Content

Introduction

The disease called COVID-19 (COronaVIrus Disease 19), also known as acute respiratory disease caused by the SARS-CoV-2 virus (from English: severe acute respiratory syndrome coronavirus 2), is an infectious disease caused by a virus belonging to the coronavirus family, so named for the characteristic crown of proteins present on their surface.

The time it takes to recover from SARS-CoV-2 infection, i.e. from the disease called COVID-19, differs from person to person: most recover completely within two months but some disorders (symptoms) and clinical manifestations may last longer than long. In this case it is said that people suffer from Long COVID, an English term that is commonly used to indicate the set of disorders and clinical manifestations that persist after the infection. In English people with these characteristics are also called Long-haulers.

The possibility that symptoms last over time does not seem to be related to how bad you were during the infection. It can also happen that people who have had a mild form of COVID-19 may develop long-term problems. In general, women under the age of 60 they seem to be twice as likely to experience Long COVID compared to men, the level of risk subsequently becomes similar between the two sexes.

The Long COVIDmoreover, it is also observed in pediatric age but, at present, there does not seem to be any differences between boys and girls. All this suggests that sex hormones, which are not very relevant in childhood, may play an important role.

In addition to being a woman, advanced age and overweight, indicated by a higher than normal body mass index (BMI, from the English Body Mass Index) could also be risk factors for the development of Long COVID.

It is very important that doctors closely monitor people who have had COVID-19 to identify any long-term effects that may persist after the infection has recovered, ie after the execution of molecular swabs shows that the virus is no longer present in the body (negative buffer).

Symptoms

People who are more likely to continue to have ailments after recovering from SARS-CoV-2 infection, and therefore after performing molecular swabs demonstrating the absence of the virus in the body (negative swab) may be: women under 60 years of age (seem to be the most affected) and women of advanced age with diseases pre-existing to the infection. However, even young and healthy people can continue to be sick even for many weeks after recovering from the infection. infection (Long COVID).

The most common disorders (symptoms) and clinical manifestations associated with the Long COVID are different (about 200 have been reported), the most common seem to be:

  • chronic fatigue (asthenia)
  • breathlessness
  • memory and concentration problems
  • depression and anxiety
  • mental fog, in English brain fog
  • loss of smell (anosmia) or taste (ageusia)
  • chest pain or tightness
  • trouble sleeping (insomnia)
  • palpitations, after the slightest effort
  • dizziness
  • pins and needles
  • articolar pains
  • muscle weakness
  • whistling or buzzing or earache
  • diarrhea, stomach pains
  • loss of appetite
  • fever
  • cough
  • headache
  • sore throat
  • rashes on the skin (cutaneous)

The persistence of these disorders (symptoms) can greatly affect the quality of life of people who were perfectly fine before becoming infected with SARS-Cov-2, to the point of preventing them from working or carrying out any activity that they would have previously considered completely normal.

Causes

Disturbances related to Long COVID they can be the consequence of various mechanisms, including direct damage caused by the disease to the organs of the body, the abnormal involvement of the body's defense system (immune system) or the nervous system. As for the immune system, it is thought that the virus may have elements in common with some components of the organism (a relationship called molecular mimicry) and therefore that the immune system, in an attempt to eliminate the virus, also accidentally attacks the organs and tissues of one's own body (autoimmunity), damaging them. This hypothesis could explain the greater frequency of damage caused by Long COVID in women: in fact, the immune response in women is stronger than in men for both genetic and hormonal reasons.

Diagnosis

If, after two months from the end of the SARS-CoV-2 infection, some symptoms (disorders) such as those listed above still remain, you should consult your doctor because it could be Long COVID. Since to date not much is known about disorders related to Long COVID, it is very important that patients who have had COVID-19 are followed by their doctor to check both their psychological state and the functioning of their organs, for example the heart, and systems, for example the respiratory system. To this end, doctors may prescribe specific tests, such as spirometry, to measure respiratory capacity, or an exercise test to check the functional status of the heart. Long COVID (or COVID haulers) was proposed by the patients themselves to the World Health Organization (WHO) as an alternative to the term Post-COVID. The reason lies in the fact that Long COVID can be considered a continuation of the disease.

Therapy

To date, there are no specific therapies for disorders related to Long COVID. To alleviate them, we try to understand the causes and find customized solutions for each individual who suffers from it and for each individual clinical manifestation or disorder. Therapies may include physical rehabilitation programs, the support of a dietician for those who have lost a lot of weight or muscle mass or for those who, on the contrary, have to lose weight, and psychological support, for example for those with post-traumatic stress ( called in English Post Traumatic Stress Disorder, PTSD).

Prevention

The best way to prevent the Long COVID is to avoid contracting the SARS-CoV-2 virus infection by wearing the mask correctly, keeping the distance of at least one meter from other people, washing your hands often with soap and water or alcohol-based products for at least 40 seconds, avoiding crowded and poorly ventilated places.

Bibliography

NHS. Long-term effects of coronavirus (long COVID) (English)

Mayo Clinic. COVID-19 (coronavirus): Long-term effects (English)

Centers for Disease Control and Prevention (CDC). Post-COVID conditions (English)

EpiCentro (ISS). Long COVID: a new challenge for gender medicine?

Veronesi Magazine Foundation. Long-Covid: how to recognize it and what to do if you are not yet healed

Veronesi Magazine Foundation. Long-Covid: the most frequent ailments that remain over time

In-depth link

Kamps BS, Hoffmann C. COVID Reference. Italian edition edited by Alberto Desogus, Stefano Lazzari and Grazie Kiesner. 4th Ed, 308 p.

Christian Hoffmann. Long Covid. COVID Reference (24 January 2021)

GIMBE Foundation.Guidelines for managing long term COVID-19. Evidence 2021; 13: e1000216

Carfì A, Bernabei R, Landi F, for the Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA 2020;324:603–605 

Venturelli S, Benatti S, Casati M, et al. Surviving COVID-19 in Bergamo province: A post-acute outpatient re-evaluation. Epidemiology and Infection 2021, 149, E32

Bellan M, Soddu D, Balbo PE, et al. Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge. JAMA Network Open 2021; 4: e2036142

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