“I still have trouble remembering.” The phrase by Roza Milchova, a 59-year-old Bulgarian living in Valladolid, sums up one of the consequences of those who have overcome the covid. It is so difficult for him to remember some things that he does not know how long he was in the ICU.
“About 15 days,” he says of his stay in the intensive unit at the Hospital Río Hortega in Valladolid. Now he is in rehabilitation at the Benito Menni hospital in the city: “Everything is easier here because they take care of you. Let’s see what happens when I get home ”.
Workers from the covid area transport a baby to perform the covid-19 test, his mother tested positive for the disease.
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The State of Mexico is one of the states with the most covid-19 infections after Mexico City.
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Milchova’s case could be considered a sequel to the ICU. But other patients also report similar symptoms without even having been admitted.
Silvia Soler, a 52-year-old from Barcelona, a member of the Covid Persistent platform , which already has about 2,000 members,he became infected at the beginning of the pandemic and took 89 days to have a negative PCR. The phone rings hoarse and agitated.
“It’s the dysphonia that I have left,” he explains. It was one of his symptoms, with pharyngitis, low-grade fever, diarrhea, mouth sores, hives … “I went to the emergency room three times, but they never admitted me. They told me that I was a young, healthy woman, and that there were no beds, ”she says.
Now he lives on “a roller coaster”, where more normal days are followed by others with “low-grade fever, joint pain, migraines and brain fog.” Soler has not returned to work. “I am a philologist and there are days that I forget basic words, like frying pan,” she explains.
If you get tired, the situation worsens. “It is difficult for me to concentrate and I have many distractions. I go out without a purse or put things that I shouldn’t have in the fridge, ”he says. This confusion started after overcoming the infection,
Anglo-Saxon scientific studies and media – The Lancet , Science or the journals of the American Medical Association and the Psychological Association – call it brain fog . But the syndrome itself is not yet well defined.
In Spanish, some doctors use the term confusional syndrome associated with covid. In many cases they associate it with another well-known process, post-ICU syndrome, which is the mental and physical problems of people who have been in intensive care for a long time, but this approach does not cover all cases.
“It’s almost like mild Alzheimer’s a little exaggerated,” says Socorro Martínez Ríos, head of the Postcovid Unit at the hospital where Milchova is, who recently received the award for Best Initiative in Private Hospital in Spain.
“It can be from not remembering what happened a while ago to not knowing how to name a drawn elephant.” “Covid enhances what would be the normal damage of being hospitalized,” adds the neuropsychologist of the unit, Isaac Fernández. This can manifest itself, according to Jesús Porta-Etessam, vice president of the Spanish Society of Neurology (SEN) in the form of “ dizziness, feeling of difficulty thinking, orientation disorder, headache … ”.
Porta-Etessam links most of the cases described so far with situations that are not specific to covid, such as the length of time the hospitalization lasts – ”although it may be longer than in other pathologies,” he clarifies—, or the presence of symptoms depression and anxiety.
That combination of neurological and psychiatric problems occurs in Milchova, for example. She verbalizes it like this: “The mood depends on the day. If I do not have dizziness [neurological problem] I feel good [indicator of her psychiatric state ] “In a” minority, minority “, says the neurologist expressively, it may be due to the infection itself causing vascular problems (mini-stroke).
Eva Mateo, director of the ICU of the General Hospital of Valencia, believes that, although it looks like what is already known, “this coronavirus brain fog is new.” “There is a brutal inflammatory response that is seen when neurological CT scans are performed on those affected in specific areas of the brain, such as the hippocampus,” he says.
And the hippocampus is the part of the brain that regulates learning, where memory and the ability to navigate reside. “It’s as if the brain has aged,” he says. In their unit they have calculated that neurocognitive disorders affect half of those admitted to a greater or lesser extent, and anxiety and depression approximately 18%.
This fog also clouds the mind of Eugenia Díez, a 43-year-old nurse from Madrid, who did not go through the ICU, nor was she even admitted. He became infected in March and 29 days later the PCR was negative. He spent the illness at home. But his problems did not end when he was cured.
The dizziness and headache that were symptoms of her infection still continue months later. “I forget the words, and sometimes I write backwards. When it happens to me I say to myself: ‘Today I have high dyslexia’. It’s hard for me to concentrate.
“He alternates highs and lows.” Before, in my work, I could be carrying a medication and talking to a colleague, now I have to do things one at a time and with a lot of concentration. When before they gave me a verbal order, now I ask for it in writing, “he says.
They have not given him an explanation of what he has. She is awaiting a CT scan after the neurologist found her examination to be normal. He does not know if a change in medication makes it better: “Before maybe I was bad four days a week, now two.”
Specialists agree on the importance of the psychological factor. “This disease has a tremendous emotional component,” in part because of its notoriety, says Mateo. “A patient who is told that he has covid can react much worse than one who is told that he has something much more serious.”
In addition, many patients have been alone in the rooms for a long time for safety reasons. “Not everyone has mechanisms to deal with these situations,” explains the doctor.
“The affective and emotional part takes many times longer than the purely physical to recover,” says neuropsychologist Isaac Fernández, who opts for a holistic, interdisciplinary approach to the disease.
While in the medical part more and more is known and can be treated better —within limitations due to the lack of specific medications and saturation of services—, in the second wave, patients “are more affected”, more affected.
“They don’t accept it”, and they already arrive with the refusal to enter, to stay for a long time, confirms Martínez Ríos. And sometimes discharge is not the end either: “It does not mean that you are completely cured; They leave without serious consequences but they have to learn to live with the little ones ”.
Aftermath that is not known if they will be reversible, or how long they will last. Will the fog dissipate? Milchova is optimistic:
With just eight months into the pandemic, researchers are still trying to define whether a specific postcovid syndrome exists and how many it affects. In April, in the heat of the first wave, the Spanish Society of Neurology (SEN) calculated that more than 30% of those affected had some type of disorder.
But then it was too early to know its evolution and in those days, with the overloaded healthcare system, keeping a record rigorously was difficult.
On the web clinicaltrials.gov, from the US health, world repository of data on clinical trials, there are already 152 studies if you look for “postcovid”, proof of interest in the medium and long-term effects of the coronavirus in those who have overcome what the disease itself is, but they are not healthy.
Of these, just over a dozen have concluded, and they refer to very specific aspects (effect of infection in pregnancies, the usefulness or not of any medication). To have other conclusions we will have to wait.