The proposal for the creation of organized medical structures for patients suffering from Long Covid syndrome is being implemented.
This emerged from the meeting that the Minister of Health Thanos Plevris had with the president of the Hellenic Association of People suffering from its long-term consequences. Covid-19, Eleni Iasonidou.
The patient's representative submitted the comprehensive proposal for the design of medical structures for patients suffering from its long-term consequences. Covid-19, with a patient-centered approach ", which the Minister of Health accepted and promised that in the coming days the necessary actions will be taken to implement the proposal.
In our country since the beginning of the pandemic more than 1.000.000 cases of coronavirus have been recorded, with about 10% of these patients suffering from persistent symptoms at least six months after the initial disease. In fact, experts point out that the number of patients with Long Covid will continue to increase as the incidence of coronavirus increases.
The profile of patients
Long Covid is a multisystemic disease. The intensity of the symptoms and the rate of their occurrence vary depending on the severity of the disease during the acute phase. However, if patients needed high-flow oxygen or ICU treatment, some of their symptoms may be due to syndromes generally associated with ICU.
"Long Covid syndrome seems to affect more middle-aged women. Weight gain, smoking, chronic diseases and especially from the mental realm, serious illness COVID-19 and the need for hospitalization have been identified in studies as risk factors. "Socio-economic status, social exclusion as well as other genetic, social or cultural factors can affect the diversity of symptoms and their duration," he told ygeia mou, which was published in THEMA on October 31. Assistant Professor of Pathology-Infectious Diseases of the XNUMXrd Pathological Clinic of EKPA at "Sotiria" Hospital and Scientific Officer of the Post-COVID Clinic Garyfallia Poulakou.
"According to a British study, 1 in 10 patients with mild symptoms may develop Long Covid. "It seems that older people, obese people and patients with underlying diseases (pre-existing lung, cardiovascular, kidney disease, chronic neurological or psychiatric problems) are more likely to develop prolonged COVID disease," according to the NSS Superintendent. COVID-19 at the Therapeutic Clinic of the "Alexandra" Hospital Eleni Koromboki.
So far there are no published data on the impact of Long Covid on the Greek population. The ongoing studies as well as data from the databases of the Post-COVID clinics of the hospitals are expected to give a clearer picture.
The symptoms of Long Covid
The main symptoms are fatigue, shortness of breath, cough, headache, chest pain and myalgias. Other common symptoms are: taste and smell disorders (often a torturous odor, ie the impression of unpleasant odors such as burnt rubber or rotten meat or fish), orthostatic tachycardia or hypotension, sleep disorders, alopecia, peripheral lesions (peripheral lesions) nausea (stings), endocrine disorders mainly of the thyroid or diabetes, skin rashes, weight loss, anorexia, arthritis, migraines, dizziness, dizziness, sweating, diarrhea. Psychiatric and cognitive disorders such as post-traumatic stress disorder, memory and concentration disorders, anxiety and depression are also common.
Pathogenetic mechanisms
The mechanisms involved in Long COVID are complex. They may be related to the cytokines released by the body in the inflammatory phase of acute disease, or to the action of SARS-CoV-2 itself and the invasion of cells into a wide range of human tissues or to the mechanism of immun thrombosis that may trigger the coronavirus in small vessels.
The Post Covid structures of the NSS
At the international level, various models of care have been used either with interdisciplinary polyclinics in reference hospitals, or with networks between tertiary hospitals and primary care, but also mobile services for vulnerable populations or in areas with remote geographical access to specialized services. Counseling is also offered to health professionals who treat patients with similar symptoms or complications. The general treatment protocol is adapted to the peculiarities of each patient.
The operation of Post-COVID clinics in our country started mainly with the initiative of the doctors who had treated patients during the acute phase, deeming it necessary to monitor them after leaving the hospital for a reasonable period of time.
Most hospitals have beds COVID-19 They also have Post-COVID clinics to monitor mainly the patients who were treated. Examples are the hospitals Evangelismos, Sotiria, Attiko, Sismanogleio in Athens, AHEPA, Papageorgiou, Papanikolaou in Thessaloniki, but also the University Hospitals of the Region. Patients with mild illness and no need for hospitalization have limited access to these specialist clinics.
The Long Covid treatment protocol
The 2020rd Pathological Clinic of EKPA in "Sotiria", which operates under the direction of Professor Konstantinos Syrigos, operates a Post-COVID Clinic since May 2, in collaboration with the 2nd Pulmonary Clinic. "Patients are scheduled an appointment in 6-12 weeks after discharge according to their needs and then in 12 weeks for the final assessment of their respiratory, cardiovascular, metabolic, neurological, psychosocial rehabilitation through a holistic interdisciplinary approach. During the initial evaluation it is decided if any additional tests or services are needed from the basic package that includes cardiogram, blood tests, assessment of quality of life, mental health and neurocognitive state. Almost all patients undergo computed tomography XNUMX weeks after the disease and if necessary in full functional respiratory control. The team that manages their care consists of a Pulmonologist, a Pathologist-Infectious Diseases Specialist, a Nurse, and a Social Worker. There is a stable cooperation with a cardiology clinic and in case of referrals can be made to other specialties e.g. Clinical Psychologist, Psychiatrist, Neurologist, Rheumatologist, Dermatologist ", according to the Pathologist-Infectious Diseases, NSS Curator at the XNUMXrd Pathological Clinic of EKPA of" Sotiria ", Scientific Officer of the Post-COV Clinic.
In turn, Ms. Koromboki adds that "additional laboratory tests are important to assess the function of the liver, kidneys, endocrine glands (thyroid function), blood lipids, sugar and glycosylated hemoglobin, markers , myocardial enzymes, but also hematological markers (eg coagulation), as it can reveal late lesions from different target organs of the virus, even in cases where there were no lesions initially during the acute phase of the disease.
The institutional framework
In the US, the disease has already been recognized as a form of disability with the corresponding coverage of rehabilitation costs by insurance funds. In Greece the framework is being developed.
"A few months ago, an attempt was made to register Post-COVID clinics by the Ministry of Health and there was an initiative to educate the medical community on Long COVID syndrome, including this section in the training activities organized by the Quality Assurance Organization for Health Services (ODIPY) in collaboration with ΕΚΠΑ. The medical community in collaboration with the Greek support team for patients with Long COVID must inform the Ministry of Health about the problems in the operation of Post-COVID clinics, ensuring insurance coverage of diagnostic tests, but also free access to rehabilitation treatments where needed "with an indication of this disease", said on October 31 the Professor of the Medical School and Rector of the National Kapodistrian University of Athens (EKPA) Thanos Dimopoulos.
So far, rehabilitation in special centers is covered only for those who have been hospitalized and have a serious residual disease or have complications due to prolonged hospitalization in a COVID clinic or in the ICU. Also, respiratory, motor and psychosocial rehabilitation programs are implemented in large referral hospitals, but priority is given to patients after serious illness or hospitalization in the ICU.
"In many European countries, resources have been provided, both human and economic, to strengthen health care delivery structures and to cope with the increased burden of the pandemic," said Ms Poulakou. In our country there are inherent weaknesses in public health structures that have intensified due to the pandemic. Indicatively, critical examinations such as the functional control of the respiratory and cardiovascular function are not performed in public structures of the Region. However, according to the Ministry of Health, at present "the examinations required for the monitoring of patients with prolonged illness as well as their treatment, are covered by the insurance system".