Editorial
On the new post COVID-19 condition
Sobre la nueva condición post COVID-19
a Servicio de Neumología, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
b Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
c COVID-19 Clinical Management Team, WHO Health Emergency Programme, World Health Organization HQ, Ginebra, Switzerland
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Soriano, Julio Ancochea" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Joan B." "apellidos" => "Soriano" "email" => array:1 [ 0 => "jbsoriano2@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Julio" "apellidos" => "Ancochea" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "COVID-19 Clinical Management Team, WHO Health Emergency Programme, World Health Organization HQ, Ginebra, Switzerland" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sobre la nueva condición post COVID-19" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Coronavirus disease 2019 (COVID-19) is still far from over<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. At the end of spring 2020, when the first wave of cases began to be controlled, something unusual was observed: some COVID-19 patients still had symptoms weeks after the initial infection had passed. They reported symptoms that included fatigue, dyspnea, chest pain, palpitations, gastrointestinal symptoms, mental confusion, anxiety, and depression, and more than 150 other possible associated symptoms<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> that persisted for weeks or months. This was surprising, because some patients who had less severe disease initially and were treated only in primary care or remained practically asymptomatic during acute infection, were eventually among the most sick<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. The terminology for this phenomenon varies (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The WHO currently recommends calling it a “post-COVID-19 condition”, as this name does not attribute causality or duration, and there are already specific ICD-10 (U09) and ICD-11 (RA02) codes to identify it<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>. Beyond the name, a universal definition agreed by consensus with societies, organisms, and patients, is necessary<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Estimates of how many people develop post-COVID-19 condition vary. Curiously, it seems to affect more middle-aged adults than elderly people, but so far no one knows for certain why it occurs or who is most likely to be affected, and with more than 126 million cases of COVID-19 to date worldwide, the number of people at risk is increasing<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>. Many post-COVID-19 patients, individually or jointly in associations such as SOSCOVID, Persistent COVID-19 Collective Madrid, and others, report that their primary care doctors (and pulmonologists) initially ruled out and ignored their symptoms, thus aggravating their suffering<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>. This phenomenon also occurs in children, to their parents’ despair. Multidisciplinary clinics to treat these patients have now sprung up in hospitals and clinics in the United Kingdom and Italy<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">SARS-CoV-2 is not the first virus to cause lasting symptoms or new associated syndromes<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>. Previous epidemic viral outbreaks such as Zika, chikungunya, SARS, and MERS, and before them, the 1918 flu (wrongly called the Spanish flu) left many people weakened for months, sometimes years. In these patients, the virus is no longer live or active, but they present persistent symptoms. In terms of causative mechanisms, we have some possible suspects.</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Excess inflammation</span>: this is the primary candidate, as abnormally high levels of inflammation are seen in many patients.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Autoimmune response:</span> raised levels of autoantibodies have been found in patients with post-COVID-19 condition. And certain autoimmune diseases, such as lupus and rheumatoid arthritis, commonly cause fatigue and digestive problems.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Nervous system problems:</span> dysautonomy, which refers to the deregulation of the autonomic nervous system, affects blood flow, including to the brain, and can cause fatigue, headaches, mental confusion, and exercise intolerance.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Blood clots and vascular damage:</span> many patients with elevated <span class="elsevierStyleSmallCaps">d</span>-dimer blood levels improve with the administration of prophylactic anti-coagulation. Autopsies of people who died of COVID-19 have revealed widespread clots.</p><p id="par0040" class="elsevierStylePara elsevierViewall">This brings us to the question of how these patients should be treated. Many need to be seen by various specialists, from respiratory medicine experts to cardiologists, gastroenterologists, and of course, primary care physicians<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a>. After magnetic resonance imaging, tomography, blood analyses, and other tests have been performed, the goal of treatment must be to identify underlying problems, control symptoms, and improve functional capacity.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The post-COVID-19 condition is a new challenge<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>, caused by a new virus. New studies will soon provide some answers. Meanwhile, the best way to protect yourself is … avoid infection. If you contract COVID-19, be sure to take enough time to recover before returning to your normal activity. We know from Zika, chikungunya, SARS, and MERS, and from patients with chronic fatigue syndrome (now called systemic exercise intolerance disease) that putting on too much pressure on sufferers can cause recurrence and a slower than expected recovery. The good news is that after 6 months a gradual improvement is seen in most series of patients, including those who were admitted to the ICU<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>. Paraphrasing George Bizet’s Carmen (1845): “<span class="elsevierStyleItalic">Prends garde de faire un faux pas!!</span>” — “Watch out … for the post-COVID-19 condition!”</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Soriano JB, Ancochea J. Sobre la nueva condición post COVID-19. Arch Bronconeumol. 2021. <span class="elsevierStyleInterRef" id="intr0030" href="https://doi.org/10.1016/j.arbres.2021.04.001">https://doi.org/10.1016/j.arbres.2021.04.001</span></p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Name</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reference \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Chronic COVID syndrome</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Baig AM. Chronic COVID syndrome: need for an appropriate medical terminology for long-COVID and COVID long-haulers. <span class="elsevierStyleItalic">J Med Virol</span>. 2021. DOI: <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1002/jmv.26624">https://doi.org/10.1002/jmv.26624</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Late sequelae of COVID-19</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CDC website [Accessed 29 March 2021] Available from: <span class="elsevierStyleInterRef" id="intr0010" href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/late-sequelae.html">https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/late-sequelae.html</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Long covid</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mahase E. <span class="elsevierStyleItalic">BMJ</span>. 2020 July 14;370:m2815 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Long COVID</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perego E, et al. <span class="elsevierStyleItalic">Wellcome Open Research</span> 2020;5:224; Editorial. The Royal Society \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">LONG COVID</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nature Editorial [Let patients help define long-lasting COVID symptoms] 8 October 2020; Long COVID Forum 9–10 December 2020 from ISARIC/GLOPIDR/LONG COVID Support; Lancet Editorial [Facing up to long COVID] 12 December 2020; \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Long-haul COVID</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nath A. Long-Haul COVID. <span class="elsevierStyleItalic">Neurology</span>. 2020 September 29;95(13):559–560.; Scientific American (By Carolyn Barber on December 29, 2020) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Long-term COVID-19</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A special issue of <span class="elsevierStyleItalic">Journal of Clinical Medicine</span> (ISSN 2077-0383) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Post-acute sequelae</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NIH-National Institutes of Health (EE. UU.) [Accessed 29 March 2021] Available from: <span class="elsevierStyleInterRef" id="intr0015" href="https://videocast.nih.gov/watch=38878">https://videocast.nih.gov/watch=38878</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Post-COVID syndrome</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NHS-National Health Service (UK) [Accessed 29 Mar 2021] Available from: <span class="elsevierStyleInterRef" id="intr0020" href="https://www.england.nhs.uk/coronavirus/post-covid-syndrome-long-covid/">https://www.england.nhs.uk/coronavirus/post-covid-syndrome-long-covid/</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Post-acute COVID-19</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Several papers in: <span class="elsevierStyleItalic">BMJ</span>, <span class="elsevierStyleItalic">Eur J Phys Rehabil Med</span>, <span class="elsevierStyleItalic">Eur J Intern Med</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Post-acute sequelae of SARS-CoV-2 infection (PASC)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subbaraman N. US health agency will invest $1 billion to investigate ‘long COVID’ <span class="elsevierStyleItalic">Nature</span>. 2021;591:356. DOI: <span class="elsevierStyleInterRef" id="intr0025" href="https://doi.org/10.1038/d41586-021-00586-y">https://doi.org/10.1038/d41586-021-00586-y</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2798291.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Repository of suggested names for post-COVID-19 condition.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SARS-CoV-2 variants and ending the COVID-19 pandemic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Fontanet" 1 => "B. Autran" 2 => "B. Lina" 3 => "M.P. Kieny" 4 => "S.S.A. Karim" 5 => "D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 77 | 21 | 98 |
| 2024 September | 93 | 19 | 112 |
| 2024 August | 138 | 34 | 172 |
| 2024 July | 105 | 17 | 122 |
| 2024 June | 121 | 33 | 154 |
| 2024 May | 103 | 36 | 139 |
| 2024 April | 77 | 21 | 98 |
| 2024 March | 70 | 19 | 89 |
| 2024 February | 51 | 34 | 85 |
| 2024 January | 74 | 33 | 107 |
| 2023 December | 58 | 31 | 89 |
| 2023 November | 64 | 19 | 83 |
| 2023 October | 78 | 28 | 106 |
| 2023 September | 55 | 32 | 87 |
| 2023 August | 56 | 35 | 91 |
| 2023 July | 55 | 25 | 80 |
| 2023 June | 55 | 23 | 78 |
| 2023 May | 62 | 21 | 83 |
| 2023 April | 75 | 36 | 111 |
| 2023 March | 77 | 45 | 122 |
| 2023 February | 82 | 29 | 111 |
| 2023 January | 78 | 34 | 112 |
| 2022 December | 113 | 34 | 147 |
| 2022 November | 118 | 39 | 157 |
| 2022 October | 132 | 44 | 176 |
| 2022 September | 95 | 46 | 141 |
| 2022 August | 103 | 53 | 156 |
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| 2022 June | 98 | 42 | 140 |
| 2022 May | 119 | 40 | 159 |
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| 2022 March | 197 | 63 | 260 |
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| 2022 January | 223 | 9 | 232 |
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