Most of the health spaces are forming teams dedicated to the health care of those people who had coronavirus and recovered. The sequelae that usually appear require interdisciplinary interventions in some cases. In dialogue with Salud de Hoy, Daniel Picadaci, a doctor at the Pergamino Clinic, described the situations observed in the consultation and urged the community not to delay the check-ups.
Just as the Covid-19 in its acute form represented an enormous task for the medical community and for the care services, the post-Covid-19 represents an also important challenge in terms of the follow-up of people who have suffered the disease, either in hospital or on an outpatient basis, it is of vital importance to detect and address possible sequelae and to accompany the transit through a recovery process that in some cases is extremely complex.
To know what type of controls people who had Covid-19 should carry out and inquire about the most common sequelae that are observed as a result of this medical follow-up, Salud de Hoy interviewed Daniel Picadaci, clinical doctor and member of the team dedicated to the Covid-19 patient care at the Pergamino Clinic, a private health institution in the city that assisted a significant volume of patients during the pandemic and that has formed a group of professionals who monitor people who have recovered.
– How has the work team that carries out the post-Covid controls at the Pergamino Clinic been structured?
– We have formed a group of clinical doctors who are in charge of carrying out check-ups on patients who have experienced the disease and have recovered. We carry out the clinical evaluation, we request some routine tests and, if necessary, we make the referral to specialist doctors to assist the patient. The constitution of this work team arose in response to a need, since at the Pergamino Clinic we cared for a good number of Covid-19 patients who did not have a family doctor and who needed to be followed up. In the case of those people who did have their family doctor, upon discharge we gave them an epicrisis so that their reference professional could carry out the post-Covid control. Beyond this, the service we provide is open to anyone who has gone through the disease and needs to do their follow-up checkup.
– Should the post Covid control be carried out by all people who have had the disease or only those who have had more severe symptoms?
– The convenience of carrying out the follow-up medical control reaches all Covid-19 patients regardless of whether they have had the disease on an outpatient basis or have been hospitalized.
– When is it convenient to carry out this checkup?
– The follow-up protocol is not standardized. Ideally, this medical control can be done two months after the acute picture of the disease, since the virus generates a strong inflammatory response that lasts.
– What are the tests requested in this medical check-up?
– Usually a general evaluation of the patient is made and a laboratory is requested, and in some cases when it is considered necessary, some complementary tests are requested such as radiographic plates, tomography or electrocardiogram.
-Do people who have gone through the most severe pictures of Covid-19 undergo the same type of controls or is a more rigorous monitoring required?
-In these cases, complementary studies are very important due to the information they provide. However, this is evaluated in each particular case, always taking into account the age of the patient, the risk factors and the way in which a disease manifested itself that we know affects all the organism’s systems. In those patients who have had a severe Covid-19, it is usual to request a consultation with a pulmonologist, a cardiologist or any other specialist. Prior to this consultation, it is the clinical doctor who requests the laboratory tests and other studies to evaluate the state of health.
The most frequent sequelae
-What are the most common sequels of Covid-19?
-The most common are fatigue and dyspnea – feeling short of breath. These symptoms are not related to the severity of the disease in the acute setting. It is described in studies that patients who have spent the disease at home, then experience a feeling of fatigue that persists over time. The virus produces a very large inflammation in the body and this inflammation manifests itself with fatigue. In the lung part, and something that has nothing to do with the severity of the condition, dyspnea occurs and it is as a result of this that patients report that they lack breath. This occurs more frequently in those cases in which the virus caused some pulmonary affectation.
-Are these sequels reversible?
-Yes. It is being seen that over time the patient improves his quality of life and the functionality of the affected system, mainly the respiratory system. We always emphasize risk factors. Those who have health conditions prior to Covid-19 tend to have more difficulties in recovering or this process takes longer as a result of the worsening of their underlying disease.
-There are people who after having had Covid report memory problems, are neurological sequelae reported as a result of the Sars-COV 2 virus?
-The virus affects all organs. And also neurons. It is neurotropic, it affects the neural cell. In fact, there is an entity that is the prolonged Covid, which is when the symptoms persist for months. In these patients, the neurological disorder is quite frequent and manifests itself with forgetfulness, depression and anxiety.
-Do these patients require another type of follow-up?
-They are people who need rehabilitation and the follow-up is usually more thorough. Interdisciplinary teams are often required. If there is a neurological disorder, the accompaniment of the specialist and psychological support is essential. There is a study that shows that those patients who had a long Covid and a prolonged hospitalization and have complied well with the treatment, the recovery is faster. What is being observed is that it is difficult to get the patient to resolve the depression picture.
-Is this depression associated with prolonged hospitalization or is it linked to the sequelae of the virus itself?
-Long hospitalization already produces a lot of stress. The patient admitted to intensive care units suffers neurological and cognitive consequences that are usually transitory. What the research that is being carried out in the world shows is that the virus affects the neuronal level and produces structural damage. The same studies also indicate that those who had major neurological disorders were those who had a prolonged hospitalization of more than a month. In the patients we have seen, we noticed delirium during the acute stage of the disease, something that in principle could be attributable to the low level of oxygenation in the blood. However, when these levels stabilized, the delirium persisted. What is being studied is whether the virus by invading the nervous system produced tissue damage causing this cognitive impairment expressed in the form of disorientation or delirium.
There are patients with this type of sequelae who find it very difficult to recover the cognitive or neurological part and the most difficult thing to treat in these cases is depression. In itself, it is necessary to study in depth the functioning of the nervous system, about which little is known, and the coronavirus has generated more unknowns.
-Are the sequelae and problems observed in post-Covid control occur equally in men than in women?
-In the cases that we have dealt with, we warn that in the face of acute Covid, the man has a greater risk that the disease progresses to more serious forms, mainly in those who need to be hospitalized. The post Covid, meanwhile, is more related to women. Prolonged Covid tends to occur more in people of the female sex, the causes are not yet known. It is the reverse of what happens with acute Covid.
-In general terms, is the answer inclined to carry out post-Covid controls?
-Yes, at least in personal experience people go to the controls and are interested in carrying out all the tests that are necessary. They are internalized and in some cases require studies beyond those that are necessary.