Epidemic after epidemic - post-COVID-19 syndrome

To date, the mechanisms by which this SARS-CoV-2 exhibits an affinity for lung tissue, as well as health consequences of its action on this organ, are relatively well known. Additionally, the effects of the virus on other organ systems - cardiovascular system, kidneys, brain, as well as an effect on the body as a whole, have also been observed and studied.

Scientists all around the globe have also begun to study and follow-up patients who were discharged from hospitals after recovery from acute COVID-19 disease. Most of them returned to normal life without health problems. However, it was noticed that a significant number of "cured" patients still had a significant number of problems which lasted for several weeks, even several months after the acute illness.

It has also been noticed that people who were not hospitalized (due to easier clinical picture, i.e. respiratory problems of minor or moderate intensity), had long-term health complains after the acute illness.

Experts from Centers for Disease Control (CDC) in Atlanta, Georgia, USA, indicate that the most pronounced and most common problems faced by patients who have suffered an acute SARS-CoV-2 infection are the following:
- physical and mental tiredness,
- shortness of breath,
- cough,
- joint pain,
- muscle pain.

Following symptoms have slightly lower prevalence after acute SARS-CoV-2 infection:
- loss of sense of taste and smell,
- sleep disorder,
- brain fog,
- difficulties in decision making and thinking,
- mood changes,
- depressive reaction,
- a headache,
- occasional low body temperature,
- rapid heartbeat,
- kidney complications,
- skin complications (most often redness and hair loss).

Medical doctors in the United States, call patients who suffer from post-COVID-19 syndrome post-COVID "long-haulers", while in the United Kingdom, experts say they suffer from "long-term COVID." Studies have shown that about 50 to 80% of subjects after suffering from acute COVID-19 infection may have any of the above symptoms even three months after the acute phase of the disease, regardless they test SARS-SoV-2 negative. These patients can usually be classified into two groups:
- patients who have suffered an acute SARS-CoV-2 infection and have been discharged from hospital with obvious damage of one or more organs (lungs, heart, kidneys, blood vessels, brain) and
- patients who have long-term post-COVID problems, but do not have tissue and / or organ damage observed by modern diagnostic methods. It is believed that patients in this group may develop a condition called myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS) in the future. There is no exact answer for the mechanism of this condition, but it is believed that it can be caused by a permanent inflammatory process in the brain, reduced blood flow through the brain, autoimmune response...

For now, there is no way to "predict" who will develop post-COVID syndrome, but some researches suggest that people over the age of 50 who have two or three chronic diseases or people who have had a more pronounced clinical picture of SARS-CoV-2 infection may be more prone to become “post-COVID-19 long haulers” …

An overview of the most common complications after COVID is given in Table 1.

Table 1. The most common complications reported by patients recovered from acute SARS-CoV-2 infection

Organ/system Symptoms Number of studies Prevalence
(4-6 weeks)		 Prevalence
(8, 12 or more weeks)
Respiratory system shortness of breath 18 33% 39%
cough 13 18,3% 7,7%
chest pain 7 18% 17,1%
Neurological system Tiredness 15 55% 42%
Headache 12 37,8% 18,2%
Loss of sense of smell 11 12% 12%
Brain fog 9 18% 20%
Loss of sense of taste 8 28% 12,1%
Musculo-skeletal system Joint and muscle pain 8 9,8% 16,3%
Mental health Sleep disorders 7 40% 30,8%

The experts continue to warn that the best preventive measures for stopping further virus spreading (until vaccination around the world is complete), are wearing masks, keeping a distance of 2 m between persons, frequently washing hands and avoiding crowds, especially in spaces without ventilation.

After a year of treating people with acute SARS-CoV-2 infection, I gained some experience. The clinical picture ranged from a mild inflammatory reaction due to the presence of the virus in the body to bilateral pneumonia that required an urgent hospitalization. I have often described this virus to patients as a “chameleon virus” because the clinical picture it caused was completely diverse; for example, it was characterized by muscle pain (usually in region of groins, legs, and sometimes in the shoulders), diarrhea, extreme weakness, fever, cough, pain behind the eyeballs, loss of sense of smell and taste (almost in all patients tested positive on SARS-CoV-2)…

Someone had some of these diseases, and someone had all of the above. X-rays of the lungs and heart were often normal, and a MSCT revealed "ground-glass opacity - GGO" which is characteristic of SARS-CoV-2 infection. By using the medical headphones, normal breathing sound can be detected, but the MSCT indicates bilateral inflammation of lung tissue. The C-reactive protein may be slightly elevated, while MSCT detects a bilateral inflammatory process in the lungs that requires an urgent hospital treatment. These were just some situations from practice that, according to our previous clinical experiences, were incompatible...

Some patients recovered in a few days, while others were treated for weeks with therapy that included antibiotics, antipyretics, corticosteroids, infusion solutions (according to official protocols) with the addition of microbiota and microelements.

On the other hand, as a doctor who is oriented towards an integrative approach in patients´ treatment, I also have an experience with post-COVID syndrome. I am mostly approached by patients who after officially "being cured" (all laboratory parameters were normal) felt tired, lethargic, listless, had a fast heartbeat, shortness of breath followed by chest pain... Soon after the start of an integrative approach of treatment that included correction of lifestyle habits, such as an adapted diet and intensive use of microbiota and trace elements (described in the book The HEALTH FORMULA), patients experienced a significant reduction or complete cessation of symptoms, as well as an improvement in overall health.

Since that post-COVID-19 syndrome is in the focus of the professional public everywhere in the world and that it causes great attention of patients who encounter it, in cooperation with the European Institute for Dietetics and Micronutrition based in Paris, we organized a webinar where we conveyed current views on the treatment of this syndrome. In the coming period, I will share my experiences in the field of treatment of patients with post-COVID-19 syndrome, as well as the experiences and recommended protocols of colleagues from the EU, through webinars and workshops.

Literature:
COVID-19 Scientific Advisory Group Rapid Evidence Report. November 23, 2020© 2020, Alberta Health Services, COVID-19 Scientific Advisory GroupKey Research Questions:1.
https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html
https://www.health.harvard.edu/blog/the-tragedy-of-the-post-covid-long-haulers-2020101521173
https://www.iedm.asso.fr/?lang=en