More than 92,300 patients have been discharged from Spanish hospitals after overcoming the serious phase of COVID-19. Some might drag sequels, nail pulmonary, others derived from the mismatch in the blood clotting and others motivated by prolonged stays in the ICU.
“It is early to know how many patients may have sequelae, but we must be aware of two respiratory types: fibrosis and pulmonary embolisms “, explains to Efe the head of the Pneumology Service of the Ramón y Cajal University Hospital in Madrid, David Jiménez.
In the serious phase of COVID-19, if the immune system is not able to stop the virus, an excessive immune response is generated, through the production of substances called cytokines, which cause inflammation in the respiratory tract that can spread to other parts of the body.
“That disproportionate immune response sets in motion all the repair mechanisms that the lung has and one of them is fibrosis,” says the pulmonologist.
The fibrosis is a kind of scar that hinders the function of the lung, get oxygen and remove carbon dioxide.
“We are concerned about these scars,” he says, “but we still do not know to what degree patients will develop fibrosis, and that forces us to follow those with chest radiographs not yet normalized in detail.”
Another consequence of infection by coronavirus It could be pulmonary embolism, when clots form in the arteries of the lungs, as in other pneumonias.
“These patients will require anticoagulation treatment for a minimum time of three months and some may be indefinitely, so they will need long-term follow-up, “says the expert.
One of the concerns was the vulnerability that patients with chronic obstructive pulmonary disease, COPD, could have to the coronavirus, although, however, it has been surprising that this is not the case.
“Some data suggests that they may be more protected by some of the drugs used against COPD, since they could make the inflammatory response in the lung less intense,” says David Jiménez.
Although the time of greatest healthcare pressure has passed, the Ramón y Cajal Hospital still has more than four hundred patients admitted for COVID-19 and the revisions to those who have been discharged will begin when the outpatient consultations are reopened.
“Patients with altered chest radiographs at discharge and those with respiratory failure, on a mandatory basis, they have to be reviewed within a reasonable period of time, between 4 and 6 weeks“indicates the pulmonologist.
Also the uncontrolled inflammation that the virus triggers in the most severe cases, in addition to affecting the lung, produces “imbalances in the coagulation systems,” according to the doctor. Fernando de la Calle, spokesperson for the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC).
And it has been verified when treating COVID-19 patients as an adjunct doctor in the Infectious Diseases and Tropical Medicine Unit of the La Paz University Hospital in Madrid.
“We have had several patients with strokes, neurological symptoms from mini-thrombi at the brain level, mild encephalitis and even anemias, all caused by inflammation in an acute phase” of the disease, he indicates.
According to data from the Spanish Society of Neurology, the most frequent neurological manifestations related to COVID-19 to date are mild-moderate encephalopathy (28.3%), stroke (22.8%), loss of smell (19.6%). ) and headaches (14.1%).
“These alterations entail sequelae during convalescence, a pulmonary thrombus can make the capacity of the lung less or that anticoagulant treatment is temporarily necessary, “says De la Calle.
The La Paz Hospital currently welcomes some 600 COVID-19 patients, but they reached 1,000 at critical moments in the epidemic. From now on, the reviews of people with medical discharge will be scheduled.
Fernando de la Calle was one of the specialists who was also in the front row during the Ebola crisis, in 2014, with the cases of the repatriated missionaries from Africa and the nursing assistant Teresa Romero infected while doing their work.
“Ebola has given us, in our hospital, the baggage to be able to face this virus at first, although later it overflowed. It is useful to be prepared and I tell our leaders and managers to stop thinking that this only happens in Sierra Leone or China, and that it is worth investing in personnel and resources, “he concludes.
Furthermore, if critically ill patients have spent long stays in intensive care units, they could also suffer the consequences of immobilization.
According to the Spanish Society of Intensive, Critical Medicine and Coronary Units (Semicyuc), the post-ICU syndrome involves physical sequelae, mainly respiratory and neuromuscular, with significant muscle and functional loss.
They also register cognitive problems, such as alteration of memory and attention, and psychics, such as depression, anxiety, or post-traumatic stress.