Long COVID-19
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groups were formed: “symptomatic COVID-19” (n = 68, all mildmoderate), asymptomatic cases (n = 77), and symptom-free without evidence for infection (n = 54). The strength tests were comparable between the groups. However, there was a significant decrease in VO2 max in the symptomatic cases. Approximately 19% had a decrease in VO2 max of more than 10%, whereas none of the uninfected showed such a decrease (Crameri 2020).
Monitoring, treatment options As early as August 2020, a preliminary guideline for the treatment of “long COVID-19” was published in the British Medical Journal (Greenhalgh 2020). After excluding serious ongoing complications or comorbidities, the recommendation was to manage patients “pragmatically and symptomatically with an emphasis on holistic support while avoiding over-investigation”. It was noted that “many patients recover spontaneously (if slowly) with holistic support, rest, symptomatic treatment, and gradual increase in activity”. According to the authors, blood tests should “be ordered selectively and for specific clinical indications after a careful history and examination; the patient may not need any”. In the largest and longest study to date from Wuhan, however, 35% of the patients showed a decreased glomerular filtration rate (GFR). Unexpectedly, 13% (107 of 822) of those who did not develop acute kidney injury during their hospital stay and presented with normal renal function, based on estimated GFR during the acute phase, exhibited a decline in eGFR (< 90 mL/min per 1,73 m2) at 6 months of follow-up (Huang 2021). It seems therefore reasonable to monitor renal function at least once in long COVID-19 cases. Fortunately, new onset diabetes mellitus and thrombosis were extremely rare in the Wuhan cohort study (Huang 2021). From our point of view, the control of blood glucose or D-dimers (as well as the use anticoagulation as suggested by some experts) does not seem to be necessary. This also applies to inflammatory parameters which can be slightly elevated in a considerable proportion of patients even after months (Moreno-Pérez 2021). These remain without consequences.
COVID Reference ENG 006.9
