2023-11-10 13:26:28
An opinion from the Committee for Monitoring and Anticipation of Health Risks (COVARS) relative to the post-Covid syndrome highlights a lack of clarity of the care offer, a great geographical heterogeneity, a level of knowledge of health professionals is often insufficient, and a tendency to psychiatrize symptoms, in a general context of medical shortage. Summary.
At the end of hearings organized with health professionals, patient associations, public health and research agencies, and health authorities, the Committee for Monitoring and Anticipation of Health Risks (COVARS) issues this opinion with the conviction that the question of post-Covid syndrome (PCS) must be approached from the more general angle of post-infectious syndromes (IPS), which can occur following infection by various microorganisms, and are more frequently linked to specific pathogens. This parallel between SPC and SPI led COVARS to issue a series of recommendations, to the attention of decision-makers, central administrations and Health Insurance and to the attention of researchers (Part 1).
Almost four years following the start of the pandemic and the appearance of the first cases of PCS, scientific knowledge has progressed greatly on this condition despite persistent questions concerning the definition of PCS for international experts, its mechanisms, diagnosis and treatment (Part II.A.). The literature should be read with caution: there is heterogeneity in the estimation of prevalence, in addition to the selection biases and subjectivity of diagnosis that epidemiological studies encounter (Part II.B.1). In France, on the basis of SPF data corroborated by the HAS estimate, the perception of general practitioners and occupational physicians, COVARS estimates that the number of patients still disabled in their daily lives by SPC would be around several hundred thousand people. (Part II.B.2), taking into account the reduction in the risk of PCS and the incidence of PCS with the most recent variants and the progression of population immunity acquired following infections and vaccination (Part II.B .3). However, beyond the overall estimates, Particular attention should be paid to populations at risk of PCS as well as populations in which this condition is underdetected, namely children and adolescents, the elderly and people with comorbidities (Part II.B.4).
The literature on the clinical presentation of PCS reports more than 200 symptoms, generally multi-systemic, fluctuating over time and of variable severity, the fluctuating nature over time being quite characteristic of SPIs (Part II.C.1). These symptoms generally have an impact on daily functioning, and although the majority of patients (91%) see their health improve very slowly over months and years, they nevertheless have frequent and disabling weekly relapses, even 18 months following infection (Part II.C.2). It appeared to COVARS that there was a frequent confusion between PCS and somatoform disorders while the definitions and clinical presentations differ significantly (Part II.C.3). This confusion leads in practice to a lack of understanding on the part of patients and often exacerbates the psychological impact linked to the difficulty of living with a persistent, fluctuating and little-recognized illness (Part II.D). Even today, attributing symptoms to PCS can be made difficult by the absence of established criteria (Part II.E), which, in turn, makes it difficult to establish an effective therapeutic alliance (Part II.F).
In a third part, this opinion takes stock of the provision of care, more than 3 years following the appearance of the first cases of SPC.by comparing France’s institutional response, structured into three levels (Part III.A) with the reality on the ground, which is characterized by a lack of clarity of the offer, great geographical heterogeneity, an often insufficient level of knowledge of health professionals, and a tendency to psychiatrize symptoms, in a general context of medical shortage (Part III.B). These difficulties of care must lead the French State to begin a reflection on the optimal care offer that should be implemented: holistic care putting the general practitioner at the center of the system and integrating the existing structures which provide the skills of clinicians, explorers and functional rehabilitators or physiotherapists and psychologists or psychiatrists (Part III.C). After an analysis of the more satisfactory SPC support developed in neighboring and Anglo-Saxon countries, a strengthening and restructuring of the SPC offer
care is, for COVARS, all the more essential since the analysis of the impact of SPC on the lives of patients clearly shows its multifaceted repercussions on daily life: financial, family, professional difficulties, and difficulties in accessing effective social protection (Part IV.A). Beyond these individual impacts, society as a whole must bear the burden of the SPC through its notable impact – although unfortunately little documented in France – on the economy. (Part IV.B).
Le ministère de la Santé et de la Prévention est mobilisé depuis le début de l’épidémie pour apporter une réponse adaptée aux besoins des personnes concernées, réduire l’errance médicale, faciliter et harmoniser l’organisation de la prise en charge sur l’ensemble du territoire. A ce titre : - Une plateforme d’information aux patients et d’orientation pour la prise en charge sera mise en place sur le site Santé.fr. - Chaque agence régionale de santé a mobilisé sur son territoire un dispositif coordonné de soins, permettant de guider les patients. - Le ministre a saisi la Haute Autorité de santé (HAS), en août 2023, pour disposer de ses recommandations autour de la mise en place de parcours organisés et coordonnés de soins pour le syndrome post-Covid. L’objectif est de préciser le rôle de chaque professionnel, l’articulation entre les différents acteurs et niveaux de prise en charge des patients, selon la nature de leurs troubles et la complexité de leur situation. À l’occasion de son entretien avec la présidente du COVARS, le ministre de la Santé et de la Prévention a annoncé qu’il réunirait un nouveau comité de pilotage de suivi de ces actions au début de l’année 2024, une fois l’avis de la HAS rendu.
Avis du COVARS du 7 novembre 2023 – Syndrome post-Covid – PDF | 1.67 Mo
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