Patients still far from recovery, a mystery of medicine

Several weeks after experiencing the first symptoms of Covid-19, many patients are worried that their health will not return to normal. A phenomenon that questions doctors, hospitals and offices.

When the Covid-19 epidemic subsides in France, many patients complain of experiencing symptoms for several weeks or even months after the first signs of the disease develop, and doctors find it difficult to find explanations for all of them. case.

“When I think I’ve gotten rid of the virus, fatigue returns.” For Jacqueline, 62, the fight against Covid-19 is a long test. Two and a half months after feeling the first symptoms, the virus is still not behind it.

When she became ill on March 19, Jacqueline had nevertheless developed a mild form of the coronavirus. A severe cold associated with loss of taste and smell has left room for a kind of “sore throat” and “eye pain”. “The symptoms changed constantly, even in one day,” she recalls.

“Palpitations” and “intense fatigue”

It took a month to see the symptoms subside. “I felt my form was coming back,” Jacqueline says. But this improvement did not last. “About ten days later, I fell back to the bottom of the hole,” she laments.

Despite this long recovery, Jacqueline was not hospitalized. If she is feeling better today, she still sees the stigma of the disease. “Sometimes I have heart palpitations and I feel intense fatigue. I have to take naps during the day,” she describes.

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On social networks, especially on Twitter and Facebook, testimonies of the same type are increasing. “This morning is complicated. I feel the hair in my chest. My throat problems are still there, [j’ai] difficult breathing and I lose my voice. Does anyone have these problems? “Sophie, at her fifties, asks in a Facebook group called” # AfterD20 “and brings together patients who still have symptoms after twenty days of recovery.

Stéphane, about thirty, was also weakened for several weeks, responding: “Neck discomfort then this morning, scraping, feeling of breathing sometimes.”

Dedicated consultation

Doctors see more of these patients arriving for consultations since the epidemic slowed down. Some hospitals have therefore had to set up special consultations, for example at the Pitié-Salpêtrière Hospital in Paris. “We see these types of patients every day. There are many requests, so we have to respond to them,” explains Éric Caumes, head of the Department of Infections and Tropical Diseases. For his part, Stéphane Aszerman, emergency physician for SOS doctors in Île-de-France, also said that he saw on the ground “many people in this case”.

In recent weeks, patients who have not developed severe forms of Covid-19 believe they have gone unnoticed. “I think of those who, without answers and without treatment, wait to get a normal health condition and suffer in silence,” said Dominique, 46, on Facebook, sick for 72 days.

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However, caregivers had to prioritize before the influx of patients into the intensive care unit. “At the beginning of the epidemic we were overwhelmed. We did not see these patients. They come now when this wave is over,” says Éric Caumes, for whom these patients “could be managed by city medicine”. “But the generalists are not enough,” laments the infectious disease specialist.

“It’s not a new episode of Covid-19, it’s the sequel”

“At the moment, these patients do not appear in the statistics,” explains emergency physician Stéphane Aszerman. These take into account emergency visits, hospital admissions and intensive care and deaths in nursing homes. the tests, ”he points out.

Chest pain, tachycardia, palpitations, taste and smell loss … Patients complaining are very varied. But according to Stéphane Aszerman, these signs are not new, they are sometimes simply a consequence of infection with the new coronavirus. “This is not a new episode of Covid-19, this is the aftermath,” he said. The doctor is not surprised by this enduring symptom. “It does not surprise me because this virus is not a simple cold and it causes several pathologies,” said the emergency physician.

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To explain the persistence of symptoms, Éric Caumes believes that we must first distinguish the causes. For him, it is necessary to differentiate those who develop “postinfectious asthenia”, in other words, a weakened state in the body after an infection, patients who exhibit “late manifestations of immune origin”, such as “fatigue and a cough that persists”.

Taking anti-inflammatory drugs can aggravate the patient’s condition, doctors restricted the prescription for these drugs during the crisis. A method that would have had direct effects on patients’ condition. “We are annoyed because, because most of the lasting effects are inflammatory in nature and we do not give anti-inflammatory drugs, the symptoms remain,” says Stéphane Aszerman.

According to Éric Caumes, these symptoms may also correspond to “sequelae of the virus”, such as “pulmonary fibrosis”, or “consequences of going into intensive care”, such as myopathy or difficulty moving.

Anxiety, an aggravating factor

The psychological and psychiatric consequences can also explain the presence of these signs that do not disappear. According to Eric Caumes, those who complain of several symptoms without being tested positive are likely to exhibit “psychosomatic manifestations”: physical disorders exacerbated by psychological disorders such as a feeling of anxiety.

“We are sometimes surprised by the normality of the exam: they do not report anything abnormal and the patients have only symptoms,” notes Éric Caumes.

This phenomenon shows that the new corona virus has not yet revealed all its secrets. “If we knew every time why these people always have symptoms, it would be good. But we don’t seem to understand everything about Covid-19,” admits Stéphane Aszerman. What mobilizes even more caregivers who are already exhausted by the health crisis.