“Some patients from the first wave are still severely restricted”


Now, at the beginning of the third wave of infections, it is important to deal with Long Covid again, wrote the epidemiologist and SPD health politician Karl Lauterbach a few days ago on his Twitter account. Long Covid affects a large number of people, an estimated 10 percent, who have neither pneumonia nor severe shortness of breath. So also those who are not treated in the hospital in the intensive care unit. “That will affect a lot of parents in the next few weeks,” predicted Lauterbach. Pediatricians also expect more long-term effects, not only in adults, but also in children and adolescents because of the relaxation of the measures.

So far, however, there is no specific and evidence-based treatment for those affected. There is also a lack of contact points in Germany who could support people with Long Covid in getting a diagnosis in the first place. Prof. Andreas Rembert Koczulla wants to change that. “I think the acceptance of the post-Covid syndrome has now increased in the population,” says the head of the Center for Pulmonology at the Schön Clinic in Berchtesgadener Land. “An enormous number of Covid-19 patients have already accumulated among the cost bearers who cannot easily return to work.”

The doctor has been dealing with the phenomenon for a long time and also looks after rehabilitation patients with Long Covid. Together with colleagues, he is now bringing together the few available data on the manifold symptoms in order to develop an initial guideline with recommendations. “Just open a book and read up on what special treatment should be given for this or that symptom – that doesn’t actually exist yet,” he explains.

Long Covid varies from person to person

Koczulla is an internist, pulmonologist and intensive care doctor, “which is quite helpful with this disease,” as he says. The number of patients with an abundance of symptoms is making scientists and medical professionals very alert as the pandemic progresses. “I wouldn’t play that down. I do believe that this is a very relevant problem. ”Because Long Covid brings with it a very wide range of problems. In some patients, these occur immediately after the acute Covid 19 disease has subsided. In some cases, however, they only occur after a certain period of time.

The rehabilitation patients who Koczulla accompanies on the long recovery path show whom Covid-19 hits the hardest. “We know that age is a decisive factor in the severity of the disease,” explains the doctor. “But we also see 25-year-old patients here.” A number of risk factors were also revealed: diabetes, poorly controlled blood pressure, tumor diseases and severe lung diseases. “We also see that the male gender is more often affected – because of a generally poorer immune system.”

Long Covid symptoms could stay forever

The inability to exercise physically often improves over time. But: “It is quite the case that some patients from the first wave are still severely restricted.” Even after a year, they often still suffered from symptoms of fatigue, shortness of breath, cough, and they still cannot work properly. That coincides with observations from Wuhan. There, some of the first Covid 19 patients were also examined for long-term consequences of the coronavirus infection. In a study published in January, Chinese scientists found that 76 percent of those examined were still suffering from at least one symptom six months after the acute infection.

In addition, only those who have been referred by a doctor end up in the rehabilitation clinic. So above all Covid-19 patients who were previously in the intensive care unit with a difficult course. “We don’t really know what happens to the patients who are cured at home,” says Koczulla. However, initial evaluations showed: “There are also people who come with mild cold symptoms from Covid 19 disease, but who suddenly develop symptoms as the course progresses.”

Such Covid patients have been observed for three months in the Netherlands and Belgium. “It has been shown that post-Covid symptoms such as symptoms of fatigue and shortness of breath in most patients with a mild course decrease somewhat over time,” says Koczulla. “But not excessively.” And there are also patients who tend to develop even more symptoms over time. So far there is no explanation for this. “It is also still too early to rule out the possibility that symptoms will remain permanent.”

Covid-19 or Long Covid? The symptom period is crucial

But from what point in time is we even talking about Long Covid? Doctors distinguish between three phases for assessment:

  • The acute infection with the pathogen Sars-CoV-2 and the resulting disease Covid-19 is defined for a period of four weeks after the positive virus detection is available.
  • Experts speak of a continuing Covid disease up to and including the twelfth week after the virus has been detected.
  • If symptoms persist after the first three months after the onset of the acute infection, doctors speak of post-Covid syndrome. This often includes symptoms such as fatigue, reduced performance, shortness of breath, cough, and neurological symptoms.

So far, many people are largely unclear who to turn to if they have symptoms like this, reports Koczulla. It is urgently necessary to examine to whom this responsibility is entrusted. The challenge: In order to diagnose and treat Long Covid, several medical disciplines would actually have to be brought together at one table. This is what the medical guideline now to be developed should also be about. “The coordination then possibly lies with the general practitioner, the specialist or a post-Covid outpatient clinic,” explains Koczulla.

Bureaucracy slows development of long-covid aid

A central contact point can easily assess whether a patient needs a specialist, specific inpatient treatment or rehab. “There is currently a great need,” says Koczulla. “But the extent to which such central contact points will be set up across the board is currently not foreseeable.”

“The supply structures in Germany can sometimes not do justice to patients so quickly and in an unbureaucratic way,” criticized the Long Covid expert. “It is also a problem that a comprehensive diagnosis and the therapy and care that may be derived from it require more than the few minutes usually scheduled in a normal family doctor’s practice.” The first contact takes more time, often up to an hour with examinations . Economic factors also played a major role.

Depending on the symptoms, the route usually leads to many doctors at the moment. “The findings should be discussed with the family doctor. Follow-up lung care should be carried out, as should a cardiological examination, ”advises Koczulla. “Depending on psychological problems, the neurologist must be consulted.” Also good to know: According to current RKI recommendations, vaccination against Covid-19 should not be carried out until six months after the acute infection with Sars-CoV-2, even for people with symptoms typical for Long Covid respectively.

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