Ask and answers at Long COVID-19

There is no association between the severity of acute COVID-19 and the development of post-COVID complications. Everyone is in the “long-term risk” zone, even those who suffered from COVID-19 asymptomatically and with a false-negative PCR test. And this condition can affect anyone – young, old, those who were healthy, those who had a chronic condition, those who were hospitalized and those who weren’t.

“Long-hauler” – a person diagnosed with COVID-19 who has not returned to their level of health and functioning three to six months after suffering an illness.

Post-COVID syndrome is listed in ICD-10, subheading code U09.9 “Condition after COVID-19 Unspecified”.

The following pathophysiologic processes are considered the main causes of Long COVID development:

• Systemic inflammation resulting from cytokine and free radical damage to the vascular endothelium in a hyperimmune response; serum cytokine concentrations remain higher in patients after recovery compared with controls, indicating continued inflammation after recovery. Cytokines increase the permeability of the blood-brain barrier, as a result of which SARS-CoV 2 can infect astrocytes and microglia and activate the cascade of neuroinflammation and neurodegeneration.
• Endotheliitis is one of the leading syndromes in COVID 19 and the trigger mechanism of Long COVID syndrome. The SARS-CoV 2 virus can directly infect endothelial cells by penetrating ACE receptors2, thereby causing diffuse endothelial inflammation. Direct damage of endotheliocytes by the virus or their mediated damage by immune cells, cytokines and free radicals can cause pronounced endothelial dysfunction, which further leads to microcirculatory disorders, vasoconstriction, development of organ ischemia, inflammation and tissue edema, procoagulation. In combination with chronic inflammation, as a consequence, endothelial dysfunction, there is hypercoagulation, increased levels of fibrinogen, slowed processes of fibrinolysis and anticoagulation, which may cause the formation of blood clots.
• Pulmonitis is lung damage due to vascular and alveolocyte damage by virus and cytokines.

Scientists identify more than 200 post-COVID symptoms in 10 organ systems, of which 66 symptoms are tracked over seven months (tiredness, muscle pain and headaches, accelerated heart rate, problems with sleep, concentration and memory, hair loss, loss of smell and taste, metabolic disorders, hypertension, anemia, neurological complications including polyneuropathy and acute ischemic stroke, etc.)

The patient’s current condition, exacerbation of the disease, and the appearance of new symptoms should be linked to the patient’s history of COVID-19:

• Has the patient had COVID-19 and how much time has passed?
• Has the patient returned to the state of health and functioning they had before COVID-19?

If the patient has not returned to his previous state of health, it is a “long-haul” disease.

To clarify the diagnosis of the disease, laboratory methods of examination are prescribed, through which markers of inflammation can be detected. Of the available methods are the general clinical blood test, CRP, D-dimer. Elevated levels of leukocytes and elevated CRP show systemic inflammation, D-dimer shows signs of endotheliitis, IL-6 is a marker of chronic inflammation.

The full spectrum of possible complaints should also be considered:

• the leading generalized symptom “general weakness” indicates an asthenia;
• leading symptoms in neurology: headache, cognitive impairment, brain fog, anosmia, dysosmia – disturbance of smell perception, symptoms of peripheral neuropathy (“goosebumps” and numbness), anxiety;
• in cardiology: chest pain, palpitations, increased BP;
• in pulmonology: continuation of respiratory symptoms – cough, shortness of breath, heaviness in the chest.

After COVID 19 requires mandatory monitoring of respiratory function, cardiac symptoms, the state of the nervous system and mental functions, as well as a syndromic-pathogenetic approach to rehabilitation of patients, aimed primarily at eliminating systemic inflammation, improving endothelial function, reducing manifestations of asthenia:

Edaravone helps reduce systemic inflammation by suppressing proinflammatory cytokines, neutralizing free radicals, and reducing microglia and astrocyte activation.

 A fixed combination of L-arginine and L-carnitine improves myocardial energy supply and helps to eliminate the effects of endotheliitis; to enhance the latter effect it is recommended to take L-arginine orally after completion of the infusion course.

 Parenteral N-acetylcysteine – pneumoprotective effect of parenteral N-acetylcysteine with the ability to prevent apoptosis of the respiratory epithelium, reduce neutrophil activity in the respiratory epithelium, protect antiprotease enzymes (α1-antitrypsin that cleaves collagen cells), stimulate surfactant release by pneumocytes.

 Xylitol-based solution – an energy source independent of insulin, reduces manifestations of asthenic syndrome.

 Lodixem®, a universal organoprotector with the effect of a daytime tranquilizer, helps reduce anxiety and improve sleep.

For maximum recovery, multidisciplinary inpatient rehabilitation is recommended for patients with moderate to severe post-covid symptoms.

Symptomatic treatment is not sufficient. Without influence on the cause of post-covid complications development (syndromes of systemic inflammation, endotheliitis, pulmonitis) it is impossible to eliminate completely the consequences of long COVID.