Long term COVID

Long-term Health Consequences of COVID-19
(JAMA, 5th October)

https://www.telegraph.co.uk/global-health/science-and-disease/long-covid-can-really-grim-rarer-think/

Ongoing symptoms to substantial end-organ dysfunction

https://jamanetwork.com/journals/jama/fullarticle/2771581?guestAccessKey=6c60fb00-1424-47b5-abc9-0b502a194f46&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=100520

Post-Acute COVID

Persistent severe symptoms, beyond 3 weeks

Chronic COVID-19

Beyond 12 weeks

Common complaints

https://www.bbc.co.uk/news/health-54296223

Crippling fatigue

Breathlessness

Persistent cough

Joint pain

Muscle aches

Chest pain

Hearing and eyesight problems

Headaches

Loss of smell and taste

Damage to the heart, lungs, kidneys and gut

Depression

Anxiety

Struggling to think clearly

Not directly related to severity of acute phase

Some cases may be related to pneumonia
Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19

https://pubmed.ncbi.nlm.nih.gov/32730238/

US CDC

Random sample of 292 adults who had tested positive

35% of 274 symptomatic respondents, not returned to usual health 14 – 16 days after testing

18 – 34 year olds

N = 85, 26%. (74% returned to normal)

35-49 years

N = 96, 32% (68% returned to normal)

50 and older

N = 89, 47% (53% returned to normal)

Post–intensive care syndrome

6 – 12 months, cognitive, mental health, physical function

Persistent Symptoms in Patients After Acute COVID-19 (JAMA, July 2020, Rome)

https://jamanetwork.com/journals/jama/fullarticle/2768351

143 patients discharged from the hospital

18 patients (12.6%) were completely free of any COVID-19–related symptoms after a mean of 60 days

Therefore 87.4 not returned to full normal

Manifestations

None of the patients had fever or any signs or symptoms of acute illness

Worsened quality of life, 44.1%

Pathogenesis

Direct tissue invasion by the virus

The virus cleares from most of the body, but lingers in some small pockets

If there's long-term diarrhoea then you find the virus in the gut, if there's loss of smell it is in the nerves - so that could be what's causing the problem (Tim Spector)

Metabolic effects

New-Onset Diabetes in Covid-19

https://www.nejm.org/doi/full/10.1056/NEJMc2018688

COVID induced diabetes

Profound inflammation and cytokine storm

Immune system does not return to normal

https://www.immunology.org/sites/default/files/BSI_Briefing_Note_August_2020_FINAL.pdf

Ongoing immunological effects

Organ damage

Seen in MERS and SARS

https://www.medicaljournals.se/jrm/content/abstract/10.2340/16501977-2694

Lung function abnormalities

Psychological impairment

Reduced exercise capacity

Brain alterations

Cerebral Micro-Structural Changes in COVID-19 Patients. An MRI-based 3-month Follow-up Study

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30228-5/fulltext

Hypercoagulable state

Blood vessel damage

https://www.bbc.co.uk/news/health-54296223

Possible inflammation of coronary arteries
The Post-hospitalisation COVID-19 study (PHOSP-COVID)

https://www.phosp.org

https://www.youtube.com/watch?v=IiOpm_UAjgI&feature=emb_logo

MRC study under Professor Chris Brightling

Following up 10, 000 people post COVID

Develop trials of new strategies for clinical care

Видео Long term COVID канала Dr. John Campbell