Medical advisors Inge de Klerk and Alfons Olde Loohuis of C-support, along with Chang Ho Wessel (rehabilitation physician), have written an important article on recognizing and treating post-COVID-19. This article, titled "Meaningful Action in Post-COVID," was recently published in the Netherlands Journal of Medicine (NTvG). Using two case studies, the article illustrates how physicians can effectively address post-COVID-19. It offers practical tools for physicians to better understand post-COVID and effectively support patients.
Read the full article here..
Don't have access to NTvG articles? Below you can read a summary of the article.
Summary NTvG article: Meaningful action in post-COVID
Two case studies illustrate how physicians can effectively address post-COVID care in practice. For brevity, these cases are not included here.
Post-COVID-19 is a complex condition with a significant impact on daily functioning. Recognition, acknowledgement of limitations, and identification of treatable symptoms are essential for effective action. Physicians—both treating and advising—play a crucial role in this.
Post-COVID-19 is a persistent, multisystem illness that can occur after a SARS-CoV-2 infection. Post-COVID-19 is defined as the development of new symptoms after an infection that last longer than three months and for which no other explanation can be found. Patients often experienced mild symptoms in the acute phase of the infection. The course is often: partial recovery initially, followed by a clear deterioration after a few weeks. It is also common for patients to initially appear to recover, but then, over time, increasingly new symptoms develop.
Characteristic symptoms include:
- Decreased energy and post-exertional malaise (PEM). PEM refers to symptoms worsening after physical, cognitive, or emotional exertion, with severity and duration disproportionate to the exertion. PEM can occur with a delay of hours to several days and can persist for hours to weeks.
- Orthostatic intolerance (OI), possibly in the form of postural orthostatic tachycardia syndrome (POTS).
- Sleep problems, cognitive complaints, pain, and allergy-like symptoms consistent with mast cell activation syndrome (MCAS).
- Abnormalities of smell and taste occur, but not in all patients.
In children and adults the clinical picture is similar, with young children (<12 years) experiencing relatively more abdominal complaints and cognitive problems.
Risk factors include female sex, autoimmune disorders (in the patient or in the family history), and negative vaccination status.
Importance of early recognition
Early recognition of post-COVID symptoms and the severity of the limitations is crucial. Interventions based on a time-based approach, without considering PEM, can exacerbate symptoms for a long time. Furthermore, the multitude of symptoms complicates the identification of comorbidity (having multiple illnesses simultaneously). Pre-existing conditions (e.g., diabetes or celiac disease) can also be disruptive.
Treatable complaints and interventions
Although there is no curative treatment, treatable conditions have been identified, such as:
- Orthostatic complaints
- Mast cell activation
- Sleep problems
- Psychological complaints
- Ache
Because there is no curative treatment yet, treatment is currently focused on alleviating symptoms and improving functioning. Interventions can take place in various areas:
- Biomedical: drug interventions (e.g. SSRIs, antihistamines, off-label pain medication), diagnostics of comorbidity.
- Psychosocial: stress reduction, treatment of mental health issues, learning energy management skills using pacing, coordination with school or work to reduce stress.
The goal is to stabilize the clinical picture and, where possible, improve functioning. Treatment should be tailored to the patient's needs and take into account their limited capacity.
An overview of symptoms and treatment options can be found in the information for healthcare professionals below this message.
