How do people fare who have survived a corona infection but are still in poor health? A person affected feels left alone with their problems. A guideline is intended to make it easier for doctors to deal with post and long Covid patients.
Jogging five kilometers – that was never a problem for Paula. Now it is already limp after 1.5 kilometers at walking pace. The reason was already three months ago: a corona infection. “I go rather than jog, and still I gasp for air and my pulse is racing,” says the 52-year-old from Karlsruhe. The industrial engineer is a typical post-Covid patient.
In the case of an acute Covid illness, the symptoms usually persist for up to four weeks. But for many like Paula W. the suffering continues. According to Andreas Rembert Koczulla from the German Society for Pneumology and Respiratory Medicine (DGP), the number of people with long-term consequences is 550,000 nationwide. “Of those who were declared recovered, around 15 percent still struggle with a wide variety of symptoms.”
Shortness of breath, hair loss and earache – the spectrum of symptoms for the consequences of infection with the coronavirus is wide. Given this diversity, it is difficult for general practitioners to attribute their patients’ problems to Covid-19, especially when several weeks have passed since the infection.
Guidelines are intended to facilitate diagnosis
That should now be remedied. “We want to give doctors guidelines that make it easier for them to identify the consequences of infection,” says Koczulla, chief physician at the Schön Klinik Berchtesgadener Land. The handout, which he has written with experts from other disciplines and which he intends to publish shortly, serves as structured diagnostics and therapies as possible.
In relation to the duration of the sequelae, the DPG differentiates between long-covid and post-covid. The persistent symptoms of the acute illness beyond four weeks are referred to as long covid. If those affected are still struggling with the symptoms after twelve weeks, they are suffering from post-Covid. Both people with a severe course and those with a mild course are affected by the medical and psychological long-term effects.
Paula’s initial symptoms such as fever, dry cough and headache improved after 3.5 weeks in quarantine at home. What remains is her breathlessness and powerlessness. She feels left alone with her complaints. “During the illness phase, I was referred to the Covid practice by my family doctor.” But only tests would be carried out there.
Around 20 symptoms can be found in those affected. Inadequate resilience, tiredness and shortness of breath are predominant. Changes in the lungs often occur in previously hospitalized patients, as Koczulla explains. In addition to lung and heart problems, smell and taste disorders are also very common symptoms. Hair loss, sleep disorders and cognitive impairments are common. The consequences of corona are rarely expressed as tinnitus, nausea, diarrhea or loss of appetite. In all three frequency groups, psychological impairments occur more intensely: The patients are more prone to stress, more anxious and more depressed.
Some post-Covid patients fall through the cracks
During the acute phase and the follow-up phase, Paula was left to herself and the experiences of other sufferers. Vitamins, magnesium and expectorants were part of self-medication. If girlfriends hadn’t put food on their doorstep every day, they would be even more powerless today. “You have to organize yourself and are dependent on your social environment.” She wants patients like her to be taken seriously. “Training of doctors on how to deal with Covid patients who have not been clinically treated is urgently needed.” Contact via video consultation or telephone is not a problem.
Hans-Michael Mühlenfeld from the German Society for General Medicine and Family Medicine (DEGAM) admits that some patients suffering from the long-term corona consequences can “fall through the cracks”. “That happens with rare diseases like post-Covid.” If the family doctor admits that he does not know his way around, it is only responsible. The university clinic outpatient departments are good addresses.
He is surprised by the planned guideline of the GDP and points out that DEGAM has already integrated the topic of long-term effects into its guideline for combating pandemics. If departments create guidelines for other groups of doctors, it doesn’t work. “They don’t know what’s going on with us,” says Mühlenfeld.
Claus Vogelmeier, CEO of the German Lung Foundation, advises patients who believe they have Covid-consequence syndrome to monitor their symptoms closely and inform their doctor. “If after six to eight weeks there is still shortness of breath, it should definitely be examined.”
