The COVID-19 pandemic continues.
Especially in the past month, the epidemic has rapidly swept across more than 20 provinces across the country. As of 24:00 on March 14, 31 provinces (autonomous regions and municipalities) and the Xinjiang Production and Construction Corps reported There are 11,984 confirmed cases, a total of 120,504 confirmed cases and 4,636 deaths [1].
Currently, the cumulative number of new crown patients worldwide has reached 459 million, and the death toll has exceeded 6 million[2].
As the number of infections and deaths continues to increase, the long-term symptoms and hidden dangers of people infected with the new coronavirus after recovery are increasingly attracting attention. Under the severe epidemic situation, some false information has also begun to spread. These rumors , False information has caused certain interference to the fight against the epidemic.
Then,
What are the long-term symptoms of COVID-19? What are the common symptoms? How serious is it? Let’s take a look at authoritative evidence in top medical journals.
On October 6, 2021, the World Health Organization (WHO) published the first official clinical definition of Long COVID-19:
Long-term symptoms of new coronary pneumonia refer to patients with confirmed new coronary pneumonia or suspected new coronary virus infection, appearing within 3 months after infection, lasting at least 2 months, and cannot be treated by other The diagnosis explains the symptoms.
Currently, the exact number of people worldwide with long-term symptoms of COVID-19 is unknown. However, about 10-20% of patients with acute new coronavirus infection will have residual symptoms for several weeks to several months after infection[3].
A study titled “Long-term effects of more than 50 types of COVID-19: a systematic review and meta-analysis” was published in Scientific Reports, part of the journal Nature, in August 2021. [4].
(Image credit: Study Cover 4)
The study involved 47,910 infected individuals ranging in age from 17 to 87 years old.
Studies show that 80% of infected people develop at least one long-term symptom within weeks to months of recovery.
The study identified 55 long-term symptoms, of which the five most common were fatigue (58%), headache (44%), and attention deficit (27%) , hair loss (25%) and dyspnea (24%). In addition, loss of smell and taste, cough, joint pain, etc.
Lung CT abnormalities were also more common in these infected individuals, with 35% of infected individuals still showing abnormalities on lung CT scans 60 to 100 days after the first lung CT scan.
(Long-term effects of COVID-19. Image credit: Lopez-Leon, S., Wegman-Ostrosky, T., Perelman, C. et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis.)
Unfortunately, the paper doesn’t address how long these long-term symptoms last; there’s no data on how likely they are to last a lifetime.
But there is one more thing to note: The subjects of this study are all infected people before January 1, 2021. That is to say, they are basically infected with the original strain of the new coronavirus, not the Omicron strain that currently dominates the world.
It can be seen that there is a big difference between the new coronavirus infection and the research objects of the paper in the past year. Although there is still a certain reference value, continuous research is needed.
In July 2021, researchers from Imperial College London, King’s College, Cambridge University, Southampton University, and the University of Chicago, USA, investigated 81,337 people (including about 13,000 people infected with the new coronavirus) A series of clinically validated cognitive tests, including brain tests, questionnaires, etc., were conducted [5].
(Image credit: Study Cover 5)
After controlling for factors such as age, gender, native language and education level, the researchers found:
Compared with non-infected subjects, those who had previously been infected with the new coronavirus and recovered received varying degrees of symptoms of cognitive deficits, and , the degree of cognitive decline was proportional to the severity of pneumonia at the time of illness.
Unfortunately, due to the short follow-up period, the recovery of these individuals is unclear: is it a temporary decline? Or a permanent decline? The discussion does not mention it.
So what’s causing the cognitive decline in people with COVID-19? What happens to the brain before and after the new coronavirus infection?
Research published in the journal Nature in March 2022 shows that infection with the new coronavirus may not only lead to reduced gray matter thickness and brain tissue damage, but also may impair the ability of the brain to perform complex tasks. This study is the only longitudinal imaging study to compare the changes of brain tissue damage in patients with new coronary pneumonia before and after infection [6].
(Image credit: Study Cover 6)
The study involved 785 participants in the UK Biobank (UK Biobank) aged 51-81, of whom 401 tested positive for COVID-19 ( 96% were mild), and 384 tested negative for the new crown. The researchers took two brain scans of them 141 days apart.
Infected people showed 3 distinct changes in brain scans:
Decreased gray matter thickness in orbitofrontal cortex and parahippocampal gyrus
Tissue damage in areas related to primary olfactory cortex function
COVID-19 patients have reduced brain volume (brain shrinkage)
(The ratio of total brain volume to total intracranial volume. Reference source: Reference 6)
Gray matter, also known as the cerebral cortex, contains the cell bodies of most of the brain’s neurons. The gray matter involved includes areas of muscle control and sensory perception such as audio-visual, memory, emotion, speech, decision-making, and self-control.
So, a decrease in gray matter thickness means that a person’s ability to think and act decreases.
It’s important to stress that the study has several limitations, including the lack of rigorous grading of the patients’ disease and the lack of identification of the virus strains the patients were specifically infected with.
The effects of Delta and Omicron strains on the brain need further studies to prove. For example, are these brain injuries caused by the virus itself, or are there other causes? Can it be restored in the future? These issues require further study.
Another study published in the journal Nature on March 8 this year found that the thickness of the gray matter of the brain decreased by about 1% in patients with COVID-19 [7].
(Image source: Document 7)
(Changes in the cerebral cortex after infection with the new coronavirus. Image source: Document 7)
Cleveland Clinic cardiologist and biostatistician Larisa Tereshchenko said, COVID-19 may be the highest risk factor for cardiovascular disease in the post-pandemic era ”, even greater risk than well-documented factors such as smoking and obesity.
According to a February 2022 paper published in the journal Nature Medicine, U.S. researchers placed 153,760 new coronary Those who tested positive were compared with two control groups involving more than 11 million people [8].
(Image source: Document 8)
Study finds that COVID-19 patients have a significantly increased risk of cardiovascular disease, including cerebrovascular disease, arrhythmia, ischemia, within 30 days to 1 year of infection. Ischemic and nonischemic heart disease, myocarditis, heart failure and thromboembolic disease.
Infected people were 72% more likely to develop coronary atherosclerotic heart disease (coronary heart disease), 63% more likely to have a heart attack, and were more likely to have a stroke compared to the control group 52% higher than the control group.
One year after infection with COVID-19, regardless of age, gender and other cardiovascular risk factors such as obesity, hypertension, diabetes and chronic kidney disease,< strong>The risk of developing cardiovascular disease is significantly increased, and may occur in infected individuals without previous cardiovascular disease. The associated risk was increased even in non-hospitalized patients with mild disease.
However, this study also has certain limitations, as it did not detail which new coronavirus strains and vaccinations were infected. Moreover, during this period, the new crown vaccine has not been widely used, and the Delta and Omicron strains have not yet emerged.
Recently, the team of Yuan Guoyong of the University of Hong Kong conducted an experiment in hamsters. After hamsters were infected with 2019-nCoV intranasally, sperm counts and testosterone levels dropped sharply on days 4-7, and testicular atrophy, volume and weight decreased. Serum sex hormone levels were significantly decreased from 42 to 120 days after infection[9].
(Image credit: Study Cover 9)
And intranasal infection of the Omicron and Delta variants caused similar testicular changes. However, hamsters infected with influenza virus H1N1 intranasally or testes did not develop testicular tissue damage.
The researchers further inoculated the hamsters with inactivated vaccines, and then infected the hamsters with the new coronavirus. The results showed that there was no testicular histopathological damage. Protects the testicles from the infection of the new coronavirus and the possible complications of testicular damage.
Overall, COVID-19 infection can cause acute testicular damage, followed by chronic asymmetric testicular atrophy and associated sex hormone changes, which can be effectively avoided by vaccination against COVID-19 testicular injury.
This also reminds that male patients who have recovered from the new crown should pay attention to the possible problems of hypogonadism and reduced fertility, and also emphasizes the importance of vaccination against the new crown.
For possible long-term symptoms of COVID-19, 2020On May 13, the National Health and Health Commission, the Ministry of Civil Affairs, the National Medical Insurance Administration, and the State Administration of Traditional Chinese Medicine jointly issued the “Rehabilitation and Treatment Plan for the Major Functional Disorders of Discharged Patients with New Coronary Pneumonia” (hereinafter referred to as the “Plan”), which aims to improve respiratory and cardiac function. , physical function, psychological function and the main manifestations, assessment methods and rehabilitation training methods of the impairment of activities of daily living were standardized. Focus on critically ill and critically ill patients, and take rehabilitation measures for patients with different conditions and functional impairments.
For patients discharged from the hospital with new coronary pneumonia, it is recommended to do more breathing training, aerobic exercise, muscle strength and endurance training, flexibility training, balance function and coordination training according to the condition and tolerance. People with psychological dysfunction such as depression, anxiety, and post-traumatic stress should receive psychological counseling and treatment in a timely manner.
Here’s what we know about the long-term symptoms of COVID-19 as of March 2022. Regarding the “sequelae” of the new crown, we should neither demonize nor take it lightly. The new crown epidemic is not over yet, and although our understanding of the long-term symptoms of new crown pneumonia has yet to be deepened, in the face of epidemic prevention and control, no one can stay out of it.
Our country is currently facing a critical moment in the fight against Omicron. What we can do is to actively vaccinate, do a good job in personal protection, reduce mobility, and scientifically and rationally treat the various diseases brought by the new crown pneumonia to us. a medical problem.
Reviewer: Liu YechengChief Physician of Peking Union Medical College Hospital
References
[1]http:https://www.nhc.gov.cn/xcs/yqtb/202203/8d8d2035b3884fcfb734e0ab07bede79.shtml
[2]https:https://news.google.com/covid19/map?hl=zh-HK&mid=%2Fm%2F02j71&gl=HK&ceid=HK%3Azh-Hant
[3]https:https://www.who.int/emergencies/diseases/novel-coronavirus-2019/media-resources/science-in-5/episode-68-covid -19-update-on-long-covid
[4]Lopez-Leon, S., Wegman-Ostrosky, T., Perelman, C. et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep 11, 16144 (2021). https://doi.org/10.1038/s41598-021-95565-8
[5]dam Hampshire, William Trender, Samuel R Chamberlain, et al. Cognitive deficits in people who have recovered from COVID-19. EClinicalMedicine. 2021 Sep;39:101044.DOI:https : https://doi.org/10.1016/j.eclinm.2021.101044
[6]Douaud G, Lee S, Alfaro-Almagro F, et al. SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature. 2022 Mar 7. doi : 10.1038/s41586-022-04569-5. Epub ahead of print. PMID: 35255491.
[7]Gollub RL. Brain changes after COVID revealed by imaging. Nature. 2022 Mar 8. doi: 10.1038/d41586-022-00503-x. Epub ahead of print. PMID: 35260835 .
[8]Xie, Y., Xu, E., Bowe, B. et al. Long-term cardiovascular outcomes of COVID-19. Nat Med (2022). https:https: //doi.org/10.1038/s41591-022-01689-3
[9]Li C, Ye Z, Zhang AJ, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections by intranasal or testicular inoculation induces testicular damage preventable by vaccination in golden Syrian hamsters. Clin Infect Dis. 2022 Feb 18:ciac142. doi: 10.1093/cid/ciac142. Epub ahead of print. PMID: 35178548; PMCID: PMC8903466.
Author: Yu Jia | Editor: Di Hao, Zhang Jie
Typesetting: Han Ningning | Operation: Li Yongmin | Coordination: Ye Yichu
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