Melbourne's Alfred Hospital post-COVID clinic, Long Covid, & Covid update
Inside a long COVID clinic, a chronic condition is revealedFebruary 27, 2022
It was mid-2020, and Melbourne was locking down for a second time, when Giovanna Romano showed up at the Royal Melbourne Hospital, desperate.
One month after contracting COVID-19, the typically fit and healthy medical scientist and mother of two had lost the ability to walk.
The 36-year-old was using a wheelchair to get around due to extreme fatigue and a heaviness in her legs that rendered them powerless.
Bedridden for months, movement would often see her heart rate shoot to 150 beats a minute. Her pupils shrank to pinpricks. She felt her skin vibrating.
The doctors matched Romano’s symptoms with those described in studies examining the long-term effects of other coronaviruses such as SARS and MERS.
They went back further, to the 1918 Spanish flu, and identified an associated chronic condition called encephalitis lethargica, which sapped people’s energy, leaving them mute and statue-like.
Nearly two years into the pandemic, there is much we don’t know about long COVID – medically known as post-acute sequelae of COVID-19, or PASC.
Yet the condition has emerged as a new epidemic in Australia, with the explosion of infections during the Omicron outbreak putting many thousands at risk of suffering long-term debilitating conditions.
Pre-Omicron, heath experts predicted there would be a few hundred cases of long COVID in Australia. One respected researcher now expects the best-case scenario to be 13,000 cases, the worst 170,000. The hospital system is bracing for a flood of complex chronic conditions that demand multi-disciplinary medical responses.
Looking at lungsrving zooms in on a CT scan of a pair of lungs, as their owner — a long COVID sufferer — paces up and down the hallway, outside the doctor’s office.
The man in his 60s is lucky to be alive. While sick with COVID-19 in December, his blood oxygen level dropped to a near-lethal level of 84 per cent, and he was taken to hospital and intubated. He wasn’t vaccinated.
The doctor focuses on the CT scan from December. Healthy lungs look like two large black spaces, indicating they are full of oxygen. Instead, this man’s lungs were covered in smudges of grey — tissue scarring from COVID-19.
The doctor turns to a scan of another ICU patient who had COVID-19 in November — a 20-year-old who was also unvaccinated. The lungs are badly scarred, but Irving points to a sharp colour change in one of the patient’s lungs. The lung had collapsed.
Recent scans of the pair’s lungs show one patient has improved more than the other.
Surprisingly, the healthier lungs belong to the man in his 60s, rather the man more than 40 years his junior, whose lung had been reinflated.
Both men have cryptogenic organising pneumonia (COP), a condition that can cause breathlessness, which Irving says he has seen more of during the Omicron outbreak, despite the variant being considered mild.
COP occurs in about 5 per cent of severe respiratory infections, influenza or pneumonia cases. It can persist after an acute phase of COVID-19 pneumonia and is treated with steroids.
Who is affected?Some studies show people are at higher risk of developing long COVID if they are unvaccinated, female, over 40, have a high viral load while infected, are diabetes sufferers or have certain antibodies.
But doctors say long COVID can afflict anyone — not only people with pre-existing health issues — and many young and fit people are falling victim to it.
The Alfred hospital’s head of respiratory medicine, Anne Holland, who oversees the hospital’s long COVID clinic, has treated more than 600 patients. She says fatigue is the most common chronic symptom, experienced by 50-60 per cent of patients, while about 30 per cent experience shortness of breath.
Changes in taste and smell are less prevalent and typically wear off after two to three months, Holland says. Anxiety and depression are also widely reported
There are several theories on what causes long COVID. One is that a non-infectious viral reservoir lingers in the body, causing a chronic inflammatory response.
Another is that the infection causes a persistent immune response that can’t turn off, akin to an autoimmune or inflammatory disease.
A subset of people may also be genetically predisposed to developing these immune responses.
In the mindA bad case of COVID-19 can leave a person with some kind of cognitive dysfunction for several months, he says. But those people are not the ones flooding into the clinic. Instead, people recovering from mild cases are presenting with the greatest concerns about cognition.
They are typically high-performing people, including healthcare workers who make up 50 per cent of the clinic’s caseload of 150 patients.
There is no evidence that COVID-19 can cause brain damage, Malpas says. Rather, extreme fatigue or chronic pain caused by the virus can lead to forgetfulness, and a lack of confidence can then heighten this.
Tracking long COVIDThere is no official database tracking the prevalence of long COVID in Australia, but health economist Martin Hensher is modelling the scope of what he describes as “an epidemic on top of the pandemic”.
Based on world-leading British surveillance data, he estimates about 5 per cent of Australians who are infected with COVID-19 will get chronic conditions, which is lower than the 10 to 30 per cent estimated overseas, in part due to Australia’s high vaccination rates.
Of the 3 million Australians he estimates will be infected with Omicron, 13,000 will get long COVID at best and 170,000 at worst, Hensher says.
Read more:-
smh.com.au
disallowed/national/inside-a-long-covid-clinic-a-chronic-condition-is-revealed-20220223-p59yub.html?js-chunk-not-found-refresh=trueLong COVID: How clusters of symptoms have emerged and changed over the pandemicPosted Yesterday at 5:30am,
Since the first COVID "long haulers" were reported in 2020, millions of people have experienced long COVID.
While long COVID has no strict definition, it's generally used to describe an illness following a SARS-CoV-2 infection with symptoms that last at least two to three months.
It can manifest as a whole suite of symptoms ranging from body aches and pains to brain fog, and these can substantially vary between people, says Lou Irving, respiratory physician and head of the Royal Melbourne Hospital's post-COVID clinic.
"We now have … over 600 cases and they really help us understand that there's a wide range of presentations."
But under that broad "long COVID" umbrella, clusters of symptoms have emerged, and as the pandemic's worn on, those symptoms have shifted.
Senior respiratory physiotherapist Janet Bondarenko has been working in Melbourne's Alfred Hospital post-COVID clinic since its doors opened two years ago.
And while she still sees these symptoms in patients now, she also sees more people with heart-related symptoms.
"If they're going from sitting to standing, their heart rate will jump and they'll get palpitations, chest pains, things like that," Ms Bondarenko says.
This is an example of what's known as "autonomic dysfunction", where a part of our nervous system that controls things like blood pressure doesn't work properly.
If a person's blood pressure drops, their heart has to work harder and pump faster to compensate and keep blood moving around the body.
This, in turn, produces symptoms such as dizziness and extreme fatigue.
"What's interesting is people now often present with breathlessness, but it's not breathlessness caused by the respiratory disorder," Ms Bondarenko says.
"It's breathlessness from fatigue and from this autonomic dysfunction."
Read more:-
https://www.abc.net.au/news/health/2022-11-25/long-covid-subtypes-treatment-disease-condition-heart-symptoms/101652610
The latest COVID-19 news and case numbers from around the states and territoriesPosted 19h ago
Here's a quick wrap of the COVID-19 news and case numbers from each Australian jurisdiction for the past week, as reported on Friday, November 25, 2022.
The states and territories are now reporting their COVID-19 statistics weekly instead of through the daily updates that were provided from the early days of the pandemic.
New South WalesVictoriaQueenslandAustralian Capital TerritoryWestern AustraliaSouth AustraliaTasmaniaNorthern Territory
One thing to know: Long COVID symptoms are shifting as new variants bring new challengesUnder the broad "long COVID" umbrella, clusters of symptoms have emerged, and as the pandemic has worn on, those symptoms have changed.
"We saw a lot of breathlessness in people, and they could only manage walking a few metres at a time," Dr Bondarenko says.
"Then we started to see memory and concentration issues."
And while she still sees these symptoms in patients now, she also sees more people with heart-related symptoms.
Read more:-
https://www.abc.net.au/news/2022-11-25/covid-19-case-numbers-from-around-the-states-and-territories/101697738
