Valery Ivanovich! The multidisciplinary metropolitan hospital that you direct was among those that took the brunt of the covid pandemic and withstood it with dignity. And now he inevitably faces its consequences.
Valery Vechorko: You are right. The term “post-covid syndrome” is used frequently and in wide circles. Different concepts are understood below: twins. Such as “prolonged covid”, “persistent post-covid syndrome”, “consequences of acute SARS-CoV-2 infection” and, finally, “post-covid syndrome” itself. However, regardless of the terminology used, post-COVID syndrome (PCS) is a condition in which there are symptoms of a violation of various body systems that occur 3 to 12 weeks or more after the diagnosis of COVID-19. At the same time, the post-covid syndrome includes more than 100 symptoms of varying severity.
In your opinion, why is the term “post-COVID syndrome” so popular now? How does the problem of COVID-19 combine with a decrease in incidence?
Valery Vechorko: In fact, since the end of the last wave of COVID-19, which was observed last winter, the incidence has decreased significantly. Furthermore, this trend was observed all over the world. But, despite this, it is not possible to completely defeat the disease. And now every day in the world there are about 180 thousand new cases of COVID-19, about 1800 deaths. In Russia, 9-10 thousand new cases and about 50 deaths from COVID-19 are registered daily. In total, there are more than 750 million people who have recovered from coronavirus infection in the world. In Russia – more than 22 million. And almost everyone who had this disease noted a violation of smell, unreasonable weakness, problems with the gastrointestinal tract and other symptoms. However, some conditions may not develop immediately, but after several weeks or even months. That is why the problem of post-covid syndrome is extremely relevant.
I will probably ask the wrong question, but … Sometimes you hear that this or that person got sick after vaccination. How common is this? Is vaccination against COVID-19 dangerous?
Valery Vechorko: According to studies, the frequency of adverse effects after vaccination against coronavirus infection is not higher than after vaccination against other diseases. However, everything related to COVID-19 is widely discussed. Including the issue of vaccination. Therefore, those infrequent cases of complications after vaccination, which inevitably occur, are widely publicized. This condition can be considered as a post-vaccination syndrome. It is similar to the classic post-COVID syndrome and can present with chest pain, fatigue, shortness of breath, various neurological disorders: headache, insomnia, and polyneuropathies. In addition, the vaccinated have dermatological and gastroenterological disorders. This may indicate a hyperallergic reaction of the body to the immune drug. However, we must not forget how many people vaccination has saved. It has been proven that the disease is much milder in vaccinated people, the mortality rate is much lower. Therefore, despite potential complications, vaccination remains the only proven means of preventing coronavirus infection.
Is it possible to consider that the post-covid syndrome is a prolonged infection by coronavirus? Or is it still a new state?
Valery Vechorko: The fact is that the post-covid syndrome develops when there is no longer a coronavirus in the body. This means that the patient’s symptoms are no longer caused by the pathogen itself, but by processes that are initially triggered by an immune imbalance. The cause of this imbalance is an overactivation of the immune system, which over time turns into immune suppression. And then it spreads to the nervous, respiratory, musculoskeletal, gastrointestinal tract and other body systems. Therefore, scientists argue that post-covid syndrome is a new condition caused by a new coronavirus infection.
You have named many problems that arise in patients with post-COVID syndrome. Which torment you the most and above all?
Valery Vechorko: More often, problems with the nervous system: insomnia, fatigue, depression, bouts of excitement, cognitive impairment, headache. Problems with the cardiovascular system: increased blood pressure, palpitations, interruptions in the work of the heart, shortness of breath, swelling in the legs. The musculoskeletal system suffers: efficiency decreases, pain in muscles and joints torments. The consequences of the digestive system do not bypass: nausea, periodic vomiting, diarrhea. And most often there is a combination of several symptoms. Its severity depends on the severity of the transferred COVID-19.
Are the manifestations of post-COVID syndrome always limited to the development of individual symptoms?
Valery Vechorko: According to international studies, it is known that the transferred COVID-19, unfortunately, can lead to the development of new diseases. Most often, the development of arterial hypertension, coronary heart disease, myocardial infarction, diabetes mellitus, multiple sclerosis, autoimmune diseases is observed. These conditions have been found to be much more common in those who have had COVID-19 than the average population.
Who is at higher risk of developing post-COVID syndrome?
Valery Vechorko: The risk of developing post-COVID syndrome is affected by both being overweight and underweight, age over 80 years, as well as concomitant diseases: chronic and acute heart, lung and kidney pathologies, allergies and autoimmune diseases.
You mentioned international research on this topic. And similar jobs in our country?
Valery Vechorko: Of course there is. For example, a study was conducted at our hospital to determine the frequency and severity of post-COVID syndrome. According to our data, most of the patients noted psycho-emotional disorders (72.4% of patients), cognitive impairment (65.9% of patients), pain in the joints or muscles (61.4% of patients). For a more detailed study of post-COVID syndrome, our doctors tested a special questionnaire that allows us to identify the presence of the syndrome in a patient, as well as assess the effectiveness of treatment. With their help, it was revealed that more than 40% of patients had weakness, shortness of breath (30%), dizziness (9.5%). Also, in most cases, the symptoms of post-COVID syndrome persisted for more than 5 to 8 months.
Sad is not the right word in this case. What are the most effective treatment methods for this disease, called post-covid syndrome?
Valery Vechorko – successful recovery is possible only after a full diagnosis of the patient’s condition, which includes laboratory (general and biochemical blood tests, urinalysis) and instrumental methods of research (ultrasound of the kidneys, neck vessels, lower extremities, etc.) .) Assessment of the patient’s functional capacities (ECG, spirometry, velorgometry or treadmill test, orthostatic test), as well as consultation with a cardiologist and neurologist. It is desirable to use methods to detect anxiety, depression and assess the cognitive status of the patient. Once the diagnosis has been completed, emphasis should be placed on the impaired functions. At the same time, you need to remember: the treatment of post-covid syndrome must be comprehensive. When carrying out rehabilitation, the functional level of the patient before the disease and the severity of the COVID-19 he suffered must be taken into account.
If the patient has problems with the respiratory system, it is recommended to stop smoking, avoid toxic substances, extreme temperatures and excessive exercise. Breathing, moderate aerobic exercise should be performed, choosing optimal postures to facilitate breathing.
If signs of angina, arrhythmia, acute coronary syndrome are detected, according to international guidelines on post-covid syndrome, you should urgently seek emergency medical attention.
Cognitive behavioral therapy and moderate exercise therapy are appropriate for the correction of chronic fatigue syndrome that often occurs after COVID-19. The best option is for a team of specialists to work to correct cognitive disorders: a neurologist, a psychologist, a social work specialist. If necessary, a speech therapist. Physicians may also prescribe medical support, including methylphenidate, donepezil, and memantine.
The painting is in no way an oil painting. I want optimism. What is the outlook for the post-COVID recovery?
Valery Vechorko: With good and timely treatment, most patients recover. In addition to competent treatment, the key to recovery is proper nutrition, daily walks in the fresh air and enough sleep.
