Like thousands of Brazilians, Nicole Oliveira, 29, had covid-19 at the end of last year amid the explosion of infections. Symptoms were flu-like and recovery at home. What she didn’t expect was to get so bad after getting rid of the virus. “I entered covid at 29 and I’m leaving at 59. I don’t recognize myself in my body.”
The weakness is such that now, two months after being cured, the young woman is looking for neurologists and tests with complicated names to try to understand and correct the damage that the coronavirus has done. The increase in infections leveraged by the Ômicron variant sounds the alert for new cases of patients who, like Nicole, have prolonged symptoms. And it should raise demand for post-covid treatments, already high due to previous waves.
The long-term effects of Sars-Cov-2 infection have a name – long or post-covid covid -, but they are surrounded by uncertainties. The World Health Organization (WHO) considers symptoms that last three months after infection to be long-term. Among doctors and scientists, the definition of long covid considers even shorter periods than this. One in five infected people may have symptoms after recovering from the acute phase, calculates the WHO.
“I have an absurd weakness and a lot of shaking, dizziness and migraine”, says Nicole, infected in mid-December. The young woman had taken two doses of the vaccine. Today, she even has trouble taking the train to work and has anxiety attacks. “It’s the worst time I’m living.”
Weakness is at the top of the most common complaints of those who have had covid. In clinics, symptoms such as memory loss and difficulty concentrating also appear. “It has an impact on more complex actions, such as making a bank transaction or making decisions at work”, says Milene Ferreira, medical manager of rehabilitation services at Hospital Israelita Albert Einstein, in São Paulo.
Even people with light paintings can have the long covid. “I have patients who did not have any major respiratory manifestations, stayed at home, but persisted with fatigue and difficulty concentrating”, says physician Linamara Rizzo, a professor of physiatrics at USP and creator of the Lucy Montoro Network, a rehabilitation program in the State of São Paulo. .
“It is plausible that the new wave with Ômicron will greatly increase the number of people with long-term covid. Even if the pandemic ends, we will be left with millions of people in the world with sequelae”, says doctor Regis Rosa, a researcher on the topic for the SUS Institutional Development Program (Proadi-SUS) and member of a WHO working group on covid. long.
In the capital of São Paulo alone, 27,200 patients are still being followed up after hospitalization for covid, according to the City Hall. Long-term hospitalized patients are at greater risk of sequelae. There are already documented reports of physical and mental symptoms one year after ICU admission.
Now, new scientific research in this area needs to answer key questions: What is the role of the vaccine to prevent long covid? And what is the impact of the Ômicron variant on the sequels? For the first question, the studies already published suggest that, yes, vaccines help protect from the long covid. One of the mechanisms is obvious: they prevent infections and hospitalizations. But even among those vaccinated who end up becoming infected, the immunizing agent also seems to have a protective role.
A preliminary survey of 3,000 participants in Israel found that people who were vaccinated and had Covid were less likely to report headaches and muscle aches after infection than unvaccinated people who also contracted Covid. Another study in the UK came to similar conclusions.
One of the hypotheses as to why this happens is the fact that vaccines accelerate the fight against the virus, reducing replications. This could prevent the creation of “hidden reservoirs” of viruses in the body, capable of attacking organs later. In addition, vaccines direct the body’s immune response to attack the virus and not other parts of the body. One of the possible causes of long covid is precisely this exaggerated inflammatory response of the body to defend itself.
As for the role of Ômicron in the long covid, the world is still walking in the dark. As the variant was only identified in November, there is still little monitoring of those infected by Ômicron. On the front lines of rehabilitation, however, doctors say some complaints have changed: the loss of smell, common in earlier waves, is less noticeable now. In addition, Omicron seems to spare the peripheral nervous system more. Tingling hands, for example, are less frequent now, says Milene, from Einstein.
In addition to predicting the impact of variants on long-term covid, finding out who is most at risk for prolonged symptoms is another strategy to attack the problem. A study published in the journal Cell in January offered the first clues: among factors associated with long-term covid are the presence of antibodies that mistakenly attack body tissues and the reactivation of the Epstein-Barr virus, which infects most people, usually when young, and then becomes inactive.
For Rosa, action plans now depend on research of this type – a study by Proadi-SUS with 3,000 patients seeks more clues – and on the structuring of the health network to deal with the high number of people who already need or will need support. “The sequelae pandemic will last much longer,” she says. “We need to train professionals and design personalized rehabilitation plans.”
In state-of-the-art hospitals in São Paulo, rehabilitation activities for those with long-lasting symptoms range from walks monitored by devices to technological games to activate the brain. Those who have the long covid can go to sessions two or three times a week. It is not always necessary to take medication.
Einstein recommends that people who continue to have symptoms 21 days after infection seek help. The Hospital Sírio-Libanês, in São Paulo, also advises patients not to delay seeking evaluation. “You are wasting precious time. The risk is to have a more prolonged condition”, says the coordinator of the Syrian rehabilitation service, Christina May. The delay in seeking help can worsen other conditions, such as anxiety and depression – also quite common post-covid.
In up to three months, it is possible to restore quality of life to patients with moderate conditions – but this requires weekly attention. Far from large private hospitals, however, patients who depend on the SUS have a long and difficult recovery. Actor and producer Hugo Adescenco, 34, has not gone back to being half of what he was before the covid. In the middle of last year, during the infection, he became debilitated, but recovered at home.
“I had a program on the internet and I always presented it calmly. Today, I lose the thread, I can’t memorize text.” Tiredness also prevents activities such as cycling. Doctors don’t believe the symptoms. Not knowing what to do, he searches the internet and does crossword puzzles. “I feel kind of abandoned.”
WhatsApp and Facebook groups are crowded with people with lingering effects of covid without assistance. In these spaces, they exchange anxieties and medication tips – some without proven efficacy – to relieve pain. In one of these forums is security guard Anderson Martins, 33, who has only managed to do 20 physical therapy sessions so far and reports waiting three months for rehabilitation. In July, covid-19 caused a stroke that left him in the ICU for ten days and paralyzed the right side of his body.
Married and the father of a baby, Martins returned home in a wheelchair, quit his job and does not know when he will be able to return. “I can stand, but I have a lot of limp in one leg. I have spasms when I’m sleeping”, says he, who takes R$250 from the benefit he receives from the government to buy medicine. His mind is no better: “One day, I tried to get on a train to go to an exam. The pressure rose, the hand was sweating, as if it were an anxiety attack. I had to go home.”
Because of the high demand for rehabilitation, São Paulo Health Secretaries asked for support from the Ministry of Health to convert Covid care centers into rehabilitation units. “We estimate that, for many years, people will need follow-up”, says Geraldo Reple, secretary of São Bernardo do Campo and president of the Council of Municipal Health Secretaries of São Paulo.
The federal ministry, so far, does not have an estimate of the number of people with long-term covid in Brazil – despite presenting a daily balance of “recovered” from the disease. In Rio, the post-covid demand made Ronaldo Gazolla Hospital, one of the public reference units, create a patient rehabilitation center, with a capacity of 8 thousand monthly visits. The opening will be this month. “All efforts during the critical phases were to save lives and now this focus on patients with sequelae has to be intensified”, says Roberto Rangel, president of RioSaúde, which manages the hospital.
In the State of São Paulo, patients with Covid sequelae are referred for rehabilitation through Basic Health Units (UBSs). According to the São Paulo government, there are 30 centers for the recovery of patients who were hospitalized. At City Hall, initial care is provided by teleconsultation. Mild sequelae can be rehabilitated in the basic units. The most complex cases go to specialized centers.
In a note, the Ministry of Health reported that, last December, it expanded the capacity of rehabilitation services of the Care Network for Persons with Disabilities. It also included post-covid rehabilitation actions in the SUS procedure table. According to the folder, the SUS has 268 centers specializing in rehabilitation and 47 orthopedic workshops, in addition to 237 rehabilitation services enabled in a single modality. “It is up to local managers to define the points of care, for the provision of services to patients”, he said.
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