Post-Covid outpatient clinic at the university clinic examined 500 people
Gernot Rohde remembers most vividly the young, performance-oriented men who came to him in the second third of the delta wave. “Lawyers who suddenly mightn’t read more than one page, marathon runners who mightn’t get up from the sofa.” People for whom the fall following Corona was particularly clear and who therefore noticed particularly clearly that months following the infection something was wrong with them.
At that time, Long Covid, i.e. complaints that restrict those affected in everyday life and persist more than four weeks following infection, and Post Covid, which is spoken of three months following the illness, were of course still unknown. The post-Covid outpatient clinic at the university hospital, which the professor and his colleague Maria Vehreschild run, has now examined more than 500 patients, and hundreds of scientists from various disciplines around the world are working on researching the syndrome and its origins.
The symptoms of many patients are similar. The most common are persistently low exercise tolerance, coughing, loss of smell and taste, memory and concentration problems. But how post-Covid develops and what exactly triggers which symptom and why is still largely unknown. A central mechanism is probably the so-called molecular mimicry, says Rohde: The broader the immune reaction to Covid-19, the more likely it is that the immune system will confuse the antigens, i.e. those parts of the virus that trigger the formation of antibodies, with the body’s own antigens . The body then attacks not only the virus but also its own muscle fibers or nerve endings – long following Covid has been defeated. “But there are probably many other molecular mechanisms.” There are also individual factors that play a role, such as the nature of the immune system, genes, and age.
According to Rohde, more than 90 percent of people who come to the post-Covid outpatient clinic have a physical cause for the symptoms. But you often have to search very carefully for this. Especially in people who, despite a mild course of infection, average lung volume and normal heart function, remain less resilient over the long term. A central insight that the Frankfurt medical team has gained so far: “Despite normal lung function, the muscular breathing pump, which expands the lungs and compresses them once more, can be weakened.” Then occupational therapy can help.
The situation is similar with the heart: Often only a magnetic resonance imaging shows tiny foci of inflammation in the heart muscle, which remain undetected with ECG and ultrasound. There are also established therapies for this, as well as for memory or concentration disorders. “Actually, we don’t do any corona-specific therapy, but treat the consequences of the post-Covid symptom.”
For a time, it was therefore possible to operate the outpatient clinic without its own staff: After the anamnesis, the affected people were referred to the outpatient clinics responsible for the consequences. But knowledge regarding the disease is growing every day, and the initial symptom query now takes regarding 45 minutes. “It doesn’t work on the side, and general practitioners can’t afford it either,” says Rohde.
In addition, there is probably still a lot to come for society: According to estimates, between five and ten percent of those infected might later suffer from post-Covid. In Frankfurt alone that would be up to 24,000 people at the moment. Because the patients came to the outpatient clinic every three months until the symptoms had subsided or until they had made arrangements, the number was also increasing.
That is why the university clinic recently received a one-off payment of 204,900 euros from the Hesse pandemic fund to set up its own staff for the post-Covid outpatient clinic, which includes a doctor and several study assistants. The project is initially limited to one year, Rohde is confident that it will continue following that.
And the pulmonologist has more good news to announce: Since the vaccination once morest Corona has been available, he has observed virtually no more permanent cases of severe post-Covid. “Almost everyone’s condition improves, it just takes an incredibly long time,” says Rohde. And while the symptoms don’t always go away, most manage to come to terms with them. Also, and this is Rohde’s third piece of good news, thanks to the rehabilitation clinics, which dealt with the topic of corona very early on in the context of acute therapy and are therefore prepared.
Around half of his post-Covid patients take advantage of rehabilitation measures, “I also think that makes a lot of sense”. The time-out offers space for physical development, which in turn has a positive effect on mental well-being. Because – another finding of the team – sometimes Covid not only causes physical problems, but also full-blown depression. There are also specialists for this at the university hospital.
