It is not easy to get rid of the Covid. Not even when the last of the tests tells us that the virus is gone. Its passage in the organism could be felt for months with the “Long Covid“, That is the set of effects that the infection leaves and that last for a long time. The term, now internationally recognized, has a strong Italian imprint: it is that of Elisa Peregoa researcher at the Institute of Archeology at University College London, who on March 20, 2020 used that definition by posting it on Twitter a comment on a news report on a long positive virus, then passed to the honors of scientific research in an article in the British Medical Journal.
What exactly is long Covid?
A work published on Lancet Infectious Diseases describes it as a condition that “occurs in individuals with a history of probable or confirmed Sars Cov-2 infection, usually 3 months after onset, with symptoms lasting at least 2 months and cannot be explained by an alternative diagnosis . Common symptoms include (but are not limited to), fatigue, shortness of breath and cognitive dysfunction and generally have a daily impact. Symptoms could be new onset after initial recovery from an acute episode of Covid-19 or persist from the initial disease, they could also fluctuate or relapse over time “.
Effects of this kind are typical of various inflammatory states. For example, those who recover fromebola can suffer from “post ebola virus syndrome“, With joint pain, eye problems (which can also lead to blindness), muscular and neurological disorders. But there is also there sindrome post-poliomelite (caused by the damage of the infection on the nervous system).
I sintomi
The tiredness. A work of the Ichan School of Medicine in Mount Sinai photographs a fact: almost one in two Covid patients with the “Long” version of the infection (46%) feels a syndrome of chronic fatigue. In the study published in Jacc Heart Failure they describe this state with muscle and joint pain, chronic fatigue and depression. Furthermore, it was found that all these people also had breathing difficulties, with shortness of breath and too shallow, an aspect that leads us to think that chronic fatigue is the result of these persistent breathing difficulties.
Taste, smell and headache. The loss of taste and smell remains in the Long Covid. In almost one in four people, the disturbance of smell can remain for up to a year, if not more. This is what they described above Brain Sciences the Italian-American researchers of the University of Catania, the San Giovanni Addolorata hospital, the University of Michigan and the Wayne State University of Detroit. The study found that 32.8% of the patients had an absence of smell, 16.4% a reduction in smell, 6.6% a dysfunction of the sense of smell, and 38.2% a combination of the latter two. . Headache was reported in one in two people and mental confusion in 46.7% of cases.
The heart. At least a year after infection, according to work published in Nature Medicine, there may be an increased risk of heart disease. These include arrhythmias, inflammation, blood clots, stroke, coronary heart disease, heart attack. “For people who were clearly at risk of a heart condition prior to being infected with Sars-CoV-2, the findings suggest Covid-19 could amplify the risk,” said senior research author Ziyad Al-Aly. , professor of medicine at Washington University di St. Louis. Thanks to this work it was found that the risk is 72% higher for having coronary heart disease, 63% higher for heart attack and 52% higher for stroke. According to the study there would be in the world 15 million more cardiac patients due to Covid.
Lungs. In 60% of cases, patients with Covid two months after discharge are still symptomatic, a percentage that is reduced to 6 months but which still remains high, 40%. The most frequently reported symptoms are: difficulty in breathing, weakness and cough, followed by chest pain, tachycardia, balance disturbances, nausea or low-grade fever. This is attested by the observational study conducted by the Pneumology and Respiratory Intensive Therapy of the Irccs Policlinico di Sant’Orsola directed by Professor Stefano Nava, published in the international journal Respiration.
Lung function tests identify significant improvement in lung function for two to six months, with 86% of patients showing normal spirometry six months after discharge. The functional test that is most often impaired at six months is the alveolar-capillary diffusion of carbon monoxide (Dlco), a test that measures the ability of the lung’s capillary alveolus membrane to exchange oxygen. This observation is justified by the fact that Covid-19 pneumonia, being interstitial pneumonia, affects this pulmonary structure, whose complete recovery can take even more than six months. The six-minute walk test shows that patients who have had more severe acute interstitial pneumonia two months after discharge walk shorter distances and tend to have greater desaturation under exertion. However, these data tend to improve over time, suggesting a progressive recovery of effort tolerance, even in the absence of a standardized rehabilitation program.
Radiologically, the majority (64%) of patients present changes to the chest x-rays two months after admission; however, comparing the chest CT scan performed during hospital admission with that performed at six months, a progressive reduction in the extent of the disease and in the density of pulmonary consolidations can be noted. Again, chest CT scans that show more severe pictures at six months are those of patients who were more severe during hospitalization. Only 26% of CT scans at six months are completely “cleared”: however, by its nature, interstitial pneumonia takes a long time to resolve radiologically, and as in all pneumonia, clinical recovery precedes radiological one. For the Bolognese researchers, “for none of the hundred patients was the SARS Cov-2 disease a simple” pneumonia “indeed, it has created deep wounds, not only in the body, which will leave a perhaps indelible scar ».
The origin of the disease
But how was Long Covid born? According to a Catalan research by theGermans Trias i Pujol University which was presented in Lisbon for Eccmid, the European Congress of Clinical Microbiology and Infectious Diseases, would be one of the effects of Sars Cov-2 on the vagus nerve, which connects the brain with the intestine, heart, lungs and which regulates various functions of the organism, such as heartbeat, voice and swallowing. According to the researchers of the University of New South Wales, Sidney, who in this regard have published a work in Nature Immunology, at the origin there could be a hyper activation of the immune system that continues even after the acute phase of the disease and that can continue for months. From the analyzes of 31 patients it emerged that people who had fallen ill with Covid had a persistent alteration of the immune system, in particular they had a high activity of innate immunity cells, a high expression of interferon beta and lambda (proteins that the body uses to fight infections) and inflammatory molecules.
The frequency of the disease
A French work published on Clinical Microbiology and Infection, also confirmed by various other researches, has shown that there is a greater frequency of Long Covid among those who have had a more serious course and who therefore went to the hospital. Vaccination, with its effectiveness in protecting against more severe Covid cases, can therefore help reduce the consequences once they return negative.
What Happens in Babies?
A research conducted by pediatricians of the Agostino Gemelli Irccs University Hospital Foundation and published in Acta Paediatrica in April 2021, involved 129 young people and children diagnosed with Covid-19. During the acute phase of the infection, 25.6% of the children enrolled in this study were asymptomatic, 74.4% had symptoms; 6 children needed hospitalization and 3 needed ICU admission. Three pups developed multisystem inflammatory syndrome (characterized by fever, signs of systemic inflammation up to cytokine storm, severe respiratory and cardiac impairment, up to shock, vasculitis, coronary artery aneurysms; it can also severely affect kidneys, brain, eyes , intestine) and two myocarditis.
41.8% of the positives recovered completely from Covid-19, but 35.7% showed persistence of one or two symptoms and 22.5% of 3 or more symptoms. Among the most frequent symptoms of long Covid, insomnia (18.6%), persistence of respiratory symptoms (including pain and chest tightness) in 14.7%, nasal congestion (12.4%), fatigue (10.8%), muscle (10.1%) and joint pain (6.9%) and difficulty concentrating (10.1%).
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