Why young athletic people can't recover from COVID-19 for months
Four months after the start of the pandemic, the coronavirus disease continues to amaze doctors. And one of the unpleasant surprises that she presented is the duration of the symptoms of the disease in some patients. Dr. John Wright of the Bradford Medical Research Institute (BRI) had two such patients at once. These are young women who, even a few weeks after the onset of the disease, complain of fatigue and shortness of breath, writes Air force.
Professor of Epidemiology and BBC Interlocutor John Wright is the head of the Bradford Institute for Medical Research. He is a veteran of the fight against epidemics of cholera, Ebola and AIDS in tropical Africa. Next - his story in the first person.
A doctor from a nearby hospital, 27-year-old Amira Valley, can not catch her breath, having overcome only one flight of stairs.
A 34-year-old physiotherapist from our hospital named Molly Williams has always been an excellent athlete, but now she says shortness of breath has become her constant companion. In addition, Molly began to experience frequent bouts of intense anxiety and memory problems.
Both of them became ill with coronavirus three months ago.
In March, we knew too little about coronavirus. Everyone believed that this is a purely respiratory disease, but later it turned out that it affects almost all organs. We proceeded from the fact that we would have to rely on invasive ventilation (IVL) in intensive care units, but it turned out that non-invasive ventilation (NIVL) in the hospital at an early stage is much more effective.
We also thought that after congratulating the patients leaving the hospital on the recovery from this acute infectious disease, we would not meet with them again.
But four months later, the new enemy has become our old and at times seems to be our only enemy.
We also became aware of the long-term consequences of this ailment for patients, and not only those who ended up in the hospital, but also those who were treated at home and seemed to cope with the acute form of the disease - and only then to suffer from recurring or persistent symptoms.
As a result, patients who have been ill several months ago still cannot return to normal life.
We knew from previous medical experience that nearly half of those who had severe acute respiratory syndrome (SARS), similar to the coronavirus that broke out in 2003, developed chronic fatigue or other long-term symptoms. So it should not be a surprise to anyone that the malicious descendant of that virus, Sars-CoV2, will inherit many of the nasty traits of its predecessor.
We receive more and more requests from patients and their attending physicians for help.
Some continue to suffer from primary symptoms such as chest pain and shortness of breath. Others developed new symptoms - headaches, memory loss, vision problems. Many have developed depression and anxiety. Most complain of constant fatigue, and everyone wants to return to their normal old life. They rushed to celebrate their recovery from COVID-19, but now they are gnawing at doubt and a sense of despair is growing.
During the first week of illness, Amira Valli had only mild symptoms: headache, sore throat, slight fever. By the end of the week, she already thought that the worst was over, but the new week brought shortness of breath, which now does not go anywhere.
“Ladders are especially hard for me. After one flight, the pulse jumps to 140. The last week was particularly difficult: I could not sleep because I did not have enough air. Now I feel extremely exhausted, ”complains Amira.
To this, she said, was added a growing sense of anxiety.
Chest fluoroscopy shows no abnormalities, and listening is also normal. But something is still wrong, and we will try to get to the bottom of the problem.
Physiotherapist Molly Williams volunteered to work with coronavirus patients and most likely contracted the infection in the hospital.
In her youth, she was a successful gymnast, and then she went in for crossfit (a complex system of exercises that includes elements of track and field athletics) and even entered the top twenty athletes in Britain. However, she is now experiencing problems with shortness of breath.
“I used to have a resting heart rate of 50 beats per minute, but now it is about 90,” says Molly. “I get short of breath even when I speak, my leg muscles get incredibly tired, and when I walk my heart rate goes up to 133 beats.”
According to Molly, she has an uncontrollable urge to cry, and she is incredibly worried about any occasion. In addition, she started having memory problems.
“I keep forgetting everything - I repeat the same thing many times, but my head is not able to hold the information. I try and cannot remember the right word. Now I have to write everything down in order not to forget, ”she says.
"I have never had any health problems in the past, and it is very difficult for me to survive such a blow."
However, we still do not understand why these patients had such long-term problems.
Perhaps the virus lurks somewhere in their bodies and causes these persistent symptoms, as is the case with Ebola patients. Some of our patients test positive for the virus a few weeks after they become infected.
Perhaps this is due to the fact that the reagent finds residual fragments of viral RNA. If this is the case, then it is possible that these RNA fragments cause a prolonged response of the immune system, which explains these persistent symptoms.
However, it is more likely that patients with protracted symptoms experience a stronger reaction of the immune system to the initial infection, which is damaged by the infection of their lungs and other organs.
Our task as doctors and researchers is to find out what really causes all these long-term effects, and then develop a course of treatment that would help these and other patients who developed severe post-infection fatigue.
This is an understudied research topic, as it is very difficult to find answers here. However, COVID-19 has become an incredible scientific catalyst, and the focus on patients with long-term symptoms could bring closer understanding of these processes.
Notes from the forefront
My colleague Dr. Paul Whitaker, at the request of patients, created the first clinic for those with covid.
According to the original plan, we were to observe patients with COVID-19 for 12 weeks after they were discharged from the hospital. However, it soon became clear that some of those who needed inpatient treatment had completely returned to normal life, while few of those who had not been treated in the hospital (the same Amira and Molly) still feel bad.
Therefore, now we accept people in our clinic and in the direction of attending doctors.
When people come to our clinic, we take an x-ray of the chest, check the function of the lungs and the musculoskeletal system, and ask us to fill out several questionnaires. For those with severe symptoms, an echocardiogram (ultrasound of the heart), computed tomography, and extended lung examinations may be offered.
“If we talk about people who have recovered from COVID-19, but have not yet returned to normal life, I think that we are only seeing the tip of the iceberg. Every week I receive three to four calls from therapists who explain that they are seeing a patient who had a coronavirus infection a couple of months ago, but still showing symptoms of the disease, ”says Paul Whitaker.
"A nutritionist, a physiotherapist will soon appear in our clinic, and we will also need a lot of support from psychologists, as patients not only develop cardiorespiratory complications, but also develop post-traumatic stress disorder and depression, neurological problems and chronic fatigue syndrome."
“Therefore, it is very important to support them, to offer them psychological support and rehabilitation programs. And we also need to know exactly what works and what doesn't. ”
According to consultant psychologist Rob Whitaker, COVID-19 patients often experience waves of an unreasonable desire to cry, and this may indicate the onset of cognitive disorders, such as Molly's memory problems.
“However, at the moment it is very difficult to say which of this is associated with emotions and fatigue, and which is of a physiological nature. It is still too early to judge this. ”
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