(The Long Covid outpatient clinic at Essen University Hospital is well attended. More than 500 patients have already been examined here. )
The fear of Long Covid is great - and largely unfounded, says a doctor at Essen University Hospital. Organically, there is often nothing wrong with the patients.
Many people today are more afraid of Long Covid than of the Covid disease itself. In fact, those affected often suffer from considerable limitations for a long time. Nevertheless, there is no reason to panic, says Prof. Dr. K., Director of the Clinic for Neurology at Essen University Hospital. In the Long Covid outpatient clinic of the hospital, numerous patients have been examined - most of them can be helped.
Moreover, people suffer from common diseases permanently, or at least for many years. We don't see that at Long Covid: far more than 90 percent of our patients are completely or almost symptom-free after six to twelve months. I therefore do not share the panic about Long Covid.
Together with colleagues from infectious diseases and psychosomatics, the Department of Neurology has been running the Long Covid Outpatient Clinic at Essen University Hospital since autumn 2020. Are patients more likely to be affected who have had a severe course of the disease?
No! Only a good five percent of the patients were in a normal ward in hospital, less than one percent in intensive care. Most of the 170 or so Long Covid patients we examined in our study had a mild or moderate course of the disease. Among them are no mere suspected cases: We only included affected people who had a covid infection confirmed by a PCR test.
Symptoms range from heart palpitations to hair loss
In August 2021, the medical journal "The Lancet" listed more than 200 possible Long Covid symptoms: from heart palpitations to hair loss. What symptoms do your patients suffer from?
First and foremost is fatigue syndrome, i.e. pathological tiredness, which, by the way, also occurs after other serious illnesses. In addition, many patients suffer from headaches, concentration and memory disorders, word-finding difficulties and brain fog, i.e. the feeling that their thinking is clouded. Overall, they are severely limited in activity, performance and resilience.
How can this be explained?
We do extensive batteries of tests with the patients: This ranges from ultrasound and MRI, to neurological examinations such as the measurement of the nervous system or the examination of nervous fluid, to lung and laboratory tests. The initial presentation therefore takes several hours. At the time of evaluation, the findings in all areas are unremarkable in 85 to 95 percent of the patients. This also applies to the inflammation values.
Many Long Covid patients have previous psychiatric illnesses.
In other words, there are no organic causes?
At least they are not measurable. With the exception of individual cases of multiple sclerosis or polyneuropathy, which were discovered during the examinations and had nothing to do with Corona.
On the other hand, the entrance tests of the psychosomatics revealed that 20 per cent of those affected had previous psychiatric illnesses such as post-traumatic stress disorder or anxiety disorders. A psychiatric history is thus a risk factor for Long Covid. However, even these patients are convinced that their symptoms - including anxiety or depression - are Covid-related.
Are you saying that they are imagining Long Covid?
This is a common misconception: we neither think these patients are malingering nor do we doubt that they are actually suffering. Some of them were marathon runners who now fail at climbing stairs; they no longer recognise themselves. And in fact, neuropsychological testing also shows abnormalities more frequently. There is just not the one causal - preferably organic - explanation that some patients might expect.
The literature also includes patients with heart and lung problems. In others, the coronavirus is still discovered in the organs months after the infection. In these cases, one can hardly speak of psychiatric diseases . . .
True, heart and respiratory problems also occur. As a rule, these are still likely to be direct consequences of the acute covid-19 disease. We refer such patients to other places. We concentrate on the nervous system - and we have never found virus particles in the nervous fluid in any of our examinations.
If we do find something organic in our complex diagnostics, we treat it as a matter of course. But we have the impression that a large part of the symptoms are triggered by subconscious psychological processes. This can also be treated very well. But the willingness to do so is less pronounced because psychological suffering is not so socially accepted. Many prefer to run from doctor to doctor until there is some random finding - or an adventurous diagnosis. This can not only be expensive, but also dangerous if the desperate patients are recommended unproven therapies such as blood washing.
What do you advise instead?
There is no one therapy for Long Covid, but individual symptoms such as headaches or sleeping problems can be treated very well with medication. We have no plausible explanation for the colourful mixture of symptoms, nor do we have a panacea. However, the Clinic for Psychosomatic Medicine at the LVR Hospital has had good success with the "Cope it" programme, in which patients train to deal with stressful situations. Because it seems as if something is going wrong with the way the patients deal with their illness. This also happens after other serious illnesses: Sometimes individual symptoms are so overrated that a cycle of anxiety develops.
School and health care workers are often affected - construction workers almost never.
Is there a typical patient?
Psychosomatics say there is no Long Covid character. Our data show that it affects more women than men and that many are between their mid-30s and mid-50s, i.e. at an age when they are fully involved in their working lives and often have a strong family. It is interesting that people from the education and health sectors as well as from the service and administration sectors are represented much more frequently than, for example, craftsmen or construction workers. It seems to affect more people who are interested in health issues and who observe themselves more closely.
Science also pays a lot of attention to Long Covid ...
Medicine is also subject to fashions. Currently, Long Covid is made bigger than it is - probably for different motives. There is a growing market for rehabilitation measures that sometimes resemble wellness holidays. Politicians justify restrictions with Long Covid, doctors use the research funds. All this is accompanied by the media and leads to a kind of package insert effect: there are more and more people affected with Long Covid symptoms - even those who never had Covid. In the long run, I think research on tumours, strokes and heart attacks is more socially purposeful.
You do research on Long Covid yourself, and the outpatient clinic is well attended, people wait a long time for an appointment.
That's right, and my finding is that the prospects are good for many sufferers if they don't chase a lab value but confide in a psychologist or coach. We doctors could encourage them to dare to do something, to become active, to do sport again. If this is taken more to heart, I am not afraid of Long Covid.
Long Covid and Post Covid
Acute covid 19 usually lasts up to four weeks. If new symptoms appear after this period, it is called long covid. If the symptoms last longer than twelve weeks and cannot be explained by any other diagnosis, this is called post covid.
Long and post covid are, however, difficult to distinguish, says Prof. K. The very academic distinction is therefore hardly ever made in everyday clinical practice.
