What if it was a long Covid?

What if it was a long Covid?

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Place for integrative health

It is still a new formula for a trend that is increasingly infiltrating society into the corridors of hospitals: “integrative health” aims to reconcile conventional and complementary medicine for comprehensive care of the individual. “Given its diffuse and complex symptoms, post-Covid-19 disease is a perfect candidate for such an approach”, sums up Dr. Mayssam Nehme, doctor in the Primary Care Medicine Department of the HUG. Involved in a project aimed at evaluating the relevance of an integrative medicine consultation at HUG for patients with long Covid, the expert notes: “In parallel with the pharmacological treatments available to us, approaches such as hypnosis, osteopathy or even acupuncture seem to bring clear benefits to people battered by symptoms for which conventional medicine does not have all the answers. This complementarity of approaches takes on its full meaning today.”

Simple aftereffect of a Covid-19 infection? Result of a little too much thought and worry? … or true pathology? The answer to the question of the symptoms inherent in what was first called “long Covid” was not immediate. The fault of an unprecedented pandemic and a procession of equally new symptoms during and after the infection. The fault is also due to ailments which are themselves frequent, difficult to measure by medical examinations and which can be associated with multiple factors. And for good reason, we talk about fatigue, concentration and memory disorders, palpitations, sleep disorders, dizziness or even shortness of breath.

What do we know today? “This affection already exists! emphasizes Dr. Mayssam Nehme, doctor in the Primary Care Department of the University Hospitals of Geneva (HUG). Because indeed, there were a lot of hesitations in the early days, with patients reporting symptoms that were difficult to explain. But studies quickly multiplied and today attest to the existence of a characteristic syndrome, which would affect up to 20% of people affected by the virus. While the term “long Covid” remains accepted, the World Health Organization (WHO) now speaks of “post Covid-19 disease” and defines it as a disease occurring in people who have a history of probable infection or confirmed by SARS-CoV-2 (Covid-19 virus), symptoms usually appearing within three months of infection, persisting for at least two months and cannot be explained by another diagnosis.

If the definition has been clarified, the underlying mechanisms remain at the heart of the enigma… even if certain clues appear. “As detailed in a recent article in the journal Science*, two phenomena could be at play, says Dr. Nehme. The first would concern the immune system which, in some people, would become deregulated after infection with Covid-19. Furthermore, the presence of certain antibodies could trigger the second phenomenon observed: the persistence of markers of inflammation through specific molecules, cytokines.” It should be noted that other phenomena such as the presence of viral particles are also being studied.

Persistent or new symptoms

Hence the persistence or appearance of symptoms, sometimes after a period of remission. “A delay of a few weeks can be observed between the end of the symptoms of the acute episode and those of the post Covid-19 condition”, confirms Dr Nehme. And, even more confusingly, they can be different and more intense than those felt during the initial infection. As for the profiles of the victims? Here too, the picture becomes clearer. “Several risk factors have been identified, confirms the expert. Among them: being female, having suffered from many symptoms during infection with Covid-19, being overweight or even suffering from asthma. It should be noted that these remain risk factors and that no one is immune to this pathology. As such, the recent article in the journal Science reports 54% of cases of post-Covid-19 disease in patients who have been hospitalized due to Covid-19.

So when in doubt, what to do? “Consult your general practitioner, advises Dr. Nehme. Although, to date, there is no specific test or treatment for this condition, medical management is necessary if the symptoms persist and interfere with daily activities. The first challenge is to be able to exclude another cause, because ailments such as fatigue or dizziness can be the sign of a completely different pathology. The second challenge is of course to treat the symptoms as much as possible.” And the specialist to continue: “For some of them, such as sleep disorders, therapeutic solutions already existed. But for fatigue, for example, which is the most frequent complaint, the challenge is more complex. However, by its magnitude, it plunges some patients into absolute distress. The solution? “It is to be adjusted on a case-by-case basis of course, continues Dr. Nehme. But a condition as complex and invasive as post-Covid-19 disease can be an opportunity to broaden the range of care, both in outpatient and hospital settings, through integrative health, for example (read framed).»

And the expert concludes: “A lot of ground remains to be traveled to unravel all the mysteries of this new pathology and we must be wary of any “miracle cure” advocated here or there. Medical research needs time, even if it has been proving to us for two years that it is capable of exceptional feats.

* Merad M, Blish CA, Sallusto F, Iwasaki A. The immunology and immunopathology of COVID-19. Science. 2022 Mar 11;375(6585):1122-1127.

“Rafael” platform: artificial intelligence as reinforcement

If specialized consultations have multiplied to take care of the most complex cases of post-Covid-19 affection, another unprecedented project has emerged to optimize its care thanks to Pr Idris Guessous, chief physician of the Department of primary care medicine at the HUG,

and to the HUG Private Foundation: the “Rafael”** interactive platform. Set up by the HUG, it now has many care partners in French-speaking Switzerland and Quebec. Its objective: to guide and inform patients and care partners with new tools. Among its innovations? The integration of a chatbota computer program based on artificial intelligence, combining questions from Internet users and answers from health professionals to constantly feed the information available on the subject.

** https://www.rafael-postcovid.ch


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