Journal of a coronavirus doctor: Why do people stay sick for so long?

Four months after the start of the coronavirus pandemic, doctors are still learning. One of the surprises is the apparent duration of symptoms in some patients.

Dr. John Wright of the Bradford Royal Infirmary (BRI) talks to two young women who are still tired and out of breath several weeks after falling ill.

Amira Valli, 27, a doctor at a nearby hospital, is running out of steam on a single flight of stairs.

Molly Williams, 34, a physiotherapist at IRB, has always been a fit athlete, but “being out of breath is becoming the norm for me,” she says.

In addition to this, she experiences waves of emotion and has poor memory.

For both of them, it is about three months since they fell ill for the first time.

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As of last March, we knew so little about this virus. We assumed it was a respiratory disease, only to find out that it affects almost every organ in the body.

We assumed that we would rely on invasive ventilation and intensive care units to find that CPAP (non-invasive oxygen ventilation) in medical services was more effective.

We also assumed that when our patients who had recovered from this acute viral disease, this would be the last time we would see them.

Four months later, this new enemy has become an old enemy, and it sometimes seems to be our only enemy. We have also become increasingly aware of the long-term consequences for patients – not only those who were hospitalized, but also those who cared for themselves at home and recovered from the acute infection and then suffer from relapses and persistent symptoms.

Patients who were infected several months ago are struggling to resume a normal life.

We know from studies of SARS patients – one of the families of coronaviruses – during the 2003 epidemic, that almost half of the survivors continued to suffer from chronic fatigue or other lasting symptoms. It should come as no surprise that this wily descendant, the Sars-CoV2, has a similar heritage.

We are receiving an increasing number of desperate emails and letters from patients and their GPs asking for help. Some still suffer from chest pain and shortness of breath.

Others have other symptoms – headache, memory loss, and visual problems. Many suffer from depression and anxiety. Most of them suffer from persistent chronic fatigue. Everyone wants to go back to their previous life. They celebrated their initial survival at Covid-19 in a rush and some are now filled with stubborn doubts and growing despair.

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During the first week, Amira Valli’s symptoms were quite mild – a headache, a sore throat, maybe a slight fever. At the end of the week, she thought she would get out, but the following week, she became short of breath, and that shortness of breath remained.

“I usually struggle with things like stairs. My heart rate drops to 140 after climbing a flight of stairs. Last week I had a bad week … I felt like not being able to sleep, because I was too short of breath. And obviously, I was quite tired, “she says.

Amira also says that she is starting to be anxious.

His chest x-ray is normal, and his chest is normal when listening. But something is wrong and we will try to find out what it is.

Physiotherapist Molly Williams volunteered to work in the Covid wards, and like Amira, she almost certainly caught the virus at work in the hospital.

An elite gymnast during her teenage years, she has since started CrossFit – she is one of the top 20 CrossFit athletes in the UK. But she too is out of breath.

“Before, my resting heart rate was 50 and now it’s around 90,” she says. “Even speaking, I am breathless. I feel overwhelming muscle fatigue in my legs and my heart rate goes up to over 133 when I walk,” she said.

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Molly also says that she is in tears and that she is “upset by things”. And she has memory problems.

“I forget things, and I repeat things several times, but I don’t withhold information. If I try to remember a word, I can’t do it. I have to write things all the time to remember, “she said.

“I have no medical history and it’s very hard for me to be touched like this,” she said.

We still don’t understand why these patients have such long-term problems.

The virus may linger in tanks in their bodies and cause persistent symptoms, as we have seen in survivors of ebola.

Some of our patients are positive for the virus weeks after their first infection, but this is probably due to the fact that the antigen tests detect residual fragments of the viral RNA. If so, these RNA fragments could trigger a prolonged immune response that would explain the persistent symptoms.

But it is more likely that these people experience a prolonged and exaggerated immune response to the initial infection, in addition to damage to their lungs and other organs.

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Our challenge, as doctors and researchers, is to learn more about the causes of these long-term effects, and then to develop treatments that help these patients, and others who suffer from chronic post-fatigue. – similar viral. It is an overlooked area of ​​research because it is very difficult to find answers, but Covid-19 has been an incredible catalyst for science, and the spotlight on these survivors could help us better understand.

Logbook

Professor John Wright, physician and epidemiologist, heads the Bradford Institute for Health Research and has been involved in the management of cholera, HIV and Ebola epidemics in sub-Saharan Africa. He writes this newspaper for BBC News and also records for BBC Radio from hospital departments.

At the hospital, my colleague, Dr. Paul Whitaker, responded to patient demand by creating our first clinic for Covid-19 survivors.

Initially, the plan was to follow patients 12 weeks after discharge from the hospital, but it became apparent that some people who needed hospital treatment were already completely healed, while others, such as Amira and Molly, are still sick. This is why general practitioners now also accept patients referred to them.

When people arrive at the clinic, they undergo a chest x-ray, lung function tests and a walk test, and are asked to complete a series of questionnaires. If their symptoms are severe, they may have an echocardiogram, CT scan, and a full lung function test.

“I think there could be a big iceberg in people who have had a Covid-19 and who have not returned to normal. Each week, I receive three or four phone calls from general practitioners who tell me that they have seen a patient who had covicemia a few months ago and who is still symptomatic, “says Paul Whitaker.

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“In the clinic that we manage, we are going to have a dietician, a physiotherapist, as well as a lot of psychologists, because the patients develop cardiorespiratory complications, but also post-traumatic stress, anxiety, depression, and they have neurological symptoms and symptoms of chronic fatigue.

“And so we can support them by setting up programs – either psychological programs or rehabilitation programs. And we need solid evidence of what works,” he says.

Rob Whittaker, consultant clinical psychologist, says that crying fits are very common among survivors of Covid-19 and that there is an “emerging picture” of cognitive difficulties, such as Molly’s memory problems.

“But it is very difficult at the moment to distinguish what is related to fatigue and emotion, or what could be more organic. It is too early to say,” he explains.

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