A British study published in the medical journal The Lancet Respiratory Medicine reveals that one year following their hospitalization, only one in four patients would be “fully recovered” from Covid-19 infection. The World Health Organization (WHO) estimates that 10 to 20% of people who have contracted Covid-19 develop “Covid-long”, a form of the disease where symptoms persist for more than 3 months following infection. . Fatigue, cough, respiratory and joint problems, maladjustment to exertion… These very varied symptoms complicate patient care.
For this study, the researchers worked on the cases of more than 2,300 Covid-19 patients discharged from hospital between March 2020 and April 2021. These patients were seen by doctors five months following their hospitalization and 33% of between them returned for a follow-up visit a year following their release from the hospital. A series of medical examinations and a self-administered questionnaire led to the conclusion that only 1 out of 4 patients was “fully recovered” one year following the illness. Roland Tubiana, infectiologist at the Pitié-Salpêtrière hospital in Paris, discusses this study and the complexity of the management of long Covid. Maintenance.
TV5MONDE: the study of The Lancet shows that the long Covid is very present in hospitalized patients. Does the severity of the infection increase the risk of developing a long form of Covid?
Roland Tubiana, infectious disease specialist at the Pitié-Salpêtrière hospital: There are actually long Covids in all patients, and everyone is trying to describe and classify and understand this long Covid, because there is no treatment, and there is no objective criteria of Covid long, if not the persistence of extremely varied and variable symptoms. This study talks regarding severe Covid cases. This does not represent the majority of cases, but the severity has been retained by other studies as a risk factor for developing a long Covid. To sum up, the more symptoms you have and the more serious they are, the more you will fall into the group of people who have symptoms for a long time.
In this study, as in many others, being a woman emerges as a risk factor.
To explain this, there are many assumptions. For example, the persistence of the virus, observed by certain teams at the ENT level (otolaryngology editor’s note). There is also the question of the immune response. A classic immune response, that’s what the vaccine is asked to do, is to cure the infection, by creating specific immunity. With the long Covid, there may be a deviation, a poor adaptation of immunity to stimulation by the disease. The reactivation of other viruses is also a hypothesis. We know the reactivation of post-viral syndromes which last a long time with other viruses, such as chikungunya, which can give symptoms several years following the acute infection. There is also genetics. In this study, as in many others, being a woman emerges as a risk factor, for example.
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And what everyone remembers is the inflammatory phenomenon. It is an inappropriate reaction at the level of certain tissues, microcapillaries, that is to say small blood vessels which become inflamed and clogged. That can explain a lot of the symptoms that we saw in acute Covid but also in long Covid. In particular degenerative neurological symptoms, because the oxygen does not arrive where it must go because of the clogged vessels. These are all hypotheses, and each study will seek to show whether its hypothesis is confirmed or not. The problem is that it does not necessarily lead us to treatment.
TV5MONDE: precisely, how to deal with the long Covid?
Dr. Roland Tubiana: The first thing is to take into account the symptoms and people’s complaints. There is great suffering among these people who have seen many doctors who have told them “you have nothing at all”. Secondly: the approach must be multidisciplinary, from the psychologist to the neurologist via the cardiologist… Third thing: do not miss another diagnosis. It is necessary to medically assess and try to make a diagnosis which would eliminate the long Covid and which would allow the person to be taken care of as well as possible. But that represents very few people, not even 5% of patients.
In consultation, I cannot tell you “you have this, I give you this, and it’s over.” We don’t have an unequivocal answer.
But in my experience, what works best is two things: first, rehabilitation. For cognitive disorders, from memory it will be speech therapy, if you have cardiovascular disorders or maladjustment it will be pneumo-cardio, it can be articular… Each organ must be taken into account in its suffering and treated symptomatically. The second thing is time: for our patients, time has really improved things. Unfortunately, it requires a lot of health professionals around the patients, who do not always have access to suitable structures.
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It would be dishonest to say that we don’t have any treatment leads, but if you come to see me tomorrow for a consultation, I can’t tell you. “you have this, I give you this, and it’s over”. We don’t have an unequivocal answer.
The best prevention of the long Covid is not to catch the Covid, it is to have been vaccinated!
TV5MONDE: Does being vaccinated play a role?
Dr. Roland Tubiana: Currently we offer vaccination under surveillance, we have good results, but not for everyone. In many analyzes in progress, we see that among people who have long Covid symptoms, almost half see their symptoms improved following vaccination. The other half, on the contrary, either remains stable or is not improved at all. There are cases of aggravation of long Covid due to vaccination, but they are very much in the minority.
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But what you have to remember is that having been vaccinated prevents hospitalization, and therefore prevents these long Covid stories! The best prevention of the long Covid is not to catch the Covid, it is to have been vaccinated!
In two years, as we will have vaccinated people well, we are likely to no longer have long Covid. The vaccine as a therapy can work, but the vaccine as a preventive: you have to go all out!
TV5MONDE: cow does the healthcare system absorb the problem of the long Covid?
Dr. Roland Tubiana: We have to respond to requests, but these are very long consultations. People arrive with a year’s history, symptoms, additional examinations, prescriptions… You have to listen, sum up. And when you are a hospital practitioner in a public hospital, and this is also true for city doctors, today it is difficult to free up an hour per patient to see them. And not only is the first consultation long and complex, but the care followingwards will be a bit scattered.
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We need to do assessments, so we need nurses. You need the infrastructure. We need psychologists. Specialists are needed, the general practitioner has a role to play… There are centers which are more or less organised. But, for example, if I see someone who has significant cognitive disorders, and I want to set up an appointment for a memory consultation at Pitié-Salpêtrière, which is a major neurology center, I find it difficult to have a meeting. Not that my colleagues don’t want to see patients, but there simply isn’t room.
There is a good consideration of the problem, of the need to take time, to support people, to do so in several specialties at the same time and to offer rehabilitation, symptomatic treatments and diagnoses. But in 2022, we are not equipped to do that. We must continue to see people, guide them and support them, because that is our job. But today seen say “you can go to such a place, and you will be taken care of quickly, by people who know the thing perfectly and who have a suitable team”, it’s difficult. There is a lack of care.
