I have ongoing COVID-19: What are the treatments?

Among other things, Patients with COVID-19 have poorer T lymphocyte function, and T lymphocytes are important cells in the body’s defense system. (the immune system), as well as the reactivation of latent viruses (such as Epstein-Barr) and a significant reduction in levels of the hormone cortisol.

Until more objective methods become available, the symptoms a patient presents form the basis of diagnosis. As Pilar Rodríguez Ledo, vice-president of the Spanish Society of General Practitioners and Family Doctors (SEMG) and president of the Spanish Continuing Coronavirus Research Network (Reicop), explains, these people “spend for a period of time and believe that all its symptoms should be taken seriously.” has gone away, symptoms persist and have not returned to their previous state, or, Even if they don’t have symptoms during the acute phase, they may start to develop symptoms later“.

Experts say they are “the forgotten people of this pandemic,” and not because they are so few in number.estimate They account for 10% of those infected with the coronavirus, which in Spain means about 1,400,000 people.

Why does the coronavirus persist?

Ongoing COVID-19 can affect any part of the body, but most commonly results from general symptoms of weakness or fatigue. Many people define it as the worst fatigue they have ever experienced in their lives. Neurocognitive disorders are also common, such as attention deficit and inattention, or what is commonly known as brain fog.headache and Changes in the digestive, respiratory, and cardiovascular systems are other possible manifestations..

But why do these symptoms persist after the acute phase of infection is over? “Virus persistence theory increasingly convincing”, explains Rodríguez Ledo. Essentially, it is believed that “the body of the affected person has not yet completely eliminated the virus; it is hiding somewhere in the body and can lead to exacerbation of the disease or a specific outbreak. ”

Can COVID-19 be cured?

Some people have had persistent COVID-19 symptoms since being infected during the first wave of the pandemic in early 2020. Others have seen significant improvement in their symptoms but still can’t completely shake off some symptoms. Finally, there are many cases of complete recovery. However, it is unclear which are the most reliable prognostic markers, and there are no foolproof treatment options. “Today we must say There are currently no treatments that can cure or chronically treat persistent COVID-19” said the Vice President of SEMG.

That doesn’t mean nothing can be done. In fact, since many symptoms, such as fatigue or breathing problems, are common symptoms of other illnesses, There are different types of treatments that can significantly relieve symptoms.. Here are some examples:

• Neurocognitive Rehabilitation.
  
• Physical recovery.
  
• Occupational therapy.
  
• Speech therapy.
  
• Prescription for physical exercise.

Investigational treatments for persistent COVID-19

Likewise, there are very promising treatments at various stages of research.

antiviral drugs

Following the theory of viral persistence, Several clinical trials have been launched to test the effectiveness of different antiviral drugs. For example, the usefulness of Paxlovid (consisting of two active ingredients, nimatravir and ritonavir), has been studied.Research has also been conducted Valacyclovir, famciclovir or valganciclovir, etc. However, there are currently no approved antiviral treatments for COVID-19. Another thing is that doctors choose to use some of these drugs in clinical trials or in specific situations and take all the necessary precautions, calling for so-called compassionate use.

electrical stimulation

the group Jordi Matias Guillouspecialist in neurology at the San Carlos Clinical Hospital in Madridstart Studying cognitive changes in patients with persistent COVID-19 infection By mid to late 2020. “We conducted a very detailed cognitive study with neuroimaging protocols using magnetic resonance imaging (MRI) and very advanced sequences,” the researchers said.

They found that cognitive changes fundamentally affected attention, processing speed, and episodic memory and executive function (albeit to a lesser extent). Next, They linked these issues to changes in MRI images. “These patients had changes in their gray matter, white matter microstructure and brain connectivity compared to controls,” Matías Guiu emphasizes. These changes, in turn, “correlated with the magnitude of the cognitive changes we found.”

Researchers also found Both fatigue and cognitive changes can have a significant impact on patients’ daily lives. In fact, “they were the two symptoms most associated with returning to work and having the greatest impact on daily activities.” So they asked themselves what they could do to improve these people’s symptoms and, therefore, their quality of life.

“The discovery of altered brain connectivity prompted us to consider intervening on it,” the neuroscientist said.From there came the idea Testing the effectiveness of non-invasive brain neuromodulation techniques that allow modulation of connections across a range of brain regions or circuits. The best known are transcranial magnetic stimulation and electrical stimulation. The latter involves generating an electric current by placing electrodes on two areas of the scalp. “This very small electrical current causes changes in brain connections.”

The researchers designed a clinical trial with the primary goal of improving patients’ fatigue after eight sessions of electrical stimulation.. “This was a randomized, double-blind clinical trial: 50% of the patients received real electrical stimulation, and the other half received simulated electrical stimulation,” explains Matías Guiu.

Patients who received real electrical stimulation experienced significant improvements in physical fatigue, observed after eight sessions and one month after the end of treatment. Cognitive symptoms did not improve, but cognition was a secondary goal and was not assessed exhaustively.The results have been published in the journal brain communication.

On the other hand, given the mechanism of action of electrical stimulation, the researchers believe that when this level of change is to be induced, it should be accompanied by cognitive stimulation. That’s exactly what they did in a second recently launched study, in whichWhile the electrical stimulation was administered, which lasted 20 minutes, the patient performed a series of exercises using a computer. Attention, processing speed, and executive functioning.

respiratory rehabilitation

Respiratory symptoms experienced by people who remain infected with COVID-19 can also be severe.To stop them, a team of experts from Valencia’s Clinical Hospital Health Institute (Incliva) carried out A clinical trial shows benefits of home inspiratory muscle training program.

The idea came after it was established that many patients develop fatigue and exercise intolerance long after infection with the SARS-CoV-2 coronavirus, regardless of whether they have pneumonia or lung lesions. “I am a cardiologist, but many of the patients I refer experience shortness of breath, exercise intolerance, and dyspnea (difficulty breathing). “This cannot be explained simply by the results of a pulmonary exam,” says Patricia Palau of Incliva’s heart failure research group. People with heart failure experience these same symptoms.

The Palau team conducted multiple studies on the effectiveness of inspiratory muscle training in patients with heart failure and achieved “spectacular results.” In collaboration with pulmonologists and physical therapists, They decided to test these methods on patients who were persistently infected with the new coronavirus..

everything seems to indicate Coronavirus not only affects the lungs, but also the surrounding muscles that are important for breathing. That’s the goal of the rehabilitation program they designed: to train the inspiratory muscles. After careful assessment, participants consulted a physiotherapist, who measured their maximum inspiratory pressure to analyze how much force they needed to activate. “Based on that strength, we gave them a little device called an inspiratory resistance meter so they could do the exercises at home that the physical therapist taught them before,” Palau explained. He explained that it was “a A membrane that only “opens when the inhaled air exceeds the pressure. ”

The device is adjusted so that resistance is between 25% and 30% of the patient’s maximum inspiratory pressure, with resistance gradually increasing as the device is improved.

Compared with the untrained group, the peak oxygen consumption of the patient group trained with this method increased by an average of 4.5 points.. “This is a very important advance,” the cardiologist stressed. This means “people who previously felt fatigued while performing moderate physical activity no longer feel fatigued.” For example, climbing a flight or two of stairs.

Since this is a simple yet effective technique that can also be done while doing other activities, such as reading or using a computer, Palau hopes its use can be expanded to all patients with ongoing COVID-19 infections People experiencing symptoms of shortness of breath and exercise intolerance.