Direct Last minute on the coronavirus
The head of the Neurology Service of the Ramón y Cajal University Hospital in Madrid, Jaime Masjuan, could well sing "we already saw this coming" when two years ago he commented to this newspaper how the cases they saw in that first wave would have an impact long-term in patients.
But the tone is now different.
There is no rush in the answers, there is less uncertainty and less anguish because there are tools with which to treat the virus that caused "everything to change in less than 24 hours."
"Now we are better. Believe me, the situation is better and it is expected to continue like this," explains the coordinator of the Covid-19 Unit of the Madrid hospital.
Almost two years ago that first wave turned everything upside down, collapsed hospitals and paralyzed the world.
How do you see the current evolution of the pandemic?
Well now good.
Much better than then.
In the long term, I say nothing.
Why? Because we can't predict anything yet.
It's that we've said this so many times before, that why are we going to speculate, it looks better than other times, but... We have considered the pandemic over on many occasions and then it comes back.
But, the current situation leads to optimism... Sure.
The sixth wave progresses towards a very good situation in hospitals.
And yes, it is true that it is expected that, entering spring and facing summer, things will remain calm for a season, because if not any kind of surprise will not be good for anyone.
Two years ago,
Only with what he saw in the clinical practice of the day he already 'predicted' that we were going to see the neurological disorders of Covid in patients.
Now, there are already analyzes and studies that support it, right?
Since 2020, the situation has changed radically.
From a neurological point of view, and so our society [Spanish Society of Neurology, SEN] wants to establish the neurological problems with Covid.
We have neurological patients that we can divide, many of them, into those we saw during the acute phase, those who suffered from headaches, smell problems and some of them with a higher incidence of both hemorrhagic and ischemic strokes.
And those who were admitted to the ICU, who also had neurological sequelae, after being intubated for so long.
That group of acute diseases with the new variant,
What we have been left with is a group of patients who, after all the waves, have been left with sequelae derived from all these acute Covid diseases, such as sequelae of stroke or ICU admission, chronic problems, generally mild, such as alteration of the smell and taste.
All of them have been resolved over time.
Then there is another group that we in Neurology like to call with post-Covid symptomatology, we do not like the denomination of persistent, chronic or permanent Covid.
This created terminology has done a lot of damage to people due to the continuous bombardment of the media talking about a pathology that, first, we do not know how long it will last, why it occurs, nor the mechanisms that they are, nor clearly what the symptoms are.
But, the population tends to confuse these two situations.
How is it determined if it is a sequel to the infection or a symptom after it?
All this symptomatology is difficult to understand because most of the neurological tests of the patients, which are not derived from the sequelae, do not show anything.
They don't have the sequels,
they are a different group of signs among which we include the symptoms of lack of concentration, dysautonomy [an alteration of the autonomic nervous system (ANS), which is reflected in alterations in the organs], muscular pain, tiredness, fatigue or complaints cognitive.
From this range of events, when we test, we don't find any signs that the brain is malfunctioning.
All parameters are normal, but the patients are really affected.
Probably the media impact has to do with so much talk about persistent Covid, the feeling is transmitted that the virus has stayed inside us and that it can continue to cause damage inside the body.
This has generated a lot of social damage, it has caused many patients to have recognized themselves in those symptoms and are having a worse time than they should be having.
How is this addressed?
Well, I think we have to start transmitting a different message.
Not this feeling, again, that 10% of those who get the infection will have to live with the virus long-term.
How many will there be?
It is not known yet, because now what we are seeing is that the vast majority of patients are recovering.
Probably there will be a small group with symptoms.
But that they must also be helped from a psychological point of view, physiotherapy, reaffirmation that the disease is no longer there.
It is noteworthy that many times the symptoms do not correlate with having had positive serologies and that it occurs in specific people.
How is that group of patients?
It should be noted that all these symptoms are much more frequent in young patients than in older patients.
When we know that Covid is serious, the one that has killed many people is that one.
It usually occurs in middle-aged adults who have had a mild Covid and many times, after having passed the infection with almost no symptoms, this symptomatology appears.
So there are a series of unknowns that we will have to continue investigating: what is the relationship between Covid and the set of symptoms, to see where we can include them.
What are the neurological traces in the most serious?
Stroke occurs in 1% of patients with severe Covid, it is rare, very infrequent and that occurs at the time of acute infection.
Once it happens there is no longer any kind of relationship.
There is no more risk of new strokes due to having passed the infection, nor is the risk of Alzheimer's or Parkinson's increased.
What are the most common sequelae after Covid infection in all patients?
Headaches are usually related to acute infection from the infection.
What happens is that this lasts about three or four months after Covid.
But if they are well treated and the situation is well explained to these patients, after a few months the headache disappears.
And something similar happens to us with taste and smell, although with omicron this situation is much less.
At the beginning, in the first waves, there were people who practically had no smell or taste, but gradually they improve;
some are left with strange smells and others can recognize some specific ones.
But this happened before with other viruses, it is not a new thing.
What are the most common post-Covid symptoms in this group?
Here we must mention the great conglomerate of this series of people who are usually young and often women, in which there is a kind of symptomatology that is very difficult to specify and I think that the patients are really annoyed.
In them, sometimes even the symptoms of fibromyalgia, chronic fatigue are mixed... They themselves comment that they have a great deal of fatigue, tiredness, difficulty concentrating on doing their jobs... That's what we call post-Covid symptomatology and that is a bit undefined.
We also do not have specific pharmacological means of treatment;
we must try to work the psychological psychotherapeutic point of view,
of physiotherapy many times and little by little to transmit that the Covid has not stayed inside the body.
He says that they will not be 10%, but how many can they suppose?
Of the large volume of patients that we began to have at the end of 2020 and 2021, those that we have to see now in the year 2022, and two years later, and after omicron they are much less.
He notes that it resembles the fatigue of fibromyalgia.
In this case, patients find it difficult to explain the non-specificity of their situation and whether or not it has a solution.
How is it detected or discarded?
Since fibromyalgia and chronic fatigue are the same, we do not have biological markers or specific treatments.
For this reason, a comprehensive approach to the symptoms is made, since, in addition, there are sleep problems, depressive and anxiety symptoms.
A) Yes,
In the post-Covid units, neurologists, psychiatrists, psychologists and rehabilitators work in a multidisciplinary way, somewhat similar to a disease that responds to a series of functional disorders of the nervous system where a lot of diseases influence.
At some point during the vaccination period, it was even said that the vaccines 'erased' the post-Covid symptoms.
To what extent is this true or not?
In this time everything has been said.
Now, when one consults in Neurology and anything happens to patients, even the most unusual, they always look for a relationship with having been vaccinated.
We have all been vaccinated, almost all of us in Spain, and the diseases have continued to occur.
There have continued to be myocardial infarctions, cancer cases, strokes and we always want to relate it to the vaccine.
And the relationship has only been proven in the syndrome of cerebral venous thrombosis due to the AstraZeneca vaccine.
Regarding whether the vaccine was going to improve their post-Covid situation, I understand that many patients also put a little hope in this in the wrong way.
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