Covid-19 has caused health consequences not only during the acute infection but also a posteriori, with some symptoms persisting for some time afterwards. With the aim of analyzing post-Covid syndromes and disorders considered rare that the disease has generated in various areas of our health, we spoke with three specialists members of Top Doctors, Dr. Isabel de la Azuela, specialist in Internal Medicine, Dr. Bertina Ferrández, nutritionist, and Dr. Sergio Oliveros, psychiatrist.
What is post-Covid syndrome?
Post-Covid syndrome refers to the health consequences or symptoms that persist 12 weeks after acute coronavirus infection, when there are no other diseases causing them. Persistent coronavirus is defined as the set of discomfort or signs and symptoms that are maintained for more than 12 weeks and that encompasses many symptoms in the different internal systems and apparatuses.
The most common are related to thrombotic problems, psychiatric, pulmonary, cardiac, renal, neurological and reproductive disorders, according to Dr. Isabel de la Azuela, a specialist in Internal Medicine. She explains that, in her practice, “it is common to see reviews of serious cases that have required hospitalization and we see consequences derived from the hospital stay, as they have been patients of a certain severity, such as post-ICU syndrome. Of note here are neurological and muscular involvement, fatigue and intense asthenia (tiredness), as well as psychiatric and cognitive alterations. However, there are also subtle symptoms, and it is important to maintain a vigilant attitude, because the earlier the diagnosis, the better we can adjust the treatment”.
What other rare syndromes or pseudosyndromes have been observed after the pandemic?
In addition to the post-Covid syndrome, many syndromes or pseudosyndromes have been observed resulting from routines that we had already adopted as normal, such as wearing a mask or staying at home. These include the cabin syndrome (anxiety about being locked in) or the empty face syndrome (feeling vulnerable to removing the mask), but also attitudes and syndromes of hypochondria, according to Dr. de la Azuela. Other patients manifest mood disorders and, above all, anxiety disorders, when they return to their routines, and even psychopathic disorders that were previously “compensated”, and many require psychotherapy treatment.
What psychological and psychiatric disorders have been exacerbated?
As Dr. Sergio Oliveros, psychiatrist, explains, “our ability to tolerate sustained stress is much poorer, which translates into immediate physical and mental costs. For months we have faced uncertainty, fear of contagion, the insecurity of our rulers, illness, the lonely death of family and friends, physical deterioration, impoverishment, work overload/unemployment, deprivation of freedom, drastic changes in social interaction or the distrust derived from fake news,” explains Oliveros. And it has been the maintenance of this stress that has led to the prevalence and increase of mental disorders, something that continues to grow today.
This emotional stress has been greater in certain professional sectors whose activity has intensified during the pandemic (doctors, nurses, auxiliaries), as well as those who have been in the rearguard. And, of course, in Covid-19 patients.
The most common psychiatric manifestations secondary to Covid-19, according to data from Dr. Sergio Oliveros, are:
- Anxiety: affects 34% in the general population, which increases to 36% in COVID patients and 41% in healthcare workers.
- Insomnia: affects 40% of the population, increasing to 43% in healthcare workers and 82% in COVID patients.
- Post-traumatic stress: affects 15% of the population, increasing to 50% in healthcare workers and 96% in COVID patients.
- Depression: 31% of the population suffers from depression (which increased to 38% in quarantine), 42% in healthcare workers and 42% in COVID patients.
- Mental fatigue: 19.9% of the population.
- Emotional lability: 23.5% of the population.
- Decreased attention and concentration: affects 19.3% of the population.
- Alcohol and drug abuse: affects 56.7% of the population, doubling, especially in men.
- Euphoria: affects 10.8% of the population.
- Burnout: it has not been studied as an independent disorder, although it is evident that it has been very widespread.
- Suicide: it has increased, without establishing a specific percentage.
On the other hand, it is important to note that the lack of access to specialized mental health centers has increased self-medication, which can also lead to chronic disorders due to inadequate or insufficient treatment. In addition, sick leave due to psychiatric disorders has increased, especially in the healthcare environment (the most important and the most understaffed) and it has been shown that people who read more news about Covid-19 experience more anxiety, as well as an exacerbation of depressive symptoms.
Have sedentary lifestyles and “being at home” led to more nutritional problems?
While it is true that many people have changed their habits and practice more sports or eat a healthier diet, other people’s quality of life has worsened due to sedentary lifestyles during confinement and the abuse of junk food, according to Dr. Bertina Ferrándiz, a specialist in Nutrition and Dietetics. “Currently, in children and adolescents, there is a 40% of obesity, quite alarming data that tell us that we are not doing something right,” explains the doctor.
There is a percentage of the population that made changes in their daily lives beforehand who say that they realized the importance of physical exercise and that, after so many days with time to cook, they have acquired cooking skills and, most importantly, healthy cooking. On the other hand, Dr. Ferrándiz explains that: “there is another percentage of the population that had planned to make these changes but were held back by confinement, and we see many problems of disturbed sleep, irregular eating habits and little physical activity, problems that are increasingly occurring in young people”.
The fact is that we live in an obesogenic society, where we have within our reach many processed and precooked foods. Hence the importance for the population to be aware that health does not depend on a miracle diet, as Dr. Ferrándiz, but that being healthy depends on having a healthy lifestyle with a structured and balanced diet together with the practice of physical exercise.
In relation to the above, Dr. de la Azuela also stresses the general worsening of healthy eating habits, observing in consultation many cases of overweight and obesity, and the consequences that this entails: high blood pressure, hypercholesterolemia, increased cardiovascular risk, and the resulting mood and anxiety disorders.
Decline in health care during the pandemic: consequences in chronic patients and under-diagnosis
During the pandemic, there has been a decrease in the regulatory reviews that patients with complex or severe chronic diseases should have received. This, as indicated by Dr. de la Azuela, has caused their pathologies to worsen and warns that “it is never a solution to postpone medical follow-up or control, especially in a pandemic”. Added to this is the fact that many patients have not gone to the doctor’s office or to the emergency room out of fear, which has increased the mortality of some diseases, especially cardiovascular diseases.
On the other hand, even among the most disciplined patients, a certain rejection of the healthcare environment has been observed. This is due, in part, to the harsh experiences during the pandemic but, in other cases, to attitudes of denial of the disease in this context, where patients with suspected tumors or hidden diseases under study are of particular importance.
Dr. de la Azuela defines the current situation as a lack of cohesion, at times, between specialists, to which is
added the lack of information and, as a consequence, the difficulty in resolving cases. And he assumes that the responsibility of his specialty, of internists, is to achieve this cohesion of information, of the different organs and systems. “At the end of the day, medicine must seek the good of the patient and the communication and coordination of professionals must be improved with this objective in mind, ensuring that the patient receives orderly multidisciplinary care,” he concludes.