The many and varied consequences and complications of the new Coronavirus arising in the people who survive it, along with the quantity of those infected is worrying for the medical and scientific communities. Recovery demands a public health strategy and integral social assistance with multi-disciplinary professionals.
Eight months later and with more than 26 million cases confirmed world-wide since China announced its first positive new Coronavirus SARS-Cov2 in the middle of December 2019, Covid-19 keeps demonstrating new symptoms, complications and consequences.
Its consequences can affect those infected for up to five months after they have tested negative at first and to the follow-up examinations, something that has made a systematic study necessary in order to accumulate knowledge about the virus which is causing this illness. Since the discovery of the first case, information known about Covid-19 has grown: the source of infection, the virulence and the pathogens of the virus, transmissibility, risk factors, the effectiveness of prevention measures, vigilance, diagnostics, clinical management, complications, and the consequences due to the support of science on a global level.
However, there are growing concerns about what Covid-19 could generate after discharge and the epidemiology of the patient suffering.
To date, according to documentation, 40% of Covid-19 cases show with mild symptoms (fever, cough, dyspnoea, myalgia or arthralgia, odynophagia, fatigue, diarrhoea and migraine) and 40% present moderate symptoms (pneumonia), 15% develop severe clinical manifestations (severe pneumonia) that require oxygen support and 5% present a critical clinical state.
In this last stage one or more of the following complications appear: respiratory failure, acute respiratory distress syndrome, sepsis and toxic shock, thromboembolism, and coagulation disorder, and/or multi-organ failure, including acute kidney failure, liver failure, cardiac arrest, cardiogenic shock, myocarditis, and stroke amongst others.
These complications appear mainly in people in the high-risk category: elderly people, smokers and those with underlying comorbidities such as high blood pressure, obesity, diabetes, cardiovascular illness, chronic lung disease (Chronic Pulmonary Disorder and asthma), and illnesses such as chronic kidney conditions, chronic liver disease, cerebrovascular illness, cancer and immune deficiencies.
In addition to its effect on the respiratory system, the WHO/PAHO included other consequences such as neurological complications, delirium or encephalopathy, stroke, meningitis encephalopathy, loss of sense of smell and taste, anxiety, depression and sleep problems.
Many of these neurological complications have been reported with an absence of respiratory symptoms. There are cases of the Guillain Barré syndrome registered in Covid-19 patients, according to statistics from these institutions.
Evidence available up until now suggests that Covid-19 can also induce diverse gastrointestinal complications, which are more common in serious clinical complications. Symptoms that can be present are diarrhoea, anorexia, sickness, nausea, stomach pain and complications such as gastrointestinal haemorrhage in children.
It is well known that the clinical complications of this illness in children are generally mild in comparison with adults, however, since last May there have been reported cases of Multi-Systemic Inflammatory Syndrome in minors and adolescents that has coincided chronologically with Covid-19.
Some European countries and some from the Americas have registered cases of Multi-Systemic Inflammatory Syndrome such as Argentina, Brazil, Chile, Ecuador, United States, Honduras, Paraguay, Peru and Dominican Republic.
Likewise, recent studies of pregnant women infected with SARS-CoV2 who developed pneumonia, presented with a premature birth, miscarriage, preeclampsia, perinatal death and/or signs of an early caesarean.
The Covid-19 infection generates an intense inflammatory response from the respiratory tract and the lung is the first organ affected. However, research shows that the impact of this illness, is not only in respiratory limitations, but that it invades the cardiovascular system and the central nervous system, together with psychiatric and psychological effects.
The most frequent respiratory impacts, after the critical clinical stage, are pulmonary fibrosis, damage to the lung tissue and scar formation that provokes this organ to expand less or with greater difficulty, also dyspnoea and fatigue.
The apparition of post ICU syndrome is notorious because of prolonged hospitalisation with intubation, tracheotomy and oxygenation through a machine to simulate the heart and lung function in order to pump the blood, according to the pulmonologist and researcher Margareth Dalcomo, from the Oswaldo Cruz Foundation, the main health research centre in Brazil and the best in Latin America.
Unfortunately, little still is known about the mechanisms responsible for the damage to the cardiovascular system with significant myocardial lesions.
Whatever the cause may be, scientists are looking at which of these impacts will have short, medium and long-term consequences.
In this manner, a recent study with worrying results discovered that from 100 recovered Covid-19 patients in Germany, 78% presented some type of heart anomaly two months after being given the all clear. With respect to the kidneys, from tracking more than five thousand infected people in New York City this showed that 1,993 developed acute kidney failure.
The appearance of neurological symptoms that range from mental confusion to cognitive deterioration or delirium, have also been documented in patients with the new coronavirus.
In this field there are many different types of manifestation of the illness such as encephalopathy, mood changes, psychosis, neuromuscular dysfunction or demyelinating disorders that may last for weeks, months or for longer in some recovered patients.
In the same way, they discovered that for an unknown reason, SARS-CoV2 makes the blood clot more, which if not controlled can cause deep vein thrombosis or block an artery which can cause a stroke, a pulmonary embolism or necrosis of the extremities.
Such complications can lead to amputation, a consequence found also in patients with Covid-19.
The expert opinion of the evaluation of the direct and indirect neuro-psychiatric effects of Covid-19 on mental health is very important in planning mental health care.
Every age group, children, adolescents, young adults, elderly people, and also health care workers are at risk of suffering psychological damage caused by the lock-down and forced isolation during the pandemic. (PL)