Covid-19 sequelae affect quality of life, according to researcher

According to the World Health Organization (WHO), cases of covid-19 whose symptoms last for more than three months can be considered the so-called long covid. Professor at the Faculty of Medicine of the University of Brasília (UnB) and infectious disease specialist at the Health Department of the Federal District, Juliana Lapa leads a research, which began in the second half of 2020, with 400 patients hospitalized due to Covid at the Hospital Regional da Asa Norte ( Hran).

When the study began, it was not yet known about the existence of long Covid. Initially, the objective was to investigate the quality of life of those who had Covid. During the research, according to Juliana, persistent symptoms emerged, which required the addition of frequency, prevalence and factors associated with long Covid syndrome to the study objectives.

The main sequelae observed in participants, who had the disease in its moderate or severe forms, are chronic fatigue and cerebral symptoms. “Cerebral problems are difficult to explain, but they generally consist of difficulty in reasoning and memory failures. Hair loss can also occur up to three months after infection”, explains the doctor.

Juliana clarifies that there is still no consensus among researchers regarding the action of the virus in the bodies of patients affected by long Covid. According to her, there are theories that defend the results of microthrombosis, causing damage to different organs of the human body. Other scientists believe that the virus may act directly on the central nervous system. There is also the theory that the disease can cause changes in oxygen metabolism at the cellular level.

“It is still not known why these cases occur. Without a doubt, long Covid mainly affects women. Some studies point to obesity and advanced age as risk factors. More serious forms of the disease are also identified as a risk factor, although others Studies show that milder forms can also develop longer-lasting symptoms”, observes the researcher.

The specialist explains that even if vaccinated and having previously caught Covid-19, a person can develop long Covid, as the phenomenon has been observed even in milder cases. “As prevention, it is recommended that the patient keep their vaccinations up to date and get tested every time they experience respiratory symptoms similar to those of flu and colds”, advises the infectious disease specialist.

“Long Covid is not something new. It is real and it happens. Most of the time, it improves without treatment. But, in others, depending on how much the symptoms affect the patient’s routine, it is advisable to seek help from health professionals “, he states.

When noticing the persistence of symptoms, the patient should seek out a specialist who can help in each case, such as an otorhinolaryngologist in case of changes in smell and taste, a neurologist for cerebral symptoms and physiotherapists or physical educators when the symptom is fatigue.

Rehabilitation

Rede Sarah offers a rehabilitation program for patients with neuropsychological consequences of Covid, which lead to problems in everyday life, such as difficulties remembering words or changes in memory, conception and planning, a set of symptoms known as brain fog.

The program was created in 2020 to meet the large demand from people with these problems. According to Dr. Lúcia Willadino Braga, neuroscientist and president of the Sarah Network of Rehabilitation Hospitals, at that time there were 2,000 consultations, in Brasília alone, of people complaining of these neuropsychological difficulties with daily activities.

Concerned about meeting this demand, the neuroscientist decided to carry out a study to investigate what was happening. In the sample of 614 patients, all complained of problems with attention, concentration, orientation in time and space, verbal fluency and planning ability: 64% had anxiety problems and 47% depression.

“In our study, 75% of those affected were women. Due to hormonal reasons, men were more protected, despite many having the same problems. We saw that 90% were professionally active people with high levels of education. These people with more education , generally, have a great cognitive demand in everyday life and perceive these signals more quickly”, said Lúcia.

For the cognitive rehabilitation of patients with brain fog, psychoeducational groups have been established, where participants can talk about their difficulties and receive guidance from psychologists. “People feel very lonely, because they think that they are the only ones who are bad. When they join the group, they realize that they are not alone. From there we bring information about what long Covid is and how to deal with it”, he explained.

There are four two-hour meetings, which provide guidance on how to improve memory and language. “By teaching new strategies, such as making checklists of what needs to be done, new pathways emerge in the brain, which we call neuroplasticity,” he said. “Many people thought that the severity of Covid, being hospitalized and intubated, influenced brain fog. But there was no such relationship. There were cases of people who had a little flu at the beginning, but then had important neurological consequences.”

In the second stage of the study, the results of these psychoeducational groups were evaluated. “We realized that the patient’s subjective assessment was compatible with what we analyzed in the tests. So whoever said that their memory improved, the test said the same, which showed that people are capable of self-evaluation. And many pointed out how causes the strategies we teach in meetings, such as taking notes, setting alarms on your cell phone, organizing the environment”, he stated.

The majority of patients evaluated (70.2%) reported an improvement in their cognitive condition, when compared to the first neuropsychological assessment. There was a report of improvement in language use (50.7%), attention (57.5%), memory (57.7%), reasoning (55.9%) and planning (54.2%). Regarding neuropsychiatric symptoms, there were reports of reduction in anxiety (43.8%), depression (62%) and irritability (54%), in addition to improved sleep (56.4%).

The first stage of the study was published in June 2022 in the journal NeuroRehabilitation and published in the World Health Organization (WHO) database, evaluating 614 volunteer participants, for 12 months, on average, after the initial infection, and detailing the nature of the symptoms.

In the second stage, 208 volunteers agreed to participate in reevaluation 25 months, on average, after the initial infection. It has been demonstrated that, despite the long duration of the sequelae, proven by detailed neuropsychological examinations, rehabilitation offers a path to recovery. The second stage was published in the same newspaper, at the end of last year.

Anyone interested in participating in the rehabilitation program can register for free via the website https://www.sarah.br/consultas/primeira-consulta/atendimento-brasilia/.

Treatment

Housewife Dorailde Nobre da Silva, 69 years old, is one of the patients treated by Sarah’s rehabilitation program. She was infected in 2021. She had a history of asthma and bronchitis and ended up suffering complications, but was never hospitalized, having to go to medical units several times and undergoing treatments with antibiotics and corticosteroids.

Dorailde spent more than a year with breathing problems, tiredness and muscle pain, which ended up leading to discouragement and depression, in addition to intestinal problems. The treatments she was receiving had no significant effect on the symptoms she was experiencing. It was through her daughter-in-law that she discovered the center’s rehabilitation program. “At the first consultation, the general practitioner ordered all the blood and imaging tests related to my symptoms. A lack of vitamin B12 and high uric acid were soon identified”, she reports.

During the exams, he also discovered a break in the shoulder connection, even though he had not been through any accident that would justify it. The most likely cause is vitamin B12 deficiency, according to the housewife.

In the program, Dorailde also received individual psychological care twice, before being referred to group therapy. “It was the opportunity to expose my problems to colleagues who were going through the same or worse,” she recalls.

At these meetings, strategies were taught to deal with the symptoms of brain fog, such as writing down the day’s tasks and leaving the notes in a visible place, going for a walk or watching a movie. Before the reevaluation, Dorailde had noticed an improvement in her quality of life. “Today, I feel good, I’m excited, I even go to the gym, I’m back to driving and I’ve lost weight. Before, I wasn’t excited about anything”, she celebrates, who admits she still has memory lapses, but much less frequently.

Businesswoman Maria Elizete Lima Falcão, 64, caught Covid at the beginning of 2022, with mild symptoms, such as tiredness, headache and nausea. The fatigue increased over time, to the point where she was unable to climb the stairs at home. She also reports increased anxiety and forgetfulness. “I would forget to turn off the stove, close the filter. When I read something, I would forget what I was reading about and I would have to go back and reread everything,” she recalls.

It was five months of experiencing the symptoms, until he signed up for Sarah’s rehabilitation program. “I improved a lot with psychological care in group therapy,” she says. Maria Elizete learned to write down the day’s tasks, make summaries of what she read and mark appointments on the calendar with alarm signals. As she also had difficulty falling asleep, she was advised to turn off all devices that emit any light when going to bed. Stretching helped her relax more. She attended the program for four months at Sarah and noticed significant improvements. “My last appointment was on March 20, and the results were satisfactory,” she highlighted.