Covid-19: long-term sequelae?
Intensive care unit at Ambroise Paré hospital, in Boulogne-Billancourt, near Paris (illustrative image).
AFP - ALAIN JOCARD
Text by: Agnès Rougier
5 mins
Beyond the serious effects of Covid-19, which sometimes take patients to intensive care, a number of them, considered cured, complain weeks later of persistent symptoms.
Could Covid-19 lead to a long illness, or even a chronic illness?
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The term “
Covid long
” is an umbrella term that was coined by patients to describe everything that happens after illness and encompasses all kinds of symptoms.
We know that the disease can affect different organs, and not just the lungs, in particular because of this acute inflammatory storm which can occur and leave traces.
But there is also the passage in intensive care, traumatic for the patient.
The symptoms experienced by cured patients are therefore as diverse as the organs affected.
►Also listen: [Priority Health] Sequelae of Covid-19 in the long term
The Paris Hospital Research Patient Community,
ComPaRe
, together with the Hôtel-Dieu AP-HP Clinical Epidemiology Center, made it possible to carry out an epidemiological study based on the voluntary declarations of 600 patients.
This study identifies, from three weeks after the illness, around fifty different symptoms affecting around ten organs.
The most common signs are severe fatigue, shortness of breath, heart pain, and neurological signs such as difficulty concentrating, but we also speak of post-traumatic stress disorder, such as anxiety or depression.
A recent illness, studies in progress
In January, Chinese researchers published in the British journal
The Lancet
a study
of 1,733 patients hospitalized for Covid-19 between January and May 2020 at Wuhan hospital, which shows that 76% of hospitalized patients still have at least a symptom 6 months later.
On March 17, 2021, the results of a French study conducted at the Kremlin-Bicêtre hospital (
COMEBAC
/ Consultation Multi Expertise de Bicêtre After Covid-19) with the Paris-Saclay university hospitals were published in the journal
JAMA
.
480 patients were contacted again four months after their hospitalization and all those who had symptoms were reviewed for an exhaustive multidisciplinary assessment taking into account the psychological aspect.
The results show that 51% of patients who were hospitalized have at least one post-Covid symptom four months later, including persistent fatigue or cognitive impairment.
The patients followed had a lung scan and the doctors noted that, even after a severe form of Covid-19, there is little damage to the lungs, and very severe lesions - fibrosis - are rare.
These most severe lesions concern patients who have been in intensive care, of which a quarter of the lungs, at most, are affected.
For Professor Xavier Monnet, co-author of the study, this is good news in view of the severity of the initial disease: “
We could think that there would be significant respiratory sequelae, but we see that four months this is not the case
”.
Known symptoms, many patients
The acute inflammatory phase can cause sequelae on the affected organs, but researchers and doctors have found that these sequelae are similar to those left by diseases usually affecting these organs, and do not appear to be more serious: severe damage to the lungs by the Covid can leave the same effects as severe pneumonia caused by the flu.
► See also
: Coronavirus: symptoms, diagnosis and complications
On the psychological aspect of the disease, the Kremlin-Bicêtre study shows that in patients who went into intensive care, the rate of patients with anxious
a posteriori
or suffering from a post-traumatic syndrome is not more frequent than in other settings after resuscitation.
What is particular are cognitive disorders, attention and memory disorders, but they are also observed in other viral diseases such as mononucleosis in adults, with an almost identical frequency.
The big difference is the number of patients affected: the French study shows that 16% of people have residual shortness of breath four months after the disease, in the Chinese study, 60% of patients complain of persistent fatigue at 6 months, the volume of care required is therefore enormous.
Hence the demand from many patients who wish to see Covid-19 enter the category of long-term affections (ALD) of Social Security in France.
Building the future
Several studies are currently underway internationally.
The COMEBAC study is continuing with the objective of identifying the impact of treatments - which did not exist during the first wave - on persistent symptoms, and the impact of variants that appeared in the last quarter of 2020. On the epidemiological side , ComPaRe researchers are working on a questionnaire with the idea of providing doctors with a monitoring tool.
All patients who have been affected by the disease are invited to participate.
The association of long-term Covid patients,
After D20
, asks for the recognition of the long-term Covid, and the management of the after-effects of the disease itself.
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