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How to deal with the nearly 145 million patients with new crown sequelae worldwide?

   The new crown epidemic is about to complete its third year. Data shows that the number of infected people in the world exceeds 600 million, and the cumulative death toll exceeds 6.56 million. The aftermath of the new crown is being discussed and paid more and more attention.

  On October 10, the Journal of the American Medical Association published a large-scale global study led by WHO online, which is regarded as the most comprehensive analysis of the sequelae of the new crown since the epidemic. The study pooled data on 1.2 million people with symptomatic new crown infections in 22 countries. The model estimates that 6.2% of new crown infections will be in 2020 and 2021, and more than 74,000 people will report at least three months after their first infection. COVID-19 sequelae.

  "The new crown is not only a respiratory disease, but also affects many tissues and organs of the human body, involving the central nervous system, peripheral nervous system, gastrointestinal tract, heart, musculoskeletal, etc. More than 200 kinds of new crown sequelae have been reported. ” Akiko Iwasaki, a professor of immunology at Yale University School of Medicine, said in a video interview in August this year, “Even if the new crown pandemic stops today, tens of millions of people will still suffer from the new crown sequelae. This is an ongoing parallel. Epidemics, which receive far less attention than acute and severe Covid-19 infections."

  

"Mixed Symptoms"


  The study, published online in the aforementioned JAMA, included data on 1.2 million people with COVID-19 who had symptoms from 2020 to 2021, before the Omicron outbreak, from 44 published studies and 10 A multi-country collaborative study, and two electronic medical record databases in the United States. The researchers began collecting data in March 2020 and continued through January this year.

  The study focused on three long-term symptoms of COVID-19: persistent fatigue and physical pain, breathing problems, and cognitive problems. The results show that in 2020 and 2021, three months after infection with the new crown, the proportion of these three symptoms was 3.2%, 3.7%, and 2.2%, respectively. The proportion of infected patients who required hospitalization and intensive care was 27.5% and 43.1%, respectively, which was much higher than the proportion of non-hospitalized patients. Among patients with sequelae of the new crown, 15.1% still have symptoms one year after infection.

  The sequelae of the new crown, that is, a series of medium and long-term effects that may occur after contracting the new crown, including fatigue, dyspnea and cognitive dysfunction, etc., and direct or indirect mental health effects. Up to now, many countries around the world have followed up research on the sequelae of the new crown.

  A study published in The Lancet in July last year showed that through feedback from 3,762 people with confirmed or suspected new crown infection in 56 countries, researchers collected more than 200 "long-term new crown" symptoms in 10 organ systems. Across all symptoms, these patients experienced an average of 55.9 symptoms involving 9.1 organ systems.

  On September 13, the WHO issued an article saying that model data from the Institute for Health Metrics and Evaluation (IHME) of the University of Washington School of Medicine showed that in the first two years of the new crown pandemic, about 10% to 20% of the entire European region was infected. Those who have recovered from the infection will continue to experience COVID-19 sequelae. IHME research shows that nearly 145 million people worldwide have at least one long-term symptom of COVID-19.

  "While most people recover fully from infection, the findings suggest that more analysis is needed to monitor the long-term effects of the disease," said WHO Regional Director for Europe Hans Kruger.

  On October 5, the US Centers for Disease Control and Prevention (CDC) updated the latest tracking data on the sequelae of the new crown. According to a report by the ABC on October 6, as of September 26, 81% of adults chronically infected with the new coronavirus reported that long-term symptoms reduced their ability to perform daily activities. The highest rates of limitation of daily activities were in the 18-29 age group, while the lowest rates were in the 40-49 age group.

  On October 6, a report released by the Office for National Statistics of the United Kingdom showed that as of September 3, more than 2.3 million infected people in the United Kingdom had new crown sequelae, accounting for about 3.5% of the total British population. Of those who reported having COVID-19 sequelae, about 1.8 million were infected at least 12 weeks ago, and 1.1 million were infected at least a year ago. Many of these people were infected multiple times, and the sequelae adversely affected the daily activities of 1.6 million people.

  There are also large-scale studies on the sequelae of the new crown in China. On May 11, 2022, the team of Cao Bin from the National Center for Respiratory Medicine of the China-Japan Friendship Hospital published a two-year follow-up study of inpatients with new coronary pneumonia online in The Lancet Respiratory Medicine. The study followed 1192 patients hospitalized in Wuhan from January 7 to May 29, 2020. The survey included a 6-minute walk test, laboratory tests, and a questionnaire covering symptoms, mental health, and health-related quality of life.

  The results showed that regardless of the patient's initial disease severity, their physical and mental health improved over time, with 438 of the 494 patients returning to work after two years. But among the more than 1,000 follow-up subjects, 55% still had sequelae. Compared with patients without long-term symptoms of Covid-19, this group of patients has poorer quality of life and exercise capacity, more mental health problems, and more medical care needs after discharge.

  A common feature of these studies is that most of the information people can obtain about the sequelae of the new crown comes from the self-reports of infected people. "This makes the results lack an objective measure, resulting in the sequelae of the new crown like a 'basket' without borders," said Jin Dongyan, a professor at the School of Biomedical Sciences at the University of Hong Kong and a virus expert.

  On April 11 this year, Akiko Iwasaki, a professor of immunology at Yale University School of Medicine, said on a video link that there are many reports trying to define the prevalence of sequelae among patients with new crowns, but this needs to be considered in different situations. Among the severely ill patients with the new crown, the proportion of new crown sequelae is as high as 50%, and this proportion is 5% to 30% among those with mild or even asymptomatic infections. The reason for the discrepancy is the lack of a unified definition of COVID-19 sequelae. At present, the difference between the definitions of new crown sequelae given by the CDC and the WHO is mainly in the definition of time. The former refers to the appearance of new and recurring persistent health problems at least four weeks or more after the first infection, while the latter refers to infection of the new crown 3 Symptoms persist for at least 2 months within a month.

  "At present, the scientific community has no unified conclusion on the sequelae of the new crown." In Jin Dongyan's view, the sequelae of the new crown is not a simple disease, but should be regarded as a mixture of multiple symptoms.

Lower risk of sequelae from vaccination


  The KAIT TV station affiliated to the ABC reported on October 11 that data from the Arkansas Department of Health in the United States showed that in the past three months, the number of new infections in the state has declined steadily. In contrast, hospitalizations rose slightly, which health officials in the state attributed to the effects of COVID-19 aftermath.

  There are still many questions about the sequelae of the new crown, such as how many infected people may eventually develop long-term symptoms, and which groups are most vulnerable? How to treat and finally recover?

"Compared with the delta variant and the original virus strain, the proportion of new crown sequelae in the pandemic phase of Omicron has decreased."
   On June 18, King's College London, UK published in A study in The Lancet compared the sequelae of the new crown during the Delta and Omikron periods. Nearly 60,000 Omikron and more than 40,000 Delta infections were included in the analysis. The results of the study showed that the possibility of a new crown infected with the Omicron virus strain was 24% to 50% of that of the delta virus strain.
  Long-term symptoms are not unique to COVID-19. "After the 1918 influenza A (H1N1) pandemic, the 2003 SARS outbreak, and the 2014 Ebola outbreak in West Africa, the patients had post-infection sequelae," Jin Dongyan said.
  Akiko Iwasaki said on the aforementioned video link that the symptoms of the new crown sequelae are currently very wide, but not every patient has obvious symptoms and requires a correct diagnosis by a doctor. However, the cause of the sequelae of the new crown is still in the hypothetical stage.
  According to Akiko Iwasaki, chronic inflammation that may be triggered by the persistent new coronavirus or virus residues in tissues is one of the most important hypotheses at present. In addition, there are also hypotheses that infection may lead to autoimmune diseases and intestinal dysbiosis in some patients.
  "At present, scientists from all over the world are very concerned and worried about the sequelae of infection with the new crown." On October 13, Liang Wannian, head of the expert group of the National Health Commission's Leading Group for Epidemic Response and Disposal, said at a press conference that the pathogenesis of the sequelae of the new crown, the final The duration is not fully understood by science. Unlike general influenza and known diseases, scientists still have a lot of unknowns about the new crown.
  Long-term Covid-19 treatment protocols, updated by the National Institute for Health and Care (NICE) in November 2021, include discussing problems with patients, taking their temperature, examining the heart and lungs, and performing an electrocardiogram. If necessary, patients are referred for pulmonary rehabilitation. Treatment options also involve optimal long-term symptom control, limiting the use of adjunctive antibiotic therapy to confirmed or secondary bacterial infections.
  In July 2021, WHO’s guidelines for the recovery of patients with COVID-19 pointed out that patients with mild and moderate clinical manifestations are recommended to start rehabilitation treatment from the beginning of the disease. After recovery from mild infection, it is recommended to walk easily, do breathing exercises, and use mechanical equipment if necessary.
  Wu Zunyou, chief epidemiologist of the China Center for Disease Control and Prevention, analyzed at the press conference of the State Council Joint Prevention and Control Mechanism on October 13 that in general, people who have been vaccinated have a much lower risk of sequelae after infection with the new crown. Those who have not been vaccinated.
  "If we want to carry out updated research on the sequelae of the new crown in China, it is recommended to monitor and count the epidemic data in Shanghai, Jilin and other places caused by the Omicron strain." Jin Dongyan said that the sequelae of the new crown involves psychology and mental health. Science, psychology and other disciplines work together to deal with it.
  A study published on September 7 in JAMA-Psychiatry showed that factors such as depression, anxiety, worry, perceived stress and loneliness that existed before the new crown infection increased the risk of new crown sequelae. At the same time, after contracting the new crown, these types of psychological distress may also increase the risk of daily life obstacles by 15% to 51%.
  "Quantifying the number of people with COVID-19 sequelae may help policymakers better guide people to recover, return to work or school, and restore their mental health and social life," the aforementioned study, published in JAMA, reads. road.


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