she was still on sick leave, but was starting to reply to work emails. After 10 weeks, the diarrhea persisted and caused the most problems, but her chest tightness gradually improved.

This type of long-term illness, with Covid’s symptoms lasting 4 to 12 weeks, is now Ongoing-Symptomatological Covid-19 It clearly reflects the fact that the patient in question has not yet recovered, but is gradually improving. However, my physiotherapy patient has been symptomatic for more than 4 months, so his profile is clearly not compatible with Covid-19, which has ongoing symptoms.

My patients were not treated or hospitalized in the intensive care unit, but many had difficulty staying in the intensive care unit for extended periods of time and their symptoms worsened. However, it is well known that the majority (85%) of ICU patients take at least 6-12 months. Just to get over being in the ICU It is based on a survey conducted in 2016, long before the Covid Pandemic.

When considering all these possibilities, I have to be hit. Longcovid must be genuine and this patient must have it. He has already crossed the first hurdle. He had symptoms for over 12 weeks. I arrange for him to come for a face-to-face appointment and decide to know more about it in the meantime.

Start with the newly published one NICE Guidance December 2020Use the term, Postcovid Syndrome Instead of long covid. I think this is consistent with “post-virus syndrome”, but I’m not sure if the term will spread.

I summarize the long Covid NICE guidance as “Benice”. Meaningless corporate speeches such as “holistic evaluation” and “people-centered approach” are scattered as if there is a way to evaluate someone. Without it Being person-centered. You may find it embarrassing for NICE to publish this document, or at least decide that it is premature to write it. After all, the reason they exist is evidence. The evidence on which these recommendations are based is, at best, weak.

An important question I would like to ask after asking “Is the long Covid real?” “What’s that?” First, we had a personal explanation of how sick it was, written for the media, and probably played eye-catchingly. .. These types of reports do not understand the numbers involved or how common they are among people infected with the virus.

NICE has done its best to answer these questions. It began with a careful literature search of more than 4,000 studies and narrowed down to just four related to long Covid incidence, based in the United Kingdom, Israel and Italy. These were great to find, but NICE agrees that the quality of the evidence is low. The number associated with each study is small and the follow-up is short. If the panel wanted to see an analysis of symptom prevalence or symptomatology clusters, it would simply look at the list of symptoms. Creating a list of symptoms from each treatise is easy, but there is no consensus as to which symptoms are the most common or which are the most important.

Therefore, this guideline (in line with other guidelines such as the US CDC and Scottish sign-in) includes true A long list of possible symptoms. This may indicate that no one has a clue as to what is happening. These symptoms cover all systems in the body, from neurological to psychiatric, from nose to toes. NICE does not identify major symptoms such as coughing or shortness of breath, it only lists all 28.

Interestingly, the term “brain fog” is constantly mentioned in news reports, but these studies do not report it at all. Also, at least one had abnormal results in 33% of patients on the anxiety and depression questionnaire, but those who participated in the NICE panel may have symptoms due to mental health problems. I didn’t like being told. They were experiencing “feeling dismissed when asking for help with their symptoms, and the symptoms were mistakenly attributed to psychological causes.” The panel clearly argued that this could increase anxiety levels.

This simultaneously proves that one-third of long Covid patients may have anxiety and depression (even if they do not necessarily cause symptoms) and make it part of the assessment to the doctor. It is an unfair situation to have a doctor instructed to consider. Fortunately, NICE supplements that with Recommendation 2.1: “… Take a comprehensive history of psychiatric symptoms.”

NICE’s diagnostic advice, “consider other diagnoses” and referrals, and “see A & E for life-threatening symptoms” are, above all, Covid-specific lessons in routine clinical practice. From the risk of Covid getting longer to what to do with it, it’s graceful to end with a list of everything you don’t know (that’s all).

Fortunately, the Covid Symptom Study, led by Dr. Claire Steves and Professor Tim Spector at King’s College London, has the following sections: Especially for a long time.. Based on 4,182 (certainly) self-reported patients followed for 100 days, their sample group includes patients from the United Kingdom, Sweden, and the United States.

These patients were carefully selected to be asymptomatic for at least 2 weeks prior to the onset of Covid (to allow a clear onset date) and matched against the Covid-negative control group to compare symptoms. This suggests that there is a 2.3% chance of persistent symptoms appearing after 12 weeks. In other words, if 50 people see Covid, one of them will be a long Covid. They could even analyze the results and predict who would likely report it. Especially elderly people, people with elevated BMI, people with asthma.

Professor Specter says The long Covid “may turn out to be a bigger public health problem than the excessive death from Covid-19.” However, this data relies on the patient remembering his or her symptoms and bothering to enter them. This is more likely to occur if the patient has symptoms of concern. This is known as recall bias.

I think these numbers must be overestimated, probably due to the self-reporting nature of the data. Assuming an infection rate of 17% after the first wave in our practice population (based on antibody testing in the community), a 2.3% rate predicts that 50 patients will present long Covids. increase. But I have seen one of my physiotherapy patients.

Obviously, other GPs may have seen more, but when I check with my colleague (and compare the notes to make sure they don’t describe the same patient), there are two more instead of 49. Only one was revealed, and there was no long discharge letter from Covid. hospital.

The humorous end is that NICE is willing to recommend a long Covid referral to an interdisciplinary team. Unfortunately, there is no such interdisciplinary clinic. Nice did this often and I had to learn to see these recommendations as ambitious.

Fortunately, general practice is fully set up to handle long Covid-type presentations. Anyway, I always do it. Fatigue is always very common and has its own abbreviation, TATT. Is it difficult to explain the symptoms? GP is an expert. Multiple problems? GP This is the place to go. Symptomatology that may be nothing or something? It’s for us. Recurrence symptoms? Please come back anytime. When the situation gets tough, as long as there are people to refer to.

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My physiotherapy patient comes to get a face-to-face appointment to check weight, chest, and blood pressure. Fortunately, he has no life-threatening symptoms. I help him group the symptoms and try to understand them. As with fatigue, modify some blood tests to make sure there is no medical cause for the symptoms. We will also add a Covid antibody test.

I will focus on his chest (clearly audible, no wheezing), receive asthma management advice, and arrange a CXR. Also, given the anecdotal evidence of the Covid vaccine, it is recommended that he accept the Covid vaccine offer. We are planning another appointment next week to focus on the symptoms of diarrhea. It takes time to screen each issue.

After reading the NICE guidance, the list of research papers, and the myriad of public personal accounts, I still don’t understand the length of Covid. We still don’t know how long it will last or whether it will improve. However, without that information, you can take care of patients with these unexplained symptoms, check for other diagnoses, and provide support. I hope it helps you a little until you know the details.