About 5% of Covid-19 patients suffer from the severe form of infection requiring a longer hospital stay, oxygen support and ICU admissions.
The World Health Organization (WHO) last week defined ‘post-Covid’ or what is commonly known as ‘long-Covid’, a term used for Covid-19 patients who suffer from prolonged after-effects of the infection. The health agency used Delphi methodology – a structured exercise to arrive at a group opinion or decision by surveying a panel of experts. Five groups of stakeholders, including patients, patient-researchers, external experts, WHO staff and others were involved in formulating the definition.
What Does the Definition State?
The WHO definition of long-Covid states: “Post-Covid-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 (the virus that causes Covid-19) infection, usually three months from the onset of Covid-19 with symptoms and that last for at least two months and can’t be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning. Symptoms may be new: onset following initial recovery from an acute Covid-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.” It has also clarified that a separate definition may be applicable for children.
Was Such Categorisation Important?
The absence of both a single terminology and a clinical case definition have been repeatedly signalled as drawbacks to advance on research and management of these patients, according to WHO. Experts say categorisation is also important for patients to accept their condition.
“When there is a certain categorisation, patients learn to group themselves and come forward to seek help,” said Dr Nitin Karnik, head of medicine at the civic-run Lokmanya Tilak Municipal General Hospital in Sion.
“In the absence of categorisation, patients often get lost in follow-ups. Starting of post-Covid out-patient departments (OPDs) has, therefore, been a crucial step taken by most hospitals, where patients with lingering issues can seek help,” he said.
Critical care specialist Dr Kedar Toraskar from Wockhardt Hospital said that the definition is helpful, but doctors should not haphazardly label symptoms as post-Covid. “Patients may have health issues due to some underlying conditions that may not be Covid-related. Thus, a thorough diagnosis is a must before labelling the symptoms as post-Covid,” he said.
Commonly, effects lingering on for more than eight weeks were identified as post-Covid by doctors. Some patients, who suffered from the after effect beyond three to six months, were identified as long-haulers.
What is the Estimated Number of Long-Covid?
Estimates on long-Covid vary a lot. About 5% of Covid-19 patients suffer from the severe form of infection requiring a longer hospital stay, oxygen support and intensive care unit (ICU) admissions. Patients who have moderate to severe forms of infection are more likely to have residual health issues say doctors. However, some patients with mild Covid-19 have long term lingering after-effects too. “Conservatively, I would say about 10 % patients have long-Covid, requiring follow-ups for physical and mental rehabilitation,” said Dr Toraskar, who is also a member of the Covid-19 task force of Maharashtra.
While fatigue, myalgia (muscle pain), hair loss, body ache, poor appetite, muscle wastage are some of the common long-term impacts, patients also have frequent episodes of low-grade fever and effort intolerance wherein minutest efforts to walk from one room to another are not tolerated by the body.
“When patients suddenly find themselves struggling to do their daily chores, they panic,” said Dr Karnik. “They need a lot of reassurance that their body will recover gradually with good diet and physiotherapy. The worst impacted are families where all members got Covid-19 and all the adults developed long-Covid. In such cases, we have seen patients struggling as there are no caregivers,” he said.
Dr Karnik estimates that nearly 30% of patients suffer from long-Covid. “The long-term sequelae clear out in most patients gradually,” he said.
A study published in the medical journal JAMA Network Open on Wednesday has estimated that more than half of the patients diagnosed with Covid-19 globally will experience post-Covid or long-Covid symptoms, up to six months after recovering. The study was carried out by researchers from the Penn State College of Medicine. The team conducted a systematic review of 57 reports that included data from 250,351 unvaccinated adults and children who were diagnosed with Covid-19 from December 2019 through March this year. The researchers identified many long-term health issues involving general well-being, mobility, neurological conditions, mental health disorders, lung abnormalities, cardiovascular issues, skin conditions and digestive issues among the survivors.
“Our results indicate that clinical management of persistent post-acute sequelae of Covid-19 (PASC) will require a whole-patient perspective, including management tools like virtual rehabilitation platforms and chronic care for post-acute Covid-19 symptoms in conjunction with the management of pre-existing or new comorbidities,” the researchers stated in the study, further recommending one-stop multidisciplinary clinics to avoid multiple referrals to different specialists and encourage comprehensive care.
Source: https://www.hindustantimes.com/cities/mumbai-news/what-do-medical-experts-from-mumbai-say-on-long-covid-definition-given-by-who-101634234872062.html
