Long Covid, symptoms, how long it lasts: what Bassetti, Galli, Gismondo and Pregliasco say

How long does the Long Covid last and what are the symptoms in patients who, once the coronavirus infection is archived in and of itself, still have aftermath and no longer feel fully as before? A Chinese study published in ‘The Lancet Respiratory Medicine’, the survey with the longest follow-up conducted so far, showed that more than half (55%) of those who have been hospitalized for Covid-19 after 2 years still have at least a symptom of the disease.

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“The Higher Institute of Health is analyzing a whole series of cases to be aware of what the symptoms are – explains the Undersecretary of Health Andrea Costa, guest of ‘TimeLine’ on SkyTg24 – It is an issue we should deal with in the coming months. It was said that there was uncertainty about what the consequences of Long Covid could be. Undoubtedly, only monitoring over time will tell us what the problems are. One of the reasons we insisted on vaccinations was to protect them from disease and serious consequences. Long Covid is an issue on which we must be ready and give answers to citizens “.

BASSETTI – The data from the Chinese study on Long Covid published in ‘The Lancet Respiratory Medicine’ “are impressed, but refer to the first wave of the pandemic – comments to Adnkronos Salute Matteo Bassetti, director of Infectious Diseases of the Policlinico San Martino in Genoa – We too we have worked on the short and long-term consequences of Covid disease: former patients complain of fatigue, memory problems and even respiratory problems. But the question we must ask ourselves is the one referred to the arrival of vaccines “, because” who has had the When vaccinated Covid does not have the same symptoms as an unvaccinated. And this also seems to be true for the post Covid “, while” the unvaccinated recovered have had similar aftermath to those who had pneumonia in March-May and October-December 2020. So the watershed is vaccination “.

“We see important forms of Long Covid and post Covid today in those who are not vaccinated – continues Bassetti – That they reach up to 2 years seems a bit long to me, but we take note of it. The study shows that this is an aggressive virus, that causes a serious disease because there is an interaction between the virus and the inflammatory system. It is a non-classical infectious-inflammatory disease and this synergy creates more damage. A clear message comes from the Chinese study “, reiterates the expert:” Vaccination does the difference”.

CLERICI – “Long Covid and its impact we will understand better with time. For better or for worse. But, judging by the latest data on this issue, we can be sure that in the coming years there will be an increase in chronic conditions and the need for rehabilitation therapies. And resources will be needed on this. Because it is now confirmed by what we see: Covid is a problem that, in some respects, is not limited to the period of infection and is now confirmed by what we see “. This is the reflection of Mario Clerici, professor of immunology at the University of Milan and scientific director of the Don Gnocchi Foundation.

The expert comments on the data from the Chinese study to Adnkronos Health: “Publications keep coming out. This is only the latest in chronological order, but it is in fact the first in which the 2-year data is examined. there is a fairly long follow-up. There are two messages that I get from this work: the first is positive and tells us that the percentage of patients with post Covid symptoms after 2 years has decreased compared to what we had after a year . The negative message, however, is that there is still a large percentage of people who had Covid two years earlier and are not feeling well “.

“Which – continues the immunologist – confirms what we more or less see in the clinic: that is, there is a percentage of patients, which decreases over time, but a large portion remains, who continue to have symptoms, to feel sick. , to be weak or to breathe badly, to still experience mental fog. And it seems to me that, net of everything, what awaits us is an increase in chronic conditions in the next few years. chronicity and rehabilitation. It will be necessary to understand how to manage all these people and make them improve as effectively and quickly as possible “.

GALLI – “Evidence on the widespread phenomenon of Long Covid is emerging with increasing clarity. I myself have personal experience of it. All this makes me argue, with conviction, that those who argue that if you become infected with Omicron are not so serious, it is profoundly wrong. . It is better not to encounter this virus, “Massimo Galli, former director of the infectious diseases department of the Sacco hospital in Milan, told Adnkronos Health, about the new data highlighted by the Chinese study.

“It is not certain that this result can be exactly transposed to our Italian case studies – observes Galli – There are obviously many aspects to be explored. But the lesson to be taken into consideration, in absolute terms, is that this infection still has many sides to clarify. And so better not take it “.

“Today we have not yet managed to figure out the mechanisms involved in the Long Covid phenomenon – adds the infectious disease specialist – and what could and should be done for the containment, treatment and management of this type of problem. it also comes to terms with this element at the level of assistance organization “.

GISMONDO – Will Long Covid be a ‘pandemic after pandemic’? “I believe that Covid will not abandon us for a very long time, also and above all for its long-term effects that we must monitor”. Above all, “we must try to understand if” these sequelae “can be avoided with therapeutic tools,” microbiologist Maria Rita Gismondo told Adnkronos Salute.

Also in Italy “we are collecting data and drawing inferences on patients monitored after recovery from Covid – observes the director of the Laboratory of Clinical Microbiology, Virology and Diagnostic of Bioemergencies of the Sacco Hospital in Milan – We see that many have problems even after months”, also “memory problems, cognitive disturbances, most of them minor. But there was a rather worrying study – recalls Gismondo – certainly to be confirmed over time, in which the brain volume was evaluated in patients who have symptoms. Covid, suggesting that it is reduced “.

PREGLIASCO – The Sars-CoV-2 infection has “very significant after-effects, effects that we will see accumulate over time”. For this virologist Fabrizio Pregliasco, professor at the University of Milan and health director of Irccs Galeazzi, believes that “more Italian hospitals should equip themselves with Long Covid centers”, and proposes “a national project to define how many and where”.

At Adnkronos Health, the expert underlines how the long-term consequences of the disease are “to be thoroughly understood” and that “targeted services are needed to be made available to all”. “There are now many – recalls Pregliasco – the evidence of the relevance of Long Covid and the percentage of people affected, with varying intensity and length”. And if there is still “difficulty in framing this pathology”, the awareness that the lung is the main target of the acute phase of the pathology is now solid, but the involvement at a distance then affects different systems “.

TOSATO – For many recovered from Sars-CoV-2 the ordeal of post Covid syndrome may begin. A set of symptoms that still does not have an objective clinical perimeter, but “certainly the persistence of disorders is very important: we find it in 60-65% of our patients and the data from our observatory show that the age range is 25-55 The challenge for health systems is to be able to face this syndrome in the coming years, giving an objective definition, and in fact we are collaborating with the Higher Institute of Health (Iss) which has an open plan on good practices for Long Covid, with which standardize assistance in post Covid centers through national guidelines. We hope to arrive at an official document by the end of the summer “. Matteo Tosato, head of the Day hospital operating unit after Covid, Polyclinic Gemelli Irccs Foundation in Rome, underlines this to Adnkronos Salute. The center has treated over 2,500 patients since April 2020.

“Unlike the Chinese study” published in ‘The Lancet Respiratory Medicine’, “we have not only followed the patients – explains Tosato – but we have not had the opportunity to follow everyone on a continuous basis as to how the care design was conceived, but we have collected the data of our patients and we have evaluated them over time “.

At the moment the post Covid “has no diagnostic criteria”, highlights the expert, and “the most common symptom is ‘fatigue’, tiredness. That is, for the recovered there is a difficulty in resuming normal daily activity, but it is clear that how I perceive fatigue is a very subjective thing. We do not have, in fact, a diagnostic criterion shared at the level of the scientific community “. Here is the need for national guidelines.

Has the arrival of the anti-Covid vaccine, but also of the Omicron variant and its sub-variants, changed the Long Covid? “Today – replies Tosato – in my clinic I still see a few recovered from Omicron with post syndrome. Omicron is a variant that arrived in Italy in January and therefore we have just started. We are not certain to say whether the arrival of new variants and the high Vaccination coverage have also changed the symptoms of Long Covid. Some of the worst cardiovascular symptoms, arrhythmias, stroke or respiratory disorders, are much more common in those who have had severe forms. Fatigue, on the other hand, has been shown to be unrelated the degree of severity of the disease: those who have had a mild Covid have still had a form of posthumous fatigue “.

Does post Covid risk becoming a real disease that we will have to deal with in the next decade? “In part it is already so – warns the head of the Uo Day hospital post Covid del Gemelli – Let’s look at Lazio: up to 31 December 2021 we were a post Covid Day hospital”, while “from January on the decision of the Region a path was opened outpatient for post Covid patients, in practice clearing the post Covid syndrome as a clinical condition. Then the patient arrives with the doctor’s referral, with post Covid writing. Attention however – Tosato concludes – We need a standardization of these centers, for this the ISS is working on a document that can give a single line to which each center will then have to follow “.

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