Long COVID – the long shadow of a disease

Editorial

How the Kliniken Schmieder use their Post-COVID-19 Rehabilitation programme to help patients cope with the effects of a coronavirus infection.

Ever since the world was forced to deal with the effects of the coronavirus pandemic, life has not been the same. One single disease has, as vigorously as never before, attracted public attention, and fighting the virus has engrossed world politics and the lives of many people since early 2020.

It all happened very quickly: a few days after onset of her first symptoms, Dagmar Klünder was in a coma – for weeks.

The number of infected people in the world has reached approx 185 million and almost four million people have died from the sequelae of their coronavirus infection. Patients like Dagmar Klünder, who received rehabilitation treatment at the Kiniken Schmieder in Heidelberg from March to June 2021, have overcome the acute stage of the disease but the effects of COVID-19 are far from over. It has become obvious that even those who survived the infection or hardly experienced any symptoms may still need to fight the effects of the infection long after they were free from the virus.

During the past months, experts often discussed the best name for this phenomenon. “Long COVID” has now gained acceptance in public. According to the British Medical Journal, long COVID describes both the various symptoms and diseases of people who were so seriously ill that they required hospitalisation and the symptoms of people with a mild course. In both cases, patients report that they still experience persistent effects of the infection weeks or even months after their illness. This definition makes clear that anyone can be affected who was infected with the coronavirus.

“Prior to my illness I loved bananas but now I find them disgusting.”

The people most affected are usually patients who were seriously ill and required hospitalisation or even artificial ventilation. Four out of five of these patients sometimes report chronic exhaustion, also called fatigue, concomitant neurological symptoms or shortness of breath even months after their discharge from the hospital. But experts also observe an increasing number of symptoms such as persistent exhaustion, depression, gustatory dysfunctions or cognitive impairments even in supposedly mild cases. The evaluation of a study at King’s College London showed that from 4,182 people who participated in an on-line survey, more than 25 percent of the respondents reported one or more long-COVID symptoms four weeks to more than three months after their infection.

Surge of new healthcare challenges

Figures from Switzerland point in the same direction. In Switzerland, long-COVID symptoms were detected in one third of the non-hospitalised patients. Considering these figures, it can be assumed that there is a large number of patients requiring rehabilitation whose symptoms must first be identified as such, taken seriously and then be treated, if these patients and society as a whole want to overcome this pandemic completely. Institutions for neurological rehabilitation that have the necessary expertise to face this challenge will play an important role in this process.

What do these patients need?

There is currently not much robust scientific evidence but the symptoms associated with the effects of an infection are not unknown because they are very similar to those that are seen by e.g. the Kliniken Schmieder in patients who had a stroke, an accident or who suffer from chronic neurological disorders. They include motor and cognitive impairments, nerve and muscle pain, olfactory and gustatory dysfunctions.

Since the summer of 2020, the number of enquiries related to coronavirus infections has noticeably increased. More and more people suffering from long COVID are identified as such and seek adequate assistance. “We have the necessary expertise, and we knew that we wanted to contribute to a solution to this crisis,” said Paul-Georg Friedrich, chairman of the Management Team of the Kliniken Schmieder. Together with its own medical, nursing and therapeutic experts, the Kliniken Schmieder have acted and offer the Post-COVID-19 Rehabilitation programme since early 2021. “The many decades of experience in neurological rehabilitation have enabled us to implement a concept which ensures high-quality neurological after-care of the patients,” Friedrich continued.

In view of the various individual courses of illness, the rehabilitation measures are tailored to each patient and his/her needs. An individual treatment plan is made up reflecting what the patient needs. Involving different medical and therapeutic specialties ensures integrated consideration of all treatment aspects needed to optimally address the neurological, pulmonary and psychotherapeutic issues. This way, an interdisciplinary team can make its specific contribution to improve the patient’s physical and psychological health status.

Evaluation of long-term effects

As with many other acute or chronic neurological disorders, access to timely and, above all, adequate treatment is the main criterion for successful rehabilitation. The earlier the patients receive help, the better late effects of the disease can be relieved or even reversed so that the patient is able to e.g. return to his working life. This is definitely needed after this crisis. The Kliniken Schmieder have started research also in this regard. At our in-house research institute, the Lurija Institut (www.lurija-institut.de), scientists are developing preliminary ideas for research projects dealing with the long-term effects and the best ways to address them. The regular research colloquia of the Lurija Institut offer a platform for experts to share their views, e.g. about the optimisation of the COVID-19 treatment, and their knowledge of the course of the disease. To this aim, the experts at the Kliniken Schmieder are in close contact with German university medical centres and international experts.

Take a look at our editorial in the Ghorfa Healthcare Guide 2021.

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