Doctors told what to fear for those who have recovered from coronavirus
Postcoid syndrome, which doctors began to call the whole train of problems that the infection caused by SARS-CoV-2, has received official status. Now this diagnosis has appeared in the new edition of the International Classifier of Diseases (ICD10), where diseases are denoted by different codes to be used for statistics. In many patients, the postcovid does not develop immediately, but it does not go away for many months and needs serious treatment. MK has learned seven main symptoms of the new disease. In addition, we learned how to undergo rehabilitation after suffering COVID-19 under the compulsory medical insurance policy.
So, in the ICD-10, several symbols are assigned to the post-view at once. So, under the code U09, it is designated "Post COVID-19 condition" (condition after the postponed COVID-19 infection). Doctors will use codes U10 and U10.9 to mark COVID-19-related multisystem inflammatory syndrome, which includes Kawasaki syndrome, childhood multisystem inflammatory syndrome (PIMS) with COVID-19, and pediatric multisystem inflammatory syndrome (MIS-C) … The disease classifier is used to collect statistics, so clinical symptoms are not listed in the ICD. But doctors for several months of the pandemic have studied them like the back of their hand.
“Today we are comprehensively studying postcoid - we have collected questionnaires from 1300 patients with postcoid syndrome, but have not yet processed it. We have come to understand that the usual and unusual symptoms of COVID-19 are mainly associated with damage to the brain tissue,”says the famous doctor, chairman of the board of the Moscow City Scientific Society of Physicians, Professor Pavel Vorobyov.
Scientists called it "covid encephalomyelitis." It is similar to chronic fatigue syndrome. According to Vorobiev, behind encephalomyelitis lies a strange "misalignment" of many systems: chest congestion, tachycardia, instability of blood pressure, temperature anomalies (hyper- and hypothermia), diarrhea, headaches, strange vivid dreams, visual and hearing impairments, anosmia, cycle disorders and libido, depression, tearfulness, etc.
The expert identifies seven main symptoms of postcovid, each of which has a whole palette of manifestations.
Weakness. It occurs most often during postcovis and sometimes does not leave the patient for months. Even for young people, after COVID-19, it becomes difficult to carry out their usual activities. “Sometimes I lie for days on end, I stare at the ceiling - just the thought of getting up hurts,” says Maria, 43 years old. - Before the infection, I was not sick with anything serious, led an active lifestyle, now it has become difficult to even walk up the stairs. Four months have passed since the illness."
Headache. COVID-19 very often begins with it - many patients describe severe headaches two to three days before the onset of the disease. Many attribute this to a change in the weather, but the pain is sometimes so severe that thoughts of a stroke come. And in many patients, as it turns out, headaches do not go away even after an illness.
Mental disorders. “There are a lot of them,” says Professor Vorobyov. - Someone is haunted by obsessive thoughts that they are about to develop a stroke or that they have a severe immunodeficiency; someone begins to experience panic attacks, sleep disturbances. Sometimes mental disorders are very gross, and it is completely unclear what to do with them. We can say that these patients are whining about their illnesses - usually people do not behave like that. And this is not one or two people, but just a mass phenomenon."
“After an illness, I periodically have a sudden feeling of anxiety, it is not clear why. I started having trouble sleeping, although I had never complained before,”says Valentina, who has had COVID-19.
Heart rhythm and blood pressure disorders. “We are talking specifically about pressure violations - it can be both high and low. In addition, patients often describe heart rhythm interruptions,”continues Pavel Vorobyov.
“For four months I could not calmly climb even one floor. I haven’t finally come to my senses until now. Yes, everything is not so expressed, but still. Tachycardia attacks are much less common, dizziness is also much less common. The terrible headaches are practically gone, the hearing has sat down. Sensation in fingertips and feet did not return. I was ill easily. There are no chronic diseases. I feel very old, sometimes the pressure reaches 160 to 110,”notes Maria Livanova from Moscow.
Stool disorders. They are one of the characteristic symptoms of COVID-19, but they often persist after recovery. The stool does not bounce back for weeks, and sometimes months.
Deterioration of cognitive functions and memory. This symptom is complained about by a huge number of postcovid patients around the world. Many of them have survived COVID-19, even in the mildest form. People forget words, note the "fog in the head", get disoriented in space. Patients describe how they suddenly began to grab hot pans, forgot how to use the shower, do not remember the names of friends. This condition can last for several months. “I still can't multiply 4 by 2 without a calculator. I thought it was time to test for Alzheimer's. Something with memory is really bad, with multiplication, with numbers in general. I can forget where I put the money, I forget the groceries in the market after payment. It's been like this for over a month now,”Valentina sighs.
“The other day I could not remember the name of my former boss: I remember the last name, the patronymic too, but I had to google the name,” says Marianna. And cardiac surgeon Aleksey Fedorov describes his condition after COVID-19 suffered a month ago as follows: “I note certain deterioration in cognitive functions: it is harder to concentrate, I began to forget more things, which frightens, sometimes really important, periodically there is a feeling of fog in my head. I would be ready to write it off as suspiciousness or some kind of exaggeration, if not for the reaction of colleagues who have recovered from illness when you start talking about it. And it is almost always the same: "Yes, yes, exactly, but I thought / thought it was just me!" And a couple of examples of my own post-conspicuous absent-mindedness, following the example of my flash drive put into the refrigerator, are sure to be.
Smell disorders and olfactory hallucinations. Also a very common symptom of the postcovid. Smells in some patients do not recover for 9 months, while others begin to haunt obsessive odors or perverted tastes. There are patients who confuse the taste of pickled cucumbers with watermelon, stop feeling bitter, etc. “Two and a half months have passed since the onset of the disease,” says one of the patients, “associated with food intake. Then the tobacco disappeared, the nausea was gone and life improved. But! Just two weeks. The other day there was a smell of burning, unbearable! As if I live in the ashes. I'm starting to go crazy."
- Postkovid can torment patients for months, - says Pavel Vorobyov. - Moreover, his symptoms often appear in waves - they come and go. We see many of these patients. The main type of treatment, given that the virus deliberately infects blood vessels, is anticoagulants. This treatment is 80% effective. We prescribe them until the symptoms are eliminated plus two weeks, usually the course lasts one and a half to two months. Against their background, the main symptoms disappear: insomnia, obsessive odors, fatigue, edema, anxiety, etc.But people are turning, often already having several months of postkovid behind them, which they tried to cure themselves. Unfortunately, among patients with postcoid syndrome, there are many undisciplined patients who make independent decisions about the dosage of drugs and how to take them. This significantly reduces the effectiveness of therapy. In some cases, we have resorted to prescribing steroids with good results, in some cases we have suggested plasmapheresis.
What types of rehabilitation can be obtained today under the compulsory medical insurance policy? The expert of the All-Russian Union of Insurers Sergey Shkitin tells about it. First of all, the expert emphasizes that only patients who have undergone severe COVID19 can receive rehabilitation under the policy (approximately 10% of the total number of patients who have already been registered in Russia since the beginning of the pandemic more than 2 million). According to the recommendations of the Ministry of Health of the Russian Federation dated October 26, 2020, those who have been on mechanical ventilation for a long time (from 2 to 5 weeks) and in some cases those who have received special high-tech methods of treatment for a long time need rehabilitation measures. But even if a person fully meets the criteria, there may be contraindications to any rehabilitation methods.
Rehabilitation of patients after a severe form of coronavirus infection is carried out in three stages: first in a hospital, then in a round-the-clock medical rehabilitation department; and finally - in the department of medical rehabilitation of a day hospital or polyclinic. The first stage includes special nutrition, including through a nasogastric tube, breathing exercises, oxygen support, cyclic training on a bedside exercise bike, etc. At the second stage, inhalation of drugs for sputum discharge with an inhaler, breathing exercises with prolonged forced expiration. Exercises that develop the strength and strength endurance of the leading muscle groups, characteristic of the patient before the disease, sometimes physiotherapy. It is recommended to conduct psychological correction and psychotherapy for patients, family and relatives of the patient to prevent the development of post-stress disorders, depression, pathological addictions and psychosomatic disorders. The third stage includes aerobic training (oxygen support if needed). This can be walking, walking on a path, an exercise bike. Then, training with weights (a small additional weight on the arms) is provided after the end of the session under the supervision of a rehabilitation physician. In addition, this includes physiotherapy (for example, inhalation with medications), psychological support, the formation of patient motivation to continue independent studies.
Rehabilitation programs last 6-12 weeks. However, the attending physician may decide to repeat the rehabilitation course after a year. “In a pandemic, according to the decision of the attending physician, at the third stage, it is possible to rehabilitate at home without visiting a medical organization,” says Sergei Shkitin. “And if you are denied rehabilitation, as well as on any issues related to the procedure for receiving and the quality of medical care provided, contact your medical insurance organization at the 24-hour hotline telephone number indicated on the compulsory medical insurance policy”.