The Covid-19 pandemic has put the respiratory system at the center of attention of the entire population. The new disease has made evident a fact long taken for granted: the good health of our lungs is crucial to living well.
One of the aspects that we will hear about for a long time and which, for now, has been less detailed (also because it is necessary to collect data on many people and spend a lot of time) are the long-term consequences of Covid-19: what do we know today about the sequelae that the infection leaves in the sick?
At Tempo della Salute Vera Martinella spoke about it with Sergio Harari, professor of Internal Medicine at the University of Milan, director of Pneumology and Internal Medicine at the San Giuseppe MultiMedica Hospital in Milan.
Through the social channels of the Corriere della Sera they arrived approx 150 questions / comments. A few were selected, to which Professor Harari replied.
What is Long Covid?
«Long Covid is defined as a condition in which there are persistent symptoms in the body after 3 months of Covid infection. Probably the reason is that an immune mechanism is established by which the organism is “unregulated” in its normal defense system and attacks our organs. To translate: there are respiratory symptoms partly related to pneumonia and complete resolution, which takes a long time, but other disorders are also present and common, such as fatigue, neurological problems and other kinds … The organism may be affected by a situation that lasts longer than the disappearance of the virus and worries us because we see now what the consequences are after a year, but we do not know how it will be in the next few years “.
What are the most typical manifestations of Long Covid in the lungs?
“Today it is thought that Long Covid can affect as much as 50% of former Covid patients. Some of the respiratory disorders that remain are justified by the sequelae of viruses: lung damage takes time to heal. The good news is that it heals in most cases. Symptoms are of the asthmatic type as with all types of respiratory viruses. It also happens to have a radiological resolution, but difficulties in physical exercise persist, there are no longer the same performances. One of the most recent research says that there is an alteration of the pulmonary microcirculation, an inflammation of the small vessels that we do not see, but which justifies the picture that many patients report ”.
Who is most at risk of having such symptoms? Who has been hospitalized or are there also patients treated at home?
«The first data comes from Lombardy, so we have greater control of the weather than in other countries. Patients with hospitalization suffer from the long-term consequences with increased drug use and more hospitalizations in the following months. It can also happen in people who have been at home. Then there are the categories at greatest risk. In general, even patients treated in intensive care suffer from long timescales regarding respiratory recovery and the consequences of forced ventilation ».
Who has the ability to fully recover and who does not?
«The functional recovery usually occurs at 6-12 months and the normalization of the CT scan, but often the eradication of the virus does not coincide with the clinical recovery. On average it takes 6-12 months. We do not know which patients will recover sooner or later, it is not necessarily always linked to the severity of the Covid had. Fortunately, the majority recover completely. A number of patients have pulmonary fibrosis that remains forever “.
How do I recognize that I have a Long Covid?
“A sense of chest tightness, shortness of breath when climbing stairs or long walks. I can do a screening and chest CT scan to see if there’s any damage. However, a number of patients have a normal CT scan but still have symptoms. They are not symptoms of an anxious nature, they are something related to the microcirculation that we are not yet able to identify exactly ».
How are the lungs “helped”?
«The physical activities that make the lungs work are to be preferred: swimming par excellence. Do you have to make an effort? It is good to do this without exaggerating: monitor saturation during exercise, at least it must always be above 90-92 percent. If we see that the levels are good we can do what we feel with gradual exercise ».
What is pulmonary fibrosis?
“Fibrosis is scar tissue in the lung. It can be a consequence of some diseases, such as Covid. It remains in a limited percentage of patients after Covid: a percentage that, although limited, is already significant in Lombardy, with persistent damage over time. There is also idiopathic pulmonary fibrosis, which is a disease in itself whose cause is not known, although some risk factors are known, such as pollutants, smoking and age. It is an incapacitating disease with an important progression ».
How to tell if we have pulmonary fibrosis?
“It is a rare disease that often involves a delay in diagnosis. Symptoms are shortness of breath (although it is a rather nonspecific symptom) and an irritating cough. They are “gradual” symptoms. It has a very suggestive clinical sign when a doctor auscultates the patient’s chest: crepitus rales. The tests are those of respiratory function and the CT scan of the chest ».
Where to get treated or diagnosed if fibrosis is suspected?
«It is important to reduce the diagnostic delay in order to be able to prescribe treatments capable of slowing the disease. There are specific centers with consolidated experience. Patient associations are also very important ».
If pulmonary fibrosis remains after Covid, what are the treatments? The same as idiopathic fibrosis?
“We do not know if there are specific treatments for the post Covid form: we know that this share of patients can benefit from cortisone therapy when the damage is not consolidated. When the damage is consolidated it is not yet known which drugs will be most useful, but we await clinical data, because for now there is only experience to help us ».
Are there any drugs that can replace oxygen therapy at home for those forced to do it?
“There are two molecules we are evaluating against fibrosis that appear to lead to clinical improvement, but we are studying them. The other only alternative is a transplant. In any case, oxygen therapy can be carried out throughout life ».
Is there better abroad?
“There are also new treatments in Italy: two drugs have already been approved for years and are prescribed through the National Health Service and the others, still in experimentation, are in any case administered in clinical trials open in our country. In Italy there are practically all the most important trials in the world because ours is one of the most advanced countries in the field of fibrosis ».
Are there any differences between seniors and young adults regarding Long Covid?
“The elderly are subject to a greater frequency of complications understood as long-term mortality, other hospitalizations and increased consumption of drugs”.
How are healthy lungs checked? What exams to take?
«You have to check yourself in the presence of risk factors: smokers must undergo checks ranging from spirometric tests to low-dose CT screening, annually. Those who do not have symptoms and risk factors must not do them ».
What do you recommend to improve lung health?
“It is important to maintain a physical activity modeled on yourself and your needs with an eye to the muscles that support the rib cage that contains the lungs.”