COVID-19 infection has more than 50 long-term effects

MADRID, Spain – Clinical experiences in approaching COVID-19 from different perspectives, the results obtained by the different therapeutic options and, above all, the challenges posed by a new healthcare reality — the long-term COVID — have been the focus from a recent discussion at the 7th International Edition. Congress of the Spanish Society of Precision Health.

In this forum, entitled Precision Health: A COVID-19 Professional Debate, Dr. Mayca González, a specialist in microbiology and an expert in age management medicine at the University of Granada, reviewed the latest data on long COVID. “According to the latest evidence, 9 out of 10 patients with COVID-19 (87%) discharged from hospital experience at least one symptom 60 days after the onset of the disease, with 32% reporting one or two symptoms and 55% have three or more., more than 50% of symptomatic cases have at least one symptom of the disease 1 year after infection “.

Another study found that 12.8% of infected study participants continued to have dyspnea after 6 months, even in the absence of a diagnosis of pneumonia, Gonzalez added.

Research on this topic has also shed light on the main risk factors for developing long-term COVID. “First, gender, age, and even the number of symptoms” are risk factors, Gonzalez said. “Therefore, women and people between the ages of 40 and 54 are more likely to suffer from long-term COVID. It is also known that the more severe the acute disease, the greater the number of symptoms that appear after post-infection.

“Having a body mass index equal to or greater than 25, reporting three to seven symptoms of COVID-19 in the acute phase, and patients with more than five symptoms during the first week of illness are factors associated with being prone to “This is a health problem that will certainly be a big challenge from now on.”

González pointed out that studies have shown that there are more than 50 long-term effects of COVID-19, the most common being fatigue (58%), headaches (44%) and attention disorders. 27%) and hair loss (25%). ).

Among all the research projects carried out on this topic, González highlighted a study published in January which, in his opinion, is one of the most relevant so far “because it delves into the pathophysiological circumstances behind the symptoms at all levels, which we did. it is not known at all until now.

“For example, dyspnea, hypoxia, fatigue, ‘sharpened glass’ opacity, and pulmonary fibrosis have been shown to cause damage to the lung parenchyma. [primarily] mediated by the virus and secondarily by immune microvascular damage. On the other hand, at the cardiovascular level, up to 20 cardiovascular conditions can occur 1 year after overcoming COVID-19. This allows us to anticipate that these patients will be a major demand on health systems in the coming years. ”

Microbioma and vagus nerves

Regarding the digestive and intestinal system, González highlighted a hitherto unknown mechanism: the involvement of the vagus nerve and the intestinal microbiota.

“There are studies that suggest a persistent or recurrent pattern of viremia in some patients, leading to a clinical course of nonspecific symptoms associated with personal limitations,” he said. “This could lead us to think about the possibility that the virus may have a reservoir at this level. to forget that this nerve connects the brain and the gastrointestinal tract, as well as controlling heart rate, sweat production and nasal reflex. “

In his analysis of this pilot study conducted by a group of Spanish researchers, González commented that two-thirds (228) of the 348 participants involved had at least one symptom suggestive of vagus nerve dysfunction. After further evaluation of these 228 patients, of the first 22 subjects with vagus nerve dysfunction, 20 were women with a mean age of 44 years.

“The study also shows that the most common symptoms related to vagus nerve dysfunction were diarrhea (73%), tachycardia (59%), dizziness (45%), dysphagia (45%) and dysphonia. 86% of patients had three different symptoms related to vagus nerve dysfunction, six of the 22 patients showed a vagus nerve disorder in the neck shown by ultrasound, including a thickening of the nerve and mild inflammatory reactive changes, “he said.

Another important fact of this research was that 10 of the patients had abnormal respiratory patterns and reduced maximal inspiratory pressures, which, according to González, indicated the weakness of the respiratory muscles connected to the vagus nerve. “Seventy-two percent also had oropharyngeal dysphagia or difficulty swallowing, and eight patients showed reduced or impaired ability to move food from the esophagus to the stomach and acid reflux.”

Prescription: Exercise

At the same conference, Dr. Wilson Martínez, a specialist in sports and exercise medicine, addressed the role of physical exercise in the recovery of people who have suffered from COVID-19. “It should be noted that many patients with mild or severe COVID-19 do not fully recover and have a variety of chronic symptoms for months or weeks after infection that are often neurological, cognitive, or psychiatric in nature. it is known as post-COVID-19 syndrome, reported in between 10% and 20% of patients. ”

In his presentation, The value of exercise in the post-COVID patient, Martínez reviewed the most recent studies showing the link between exercise and health benefits in general and against SARS-CoV-2 and its consequences in particular. “In this research,” he said, “the exercises are discussed, understanding as such the substances that are produced or generated with the practice of physical activity (including hormones and metabolites) with healthy benefits at different levels. There is a varied repertoire of exercises in the systemic circulation, and it is known that the greater the intensity and momentum with which the exercise is performed, as long as it is done correctly, these exercises appear in a more positive way. ” .

In the context of COVID-19, Martínez explained this positive impact “given that SARS-CoV-2 affects the receptor for the enzyme that converts angiotensin-2, and this in turn leads to Fibrosis, Inflammation, Vasoconstriction, Reduced Neurogenesis, and Cardiovascular Damage in a sense like a polypill “.

In specifying the possible benefits of exercise in the post-COVID-19 syndrome, Martínez stressed that there is an improvement in the psychological component, as it reduces stress, which translates into an improvement in the state. of spirit and a sense of well-being.

“At the neurological level, it stimulates brain plasticity, improves cognitive abilities, decreases allostatic load and optimizes sleep quality,” he explained. “As for the cardiovascular system, angiogenesis occurs, improving the vascular system and cardiovascular function, reducing blood pressure, normalizing dysautonomy and significantly increasing mitochondrial biogenesis.

“In the respiratory system, it reduces dyspnea and improves oxygen consumption and lung function. In the muscles, it improves exercise tolerance, increases muscle strength and muscle mass, with better intramuscular coordination. in relation to the immune system, it decreases inflammatory cytokines and increases anti-inflammatory cytokines, generally improving immune function, “Martinez continued.

Essential strength training

Martinez stressed that no drug is known to produce all these benefits. “Unfortunately, we are not taught or accustomed to prescribing exercise. From all this evidence, it is obvious that it should be incorporated into the prevention and approach not only of COVID-19 and post-COVID-19, but in general, for the care of cardiovascular and metabolic health, both to prevent disease and as an adjunct in many pathologies ”.

Regarding what type of activity is most recommended in these patients, Martínez noted that “there is enough evidence to suggest that adapted and supervised training with aerobic and strength exercises may be an effective multisystem therapy for the syndrome. post-COVID-19 “.

In this sense, Martínez stressed the need to assess the importance of strength training. “Although a large part of the population practices aerobic activity, the percentage is low in terms of strength routines, especially among women, as they associate it with the risk of excessive bodybuilding. In the case of post-COVID-19 , this training is essential, as one of the most worrying signs of this syndrome is the loss of muscle mass.

“A little more research is needed in this field, but it is certainly a perfect tool to counteract and manage the many signs and symptoms that persist after suffering from COVID-19,” concluded Martinez.

González and Martínez have not disclosed any relevant financial relationship.

Follow Carla Nieto from the Spanish edition of Medscape on Twitter @carlanmartinez.

This article has been translated from Medscape Spanish edition.

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