The syndrome that killed Natalie’s husband turned out to be difficult to treat: doctors sounded the alarm

Meanwhile, in Spain, they conducted a record-breaking study on the observation of patients with post-COVID — it lasted almost two years. The result is disappointing: the proportion of those who recovered was only 7.6%. The authors of the study believe that we still have a long way to deal with the consequences of the pandemic.

Experts estimate that at least 5-10% of people who survive COVID-19 develop post-COVID syndrome (PCS). This syndrome includes a range of long-term, debilitating symptoms and medical conditions that often result in physical, social and psychological disability and have a serious impact on a person’s health. People suffer from changes in smell and/or taste, asthenia, weakness, sleep disturbances, brain fog, palpitations, gastrointestinal symptoms. The clinical picture of this condition is heterogeneous, its causes are still a mystery, there are no exact diagnostic methods, and no one really knows how to treat it. The long-term clinical consequences of PCS, in particular the frequency and rate of recovery from this syndrome, remain unknown.

Spanish scientists conducted the world’s first study that examined the evolution of post-COVID syndrome with a follow-up period of at least one year. Survivors of COVID-19 were followed up for two years, including those who presented symptoms of PCD and people with complete clinical recovery. Post-infection symptoms were systematically collected using pre-designed questionnaires, and, if necessary, additional diagnostic studies were performed.

The diagnosis of PCS was based on the criteria of the World Health Organization (they provide for the presence of persistent symptoms associated with SARS-CoV-2, recurrent or continuous, for at least three months from the onset of COVID-19).

The study included 548 people, 341 of them with PCS were followed up for an average of 23 months. Patients with PKD were divided into three clusters: Cluster A (40.8% of participants) presented symptoms predominantly with fatigue; in participants from cluster B (44.6%), fatigue plus shortness of breath, neurocognitive complaints, headache, muscle pain, chest pain and tachycardia; patients in cluster C (14.2%) had the same dominant symptoms as in cluster B, plus changes in skin, smell and taste, and diarrhea. Compared to patients in clusters B and C, there were more men in cluster A who required hospitalization and resuscitation, while fewer of them had a previous history of allergies.

Only 26 study participants (7.6%) recovered from PKC within two years (median recovery was 11.4 months). Almost all of them belonged to cluster A; only one person each belonged to clusters B and C. That is, almost all those who recovered experienced post-COVID according to a mild scenario. Recovery from PKC was more likely in males who required intensive care unit admission and who had comorbid cardiovascular disease, hyporexia, and/or olfactory/taste changes during a COVID-19 flare. Conversely, patients with muscle pain, impaired attention, dyspnea, or tachycardia were less likely to recover from PCS.

At the same time, the study showed that the likelihood of the development of post-COVID syndrome was lower in male patients and those with higher education, while the presence of a history of headache, tachycardia, fatigue, neurocognitive complaints, and shortness of breath when diagnosed with COVID-19 predicted the development of PCS. Most often, post-COVID patients suffered from middle-aged women with concomitant diseases, namely: allergies of any type (31.4%), obesity (24.8%), dyslipidemia (24%) and hypertension (19.6%). Of the 238 women included in the study, 84 (35.3%) were menopausal. Most of them had mild COVID-19. Only 130 (38.1%)

study participants were hospitalized during COVID-19, and only 16 (4.7%) required intensive care.

In comparison, participants without post-COVID were more likely to be men (55.1%), healthcare workers (37.3%), people with higher education (72.1%) and patients who needed hospitalization (45.4%). Female sex and a history of autoimmune diseases, arrhythmias, and allergies suggest a predisposition to post-COVID. The new result of the study was that people with higher education are less likely to suffer from and more likely to recover from PCD. Probably, the high cognitive status of such patients plays a role.

The authors of the scientific work emphasize that most of the people they observed were first infected with SARS-CoV-2 in the era before the advent of Omicron, and almost none of them were vaccinated before the diagnosis of PCD: only 2 people received a full two-time vaccination.

The clinical picture of COVID-19, as well as the presence of concomitant diseases and the level of education of the patient, allow predicting both the risk of developing PCS and its consequences, scientists conclude. But, unfortunately, the small chance of recovery from PKD within the first 2 years highlights that while transmission of SARS-CoV-2 continues and few people

people are cured, the number of people with a disabling post-viral syndrome will continue to grow, for which health systems must be prepared.

“Recovery in post-COVID patients during the first 2 years is extremely rare, which is a serious problem for healthcare systems,” the authors note.

…Scientists continue to discuss a variety of versions of the emergence and development of post-COVID. For example, The Lancet published a publication where the reasons are assumed to be: a delay of SARS-COV-2 for a long time in some tissues; an autoimmune reaction, when the immune response against SARS-CoV-2 during the acute phase of the infection causes damage to the body; reactivation of other latent viruses (for example, herpes viruses); damage to organs as a result of inflammatory processes during infection.

Nature published a large study on gastrointestinal symptoms in post-COVID syndrome. The main conclusions of the work: at least 42 million people in the world experience gastrointestinal symptoms due to post-COVID syndrome. Those who have recovered from COVID-19, compared with those who have not been ill, have a higher risk of developing ulcers in the gastric mucosa or in the small intestine (by 62% on average), acid reflux (by 35%), acute pancreatitis (by 46%), irritable bowel syndrome (by 54%), gastritis (by 47%), other disorders of the gastrointestinal tract without an obvious cause (by 36%). In addition, the risk of digestive-related symptoms such as bloating, abdominal pain, vomiting, diarrhea, and constipation is higher (by 54%). The more severe the course of COVID-19, the usually higher the risks of gastrointestinal symptoms in post-COVID.

SARS-СoV-2 can presumably stay in the mucosa of the small intestine, in the liver, and in the appendix for a long time.

The journal Nature Cell Biology wrote that SARS-CoV-2 damages DNA, which can lead to cellular aging and inflammation. In particular, the viral proteins ORF6 and NSP13 trigger a process that leads to replication failure and damage to mitochondrial DNA. The accumulation of DNA damage is associated with the development of cancer and with aging.

There is also evidence that ongoing inflammatory response may be the cause of prolonged headaches in post-COVID syndrome. And that air pollution can increase the risk of post-COVID symptoms.

But in general, there is still no understanding among scientists.

As a cardiologist, professor of the Department of Faculty Therapy N1 of the First Moscow State Medical University named after I.I. THEM. Sechenov, post-COVID is a very complex and ambiguous diagnosis: “There are no clear criteria and methods for diagnosing this condition, there is no clear set of symptoms. It is assumed that this is a collection of symptoms, and it is very difficult to differentiate who belongs to PCS and who does not. And several different doctors can diagnose PCS, other pathologies, and exacerbation of his chronic diseases in the same patient. Can two doctors argue about whether it is post-COVID or some other condition? In some patients, COVID-19 becomes a trigger for the development of chronic pathologies in which they either did not know before, or they appeared for the first time. As far as this study is concerned, its participants were ill with COVID-19 during the period of the Alpha and Delta strains, which are no longer there today, but they left a serious legacy. After the arrival of Omicron, the percentage of post-COVID complications became an order of magnitude smaller. The post-COVID significantly spoils the quality of life, but I don’t know if it makes sense to be afraid of it: we need to follow the development of events. What awaits us ahead, we cannot predict, but, most likely, the pandemic of this particular coronavirus has ended, and it is difficult to draw further conclusions. For most people with post-COVID, the virus is likely to exacerbate existing problems. It is not yet clear how long and how persistently to observe those who have been ill. For example, if you had measles as a child, then all health problems caused by the virus will occur within six months to a year. Therefore, it makes no sense to associate the appearance of a disease at the age of 70 with measles suffered in childhood. By covid, we simply do not know how long its effect on the body is. Until we live 10-15 years, we will not be able to assess the consequences,

But there is no doubt that the virus has swept the earth and changed our lives.”