Covid-19: “We should all pull together for health”

Europe is in a major wave of corona infections with new variants. The media usually gives the all-clear and only “risk groups” should protect themselves. Is this optimism justified?

From an acute care perspective, with concerns about overloading intensive care units, this is appropriate. We no longer see severe forms of pneumonia or long-term ventilation as often. Almost all people have had infections or have been vaccinated and are well protected during the acute course. Things look different when you look at the effects of reinfections, even milder ones, on long-term or post-Covid symptoms. The risk of developing Long Covid if you have Covid-19 remains and increases with each infection. Even if the Long Covid rates per infection are now lower than before the vaccines and the omicron variants were developed, with infection numbers as high as they are at the moment, we have a great risk of developing many new post-Covid cases. If you have an existing post-Covid illness, there is a risk that your condition will worsen.

How great is the current risk of developing Long Covid in the event of a new infection?

In the guideline group, based on the international data, we assume five to ten percent, and this means that it is by no means a rare disease. The fact that Long Covid remains a danger is probably related to the pathomechanism, i.e. the disease-triggering processes of Covid-19. The ACE-2 receptor, to which the virus docks, is located almost everywhere in the body.

Should politicians do better educational work?

The long-term health consequences for people must be taken into account. There is now a major socio-medical problem due to the long duration of illness in some groups of patients: How should reintegration into the labor market succeed? There is a huge need for advice on questions of disability pensions or long-term sick leave, on rehabilitation procedures – these are questions that require political clarification.

Which groups are at particular risk of developing Long Covid?

We have the impression that more women are affected than men and younger people more often than old people. But there is no reliable data. This is also due to the lack of awareness of post-acute illness syndromes; there is no registry for them. Even for the most severe form, myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS), we don’t know how many people are affected. In principle, Long Covid can affect anyone.

Interview

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Dr. Christian Gogoll is chairman of the Long Covid Network of the Berlin Association of Statutory Health Insurance Physicians, an expert at the German Society for Pulmonology and Respiratory Medicine and co-author of the expert guide for medical practice “Post-Covid / Long-Covid”. In addition, Dr. Gogoll senior physician at the Evangelical Lung Clinic in Berlin.

How often are children affected?

It seems that children are affected less often than young adults, but there are no reliable figures on this either.

Are children perhaps not taken seriously when expressing complaints?

Yes, but not just the children. We hear from patients again and again that their family doctors don’t take them seriously. As long as there is no clear, recognized biomarker, it is particularly important to listen to patients in diagnostics. Some post-acute complaints can be objectified, others cannot.

Long Covid is not a clearly defined clinical picture, but rather a general term for ongoing symptoms after a Sars-CoV-2 infection. Which symptoms are in the foreground?

Reviews describe up to 200 symptoms. We most often see patients with manifest physical symptoms such as a racing heart or cough, sometimes with x-ray changes, organ damage due to infection.
And then in pulmonary medicine we often see patients who have functional complaints and have difficulty breathing, even though all other findings are normal. There are also fatigue symptoms, the exhaustion syndrome. Some patients have vegetative regulation disorders such as dizziness after changing position, blood circulation problems in the vessels that suddenly become dilated. And there are neurological complaints such as difficulty concentrating or sleeping disorders.

How do you assess the status of symptomatic treatment options? And is there any prospect of a causal therapy?

We can sometimes treat the symptoms quite well. And sometimes not at all. There are some hopes in research. But I don’t believe there is one mechanism of action, one drug for all patients. My hope is that in 2030 we will look back on this pandemic and say that we understand how post-acute infectious syndromes work and have biomarkers, no matter how crazy, that explain patients’ complaints and also help primary care physicians diagnose.

While Covid-19 is often treated in the media as a flu-like respiratory infection, science is discussing a systemic vascular disease that can affect all organs. Have we even understood the virus correctly?

I don’t think so, also because we ourselves have a poor understanding of it in medicine. The fact that a respiratory virus can trigger whole-body inflammation or highly specific processes is clear in research, but has not yet been sufficiently communicated. Covid-19 is a coagulation-activating disease that triggers special forms of autoimmune processes, such as those we know from Willebrand-Jürgens syndrome, when the blood suddenly clots in the smallest vessels. As long as the pathomechanism is not fully understood, it makes a lot of sense to consider Covid-19 in the context of HIV, dengue, hemorrhagic viruses or West Nile fever, which can also trigger changes in the entire body.

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Damage after Covid-19 has now been proven for almost all organ systems, which suggests an increased risk of cancer. Will we see a cancer epidemic in the coming years?

We don’t know that. It is important that we observe the large cohorts under this question and use artificial intelligence to identify specific clusters of post-Covid patients who require special follow-up care. We know from rheumatism patients, for example, that chronic inflammatory processes such as those triggered by post-Covid play an important role in the development of tumors. We have anecdotal reports from tumor centers of an increase in lymphoma, stomach cancer, breast cancer and cancer of the mouth and nose area. We need to closely monitor whether these are local fluctuations, for example due to missed screenings in recent years, or whether there is a sustained trend. The reactivation of carcinogenic Epstein-Barr virus and hepatitis 6 infections by Covid-19 is particularly concerning.

There seems to be a lack of awareness of the problem. The “Long/Post-Covid Syndrome Patient Guideline” recommends the use of antiviral therapy and anticoagulants, medical follow-up care after the acute phase, and sports medicine extended maternity leave in the event of an infection depending on the individual risk profile. In reality, the pathogen is often not even detected.

We would need much more serious monitoring. We are dealing with a new, widespread viral disease that often takes a chronic course. It must be clear how important it is in the case of a respiratory infection to clarify whether it is, for example, a rhinovirus infection, flu or RSV – or Covid-19, which also often causes abdominal problems. The spread of Covid-19 can be prevented with simple measures such as medication to lower the viral load, isolation and wearing a face mask. The Federal Center for Health Education would be required to provide effective information about the fact that post-acute illnesses can be severe and mean a major loss of social participation.

What kind of life do you want with the virus?

Politicians must not leave those seriously ill with ME/CFS hanging. In medicine, we should take post-acute syndromes more seriously and create appropriate training incentives, because climate change will cause new viruses to spread among us and we will experience further pandemics. It would be desirable to have an open approach to patients, some of whom organize themselves into self-help groups, have excellent knowledge and can give us doctors valuable input. We should all pull together for health. Using swarm intelligence can also be instructive for the doctor’s self-image. The merit of the media would be to provide continuous, factual and low-threshold information about the infection process, for example by translating the virus data from the wastewater into a traffic light system for the population. As a society, we should have the courage to talk about chronic illnesses such as post-Covid and stress limits. From an economic perspective, prevention is also much cheaper than no prevention. The use of air filters in public spaces should also be considered.