Persistent Covid, what will remain after the pandemic

Persistent Covid will continue when no more waves dominated by new SARS-CoV-2 variants break out, or when a large part of the population has had three or four doses of vaccines combined with previous infections that reinforce their immunity. When we get control of the pandemic situation with better treatments and the evolution of the virus allows us to recover a certain normality, it is then that we will have the last of the battles, the Covid of long-distance carriers, or persistent Covid. Without a doubt, we are facing one of the greatest threats to the public health and socioeconomic system, and we have to be prepared. To better understand persistent Covid, we ask ourselves the following ten questions.

1. What is persistent Covid?

The WHO defines it as a post-Covid condition that occurs in people with a history of probable or confirmed SARS-CoV-2 infection, generally three months from the start of the disease, with symptoms that last at least two months, and cannot be explained by an alternative diagnosis. These debilitating conditions and sequelae can carry different types and combinations of health problems during different periods of time post-infection.

2. What other names are used for persistent Covid?

Among several denominations, we refer to long-term Covid (or long-Covid), sequelae, post-Covid, long-term effects, or acute post-Covid sequelae (PASC), are some of the terms that have been used to denominate the disease that continues to show symptoms months after being infected with SARS-CoV-2.

3. What are the most predominant symptoms or sequelae?

The symptoms of Covid after two weeks of the acute phase can be transformed into sequelae that remain months after infection. But a constellation of new symptoms associated with persistent Covid may also appear. In this study, more than 50 symptoms or effects of persistent Covid have been identified after collecting data from all the works published in 2020 and examining them in a meta-analysis published in the journal Scientific Reports. The most common symptoms are: fatigue, headache, attention disorder, hair loss, dyspnea, ageusia (loss of taste), anosmia (loss of smell), joint pain or cough, and a variety of neurological, rheumatic, infectious diseases or other subspecialties. Although most people with persistent Covid partially recover after three months and learn to control their most debilitating symptoms, some of them carry these symptoms and survive the year after infection.

4. Does persistent Covid also affect minors?

Undoubtedly yes, although the prevalence is much lower, as well as the severity of the symptoms, but it cannot be denied that it is a reality and that we must protect the little ones from infections. The persistent symptoms of pediatric Covid range from fatigue, cognitive problems, mood swings, irritability, lack of attention or headache, associated with the severity of the acute illness, although persistent Covid was also diagnosed after passing the mild illness or without symptoms .

5. Can the vaccine prevent persistent Covid?

Vaccinated people can also suffer from persistent Covid. The data so far indicate that one in four people with persistent Covid who are vaccinated interrupt their sequelae, but more studies are needed. We also know that vaccines halve the risk of suffering from persistent Covid, speed up the recovery of these symptoms by twice as much or reduce their symptoms.

Persistent Covid, what will remain after the pandemic Dr. Sandra López LeónDr. Sonia Villapol

6. Does persistent Covid vary with new variants?

It is still too early to understand if new variants like delta or omicron can cause different presentations of persistent Covid. It is unknown whether some variants that cause milder acute symptoms of Covid in vaccinated people can present the same, attenuated or worse manifestations in the long term. That's why we must always avoid getting infected.

7. Why does persistent Covid occur?

The cause of persistent Covid is unknown with certainty, but different theories are put forward, and probably some of them coexist. The most prominent hypothesis is that the chronic inflammation caused after the exaggerated immune response and that has not been eliminated, together with the persistent inflammation triggered by the virus reservoirs, are the triggers of persistent Covid. This continuous immune response can damage the nervous system and is probably associated with many neuropsychiatric problems. Another direction points to the activation of autoimmunity that destroys our tissues through autoantibodies generated after infection that attack ACE2 receptors causing endothelial dysfunction and aggravation of other diseases. And the latest theory is that SARS-CoV-2 interacts with other viruses that we have 'asleep', such as Epstein-Barr.

8 Why does it manifest itself differently in certain people?

Susceptibility to persistent Covid is not the same in all people, it could be different aetiologies. The following subtypes of associations with persistent Covid have been suggested: multi-sequelae, pulmonary fibrosis sequelae, myalgic encephalomyelitis or chronic fatigue syndrome, postural orthostatic tachycardia syndrome, post-intensive care unit (ICU) syndrome, or clinical sequelae. We also know that women with an average age of 50 and with underlying health problems are at higher risk. Therefore, further investigation is needed to establish risk factors and make differentiated diagnoses.

9. What is the treatment?

There is no specific treatment for persistent Covid, although there are several in the development phase. Some of the symptoms or sequelae are treated in the same way as if they will present without being diagnosed as post-Covid. Depending on the symptoms you need: pulmonary, cardiac, musculoskeletal, psychological, neurological or exercise rehabilitation. Food is essential because it can modify the intestinal flora considered one of the major regulatory components of the immune system. You have to eat healthy including probiotics in the diet, exercise moderately and sleep well. Sleep should be a priority since the symptoms or diseases to which we are predisposed can worsen. Unfortunately, some medical specialists still claim that persistent Covid has a psychological origin and limit themselves to prescribing medications to treat anxiety or depression. With these interpretations we will not be able to get to the root of the problem and this mentality of many clinicians should change and stick to scientific evidence.

10. What can I do to avoid it?

Without a doubt, to prevent the appearance of persistent Covid, you have to avoid getting the virus that causes it. To do this, implement all layers of protection and take the following measures: get vaccinated, wear a mask, avoid closed spaces, ventilate, keep distance from other people, and carry out rapid and periodic tests to detect infections and prevent the spread of the virus. We should also wash our hands to prevent the infection from spreading to other parts of the body, by touching the eyes, ears or mouth.

Under this scenario, we face a reality that health systems urgently need to consider when planning and designing support policies at a global level. Without a doubt, persistent Covid is the emerging disease that will accompany us in the coming months and years. However, we do not yet have an exact diagnosis or therapeutic regimen, and integrated approaches are required as soon as possible to detect and treat these symptoms, especially the most debilitating ones: fatigue, brain fog, and heart and lung dysfunction. An increasing number of people with persistent Covid are misunderstood and desperate for answers. A multidisciplinary team is needed, therefore post-Covid clinics, made up of various specialists, are emerging.

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