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

MADRID, Spain — The clinical experiences in approaching COVID-19 from different angles, the results obtained by various therapeutic options and, above all, the challenges posed by a new reality in health care — the long COVID — have made the subject of recent discussion at the 7th International Congress of the Spanish Society of Precision Health.

In this forum, titled Precision Health: A COVID-19 Professional Debate, Mayca González, MD, microbiology specialist and expert in age management medicine at the University of Granada, reviewed the most recent data regarding the long COVID. “According to the latest evidence, 9 in 10 patients with COVID-19 (87%) discharged from hospital have at least one symptom 60 days after illness onset, with 32% reporting one or two symptoms and 55% showing 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 experience dyspnea after 6 months, even without a diagnosis of pneumonia, González added.

Research on this topic has also shed light on the major risk factors for developing long COVID. “First of all, sex, age and even the number of symptoms” are risk factors, González said. “Therefore, women and people aged 40 to 54 are more likely to suffer from long COVID. It is also known that the more severe the acute illness, the greater the number of symptoms that appear after infection.

“Having a body mass index of 25 or greater, reporting three to seven symptoms of acute COVID-19, and patients with more than five symptoms in the first week of illness are factors associated with a trend to suffer from long COVID All this poses a health problem that will undoubtedly be a major 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 prevalent being fatigue (58%), headache (44%), attention disorders (27%) and hair loss (25%).

Among all the research projects carried out on this subject, González highlighted a study published in January which she says is one of the most relevant to date “because it delves into the pathophysiological circumstances behind the symptoms at all levels, which until now we did not fully know.

“For example, dyspnea, hypoxia, fatigue, ‘ground glass’ opacities, and pulmonary fibrosis have been shown to be due to damage to the lung parenchyma. [primarily] mediated by the virus and secondarily due to immunological microvascular damage. On the other hand, at the cardiovascular level, up to 20 cardiovascular diseases can occur 1 year after defeating COVID-19. This allows us to predict that these patients will be an important demand for health systems in the years to come. »

Microbiome and vagus nerve

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

“There are studies that suggest a pattern of persistent or recurrent viremia in some patients, causing a clinical course of nonspecific symptoms associated with personal limitations,” she said. “This could lead us to think about the possibility that the virus has a reservoir at this level. In the same vein, research currently underway points to a possible involvement of the vagus nerve as the cause of the long COVID outbreaks. We must not forget that this nerve connects the brain and the gastrointestinal tract, in addition to controlling heart rate, sweat production and the gag reflex.”

In his analysis of this pilot study 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. Upon further evaluation of these 228 patients, of the first 22 subjects with vagus nerve dysfunction, 20 were female with a median age of 44 years.

“The study also reflects that the most common symptoms related to vagus nerve dysfunction were diarrhea (73%), tachycardia (59%), dizziness (45%), dysphagia (45%) and dysphonia (45%); 86% of patients had three different symptoms related to vagus nerve dysfunction. Six of the 22 patients had vagus nerve impairment in the neck revealed by ultrasound, including both thickening of the nerve and mild inflammatory reactive changes,” she noted.

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

Prescription: Exercise

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

In his presentation, The value of exercise in the post-COVID patientMartínez reviewed the most recent studies which show the link between exercise and health benefits in general and against SARS-CoV-2 and its consequences in particular. “In these surveys,” he told the audience, “exerkines are discussed, including as such substances that are produced or generated by the practice of physical activity (including hormones and metabolites) with health benefits at different levels.There is a diverse repertoire of exerkines in the systemic circulation, and the greater the intensity and pace with which exercise is performed, provided that done correctly, the more positively these exerkines manifest.”

In the context of COVID-19, Martínez explained this positive impact “taking into account that SARS-CoV-2 affects the angiotensin-2 converting enzyme receptor, and this in turn involves the appearance of fibrosis, inflammation, vasoconstriction, reduced neurogenesis, and cardiovascular damage.This activation of a series of vascular signaling chains that occurs with exercise helps to counteract many of the symptoms of post-inflammatory syndrome. COVID-19, acting in a sense like a polypill.

Specifying the potential benefits of exercise in the post-COVID-19 syndrome, Martínez pointed out that there is an improvement in the psychological component, since it reduces stress, which translates into an improvement in mood and a feeling of well-being.

“At the neurological level, it stimulates brain plasticity, improves cognitive abilities, decreases allostatic load and optimizes sleep quality,” he explained. “With respect to the cardiovascular system, angiogenesis occurs, improving the vascular system and cardiovascular function, lowering blood pressure, normalizing dysautonomia, and notably increasing mitochondrial biogenesis.

“In the respiratory system, it decreases 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,” Martínez continued.

Essential bodybuilding

Martínez pointed out that no known drug produces all of these benefits. “Unfortunately, we are not taught or used to prescribing exercise. Based on all this evidence, it is obvious that it should be integrated 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 diseases and as an adjuvant in many pathologies.”

Regarding the most recommended type of activity in these patients, Martínez pointed out that “there is sufficient evidence to suggest that adapted and supervised training with aerobic and muscular endurance exercises can be a effective multisystem therapy for post-COVID-19 syndrome”.

In this sense, Martínez highlighted the need to value the importance of strength training. “Although a good portion of the population engages in aerobic activity, the percentage drops when it comes to strength routines, especially among women, as they associate it with the risk of excessive weight training. In the case of the post-COVID-19, this training is essential, because one of the most worrying signs of this syndrome is the loss of muscle mass.

“A little more research is needed in this area, but without a doubt, it is a perfect tool to counter and manage the multiple signs and symptoms that persist after suffering from COVID-19,” Martínez concluded.

González and Martínez did not disclose any relevant financial relationship.

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

This article was translated from Medscape Spanish edition.

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