Long Covid, how will we tackle the long tail of the pandemic?

Long Covid

The measures to combat the pandemic have just changed, opening up to a general relaxation. The epidemiological situation is constantly evolving: the omicron variant continues to hold its own, and is confirmed to be among the most infectious viruses ever, especially now that the omicron 4 and 5 sub-variants have been identified, although at the moment there do not seem to be any new signs. alarm. The feeling is that after more than two years we are preparing for a new phase of the pandemic, of coexistence with the virus, as also underlined by the European Commission, which however drew attention to the importance of continuing to strengthen vaccinations and systems of surveillance. And in this new phase of the pandemic it will be necessary to take into account and prepare to face the long-term effects of Covid, both indirect and direct ones caused by the infection, or the long Covid.

Di long Covid in reality has been talked about for a very long time, to identify the whole set of symptoms (many) that can remain or appear after the infection, physical and mental, from tiredness, to muscle aches, headaches, loss of taste and smell, brain fog, gastrointestinal disorders, cardiac arrhythmias, chest pains, breathing difficulties, mood disorders, rashes. It can affect adults as well as children. But we still understand little: we know that it exists, that it affects a large number of people, but not exactly who is most at risk, how to monitor its effects and manage it. Also to address this, the Higher Institute of Health presented in recent months a project dedicated to Long Covid, with the aim of defining its dimensions, mapping the centers that deal with it and sharing good management practices. And the first results are already starting to arrive.

The centers dedicated to Long Covid in Italy The data from the census carried out so far tell us that there are at least 120 centers in Italy that deal with long Covid, concentrated above all in large regions (with Lombardy, Lazio and Sicily those with more centers). Most of these centers - explained during a webinar Graziano Onder, director of the Department of cardiovascular, metabolic and aging diseases of the Higher Institute of Health, and coordinator of the project - offer outpatient or day hospital assistance activities, mainly dealing with adult patients. About half of the centers were born in the very early stages of the pandemic, between spring and summer of 2020. Most of the patients followed by these realities were re-contacted by the health system in proactive matters after hospitalization. But many arrive here by referral from the general practitioner or specialist.

Almost all of these centers are multi-specialized - about 90% - and it could not be otherwise for such a multifaceted condition. Multidisciplinarity, multidimensional assessment should be an essential condition in the management of long Covid, Graziano reiterated. But the appeal not to neglect any aspect, investing in an integrated approach, resounded several times by the experts who took part in the event. And it is one of the starting points in the pursuit of the goal of standardizing assistance to people with long Covid as much as possible on the national territory. Matteo Tosato, Head of the Post-Covid Day Hospital Operating Unit at the A. Gemelli IRCCS University Hospital Foundation in Rome, also reminded that it is essential, considering precisely that in the acute phase the disease can affect all organs and systems. The model put in place by Tosato and colleagues was immediately multidisciplinary, even before the long Covid had a name, he recalls, with instrumental evaluations, laboratory tests, combined with specialist visits (such as that of ENT, pulmonologist, gastroenterologist, neurologist , psychiatrist and rheumatologist). And those first insights into a 360 ° management would then be incorporated into the guidelines of the main health institutions on the management of long Covid

The most problematic aspects But if on the one hand the challenge of health systems it is multidisciplinary when talking about the long Covid queue - which will realistically involve many people, even if frequency estimates are difficult - on the other hand particular criticalities emerge within the great cauldron of the long Covid. For example, it seems increasingly evident that this is a gender problem: not only for the type of events that affect men and women, but the latter are almost twice as likely to suffer from long Covid, as explained by Elena Ortona, of the Center of reference for gender medicine of the Higher Institute of Health. But only up to about 60, explained the expert. Because? The hypothesis is that sex hormones, estrogen in particular, may play a role in the development of post-Covid symptoms. These in fact have an important role in the immune response, including autoimmune reactions, and the presence of auto-antibodies has been advanced as a possible risk factor in the development of long Covid.

Next to the gender issue, diabetes is another of the other critical issues that emerged strongly in managing post-Covid. As highlighted by a large study released a few weeks ago, Covid infection increases the risk of developing diabetes by 40% in the following year. A greater risk especially in that segment of the population that already has a higher basal risk in itself, to the point of functioning as a sort of accelerator, explained Agostino Consoli of the Gabriele D'Annunzio University of Chieti-Pescara. Post-infection diabetes should therefore be seen as a particular case of long Covid, to which particular attention should be paid.